[Chronic constipation in adults]

Psychometric evaluation of the Chinese version of the Elderly-Constipation Impact Scale: a translation and validation study

OBJECTIVE

The objective of this study was to translate the Elderly-Constipation Impact Scale into Chinese and to examine its reliability and validity in a population of older people suffering from chronic constipation.

METHODS

In this study, the scale was paraphrased, back-translated, cross-culturally adapted and pre-experimented using the Brislin double translation-back-translation method to create the initial Chinese version of the Elderly-Constipation Impact Scale. A convenience sampling method was used to select 564 study participants who met the inclusion and exclusion criteria in Liaoning and Shanxi, China, to evaluate the reliability and validity of the scale. General information about the study population was using descriptive statistics; item analysis was used to screen the items of the scale. Content validity, exploratory factor analysis, and validation factor analysis were chosen to validate the scales; internal consistency, spilt-half reliability and retest reliability were used determine the reliability of the measurement scales.

RESULTS

The Chinese version of the Elderly-Constipation Impact Scale contains 7 dimensions and 21 items. The Cronbach's alpha coefficient for the total scale was 0.901 and the range of Cronbach's alpha values for each dimension was 0.707 to 0.918. The split-half reliability of the scale was 0.736 and the retest reliability was 0.763. The exploratory factor analysis showed a KMO value of 0.873 and a Bartlett's spherical test X² value of 3499.978 (p < 0.001). A total of seven common factors were extracted, namely daily activities, treatment satisfaction, lack of control of bodily function, diet restriction, symptom intensity, anxiety and preventive actions, with a cumulative variance contribution of 77.813%. Each item had a loading value > 0.4 on its common factor. In the validation factor analysis, the model fit results were X² / df = 1.886, GFI = 0.910, AGFI = 0.874, PGFI = 0.654, IFI = 0.955, TLI = 0.942, CFI = 0.954, RMSEA = 0.056 and PNFI = 0.718. The model fit indicators were all within acceptable limits.

CONCLUSION

The Chinese version of the E-CIS has good reliability and validity in the chronic constipation population of elderly individuals. The results of the questionnaire can effectively and comprehensively reflect the impact of chronic constipation on the quality of life of elderly individuals. It provides a meaningful reference for identifying targets for intervention.

Effect of biofeedback combined with high-quality nursing in treatment of functional constipation

BACKGROUND

Functional constipation (FC) is a common functional gastrointestinal disease with various clinical manifestations. It is a physical and mental disease, which seriously affects patient physical and mental health and quality of life. Biofeedback therapy is the treatment of choice for FC, especially outlet obstructive constipation caused by pelvic floor dysfunction. High-quality nursing is a new nursing model in modern clinical work and a new concept of modern nursing service.

AIM

To explore the effect of biofeedback combined with high-quality nursing in the treatment of FC.

METHODS

A total of 100 patients with FC admitted to our hospital from March 2015 to July 2019 were selected for clinical observation. These patients were randomly divided into two groups of 50: Experimental group (biofeedback combined with high-quality nursing treatment group) and control group (biofeedback group).

RESULTS

The constipation symptom score of the experimental group was significantly lower than that of the control group, and the difference was statistically significant (P < 0.05). The anal canal resting pressure and initial defecation threshold of the experimental group were significantly lower than those of the control group, and the maximum squeeze systolic pressure of the anal canal of the experimental group was significantly higher than that of the control group (P < 0.05). The Self-Rating Anxiety Scale and Zung's Self-Rating Depression Scale scores of the two groups were significantly lower than before treatment. The Self-Rating Anxiety Scale and Self-Rating Depression Scale scores of the experimental group were significantly lower than those of the control group (P < 0.05). The patient satisfaction score of the experimental group was significantly higher than that of the control group (P < 0.05).

CONCLUSION

The application of biofeedback combined with high-quality nursing in the treatment of FC has significant advantages over pure biofeedback treatment, and it is worthy of promotion in clinical work.

Magnesium Sulfate-Rich Natural Mineral Waters in the Treatment of Functional Constipation-A Review

Functional constipation (FC) is a chronic constipation for which no physiological, anatomical or iatrogenic origin can be evidenced. This condition has a high impact on a patient’s quality of life and healthcare costs. Since FC is frequently associated with low physical activity and a diet low in fiber and/or water, first-line recommendations focus on sufficient activity, and sufficient fiber and water intake. In case of inefficacy of these measures, numerous drug treatments are available, either over the counter or on prescription. Magnesium sulfate has a long history in the treatment of FC, and magnesium sulfate-rich mineral waters have been used for centuries for their laxative properties. The laxative effect of magnesium and sulfate has since been widely demonstrated. Nevertheless, it appears that no clinical studies aiming at demonstrating their efficacy in FC had been conducted before the 21st century. In this paper, we reviewed the clinical data reporting the efficacy of magnesium sulfate-rich natural mineral waters. In view of their reported efficacy and safety, magnesium sulfate-rich natural mineral waters may represent a natural treatment for FC.

Assessment of rectal feces storage condition by a point-of-care pocket-size ultrasound device for healthy adult subjects: A preliminary study

The aim of this study was to assess rectal feces storage condition by a pocket-size ultrasonography (PUS) in healthy adults so as to define normal rectal defecation desire. Participants were first assessed rectum by PUS imaging immediately after defecation desire (pre-defecation). Nurses checked the amount and quality of the participants' feces using King's Stool Chart and Bristol stool scale. Finally, PUS was performed for defecation with no defecation desire (post-defecation). Pre-defecation PUS detected high echo area in all patients. All of the post-defecation PUS did not detect high echo area (perfectly no recognizable high echo area in 54.5%, high echo line in 36.4%, and low echo of entire circumference in 9.1% of the patients). Average diameter of rectal crescent was 4.22 ± 0.8 cm. Bristol Stool Scale 1 or 2 (indicating hard stool) of pre-defecation PUS indicated high echo area and acoustic shadow in 100% of the patients. This study showed that healthy adult with defecation desire had high average rectal echo area of 4.0 cm in diameter. PUS may be able to define the rectum diameter for defecation desire of elderly people. PUS is capable of assessing fecal retention of the rectum for point-of-care examinations in home care.

Time to treatment response of a magnesium- and sulphate-rich natural mineral water in functional constipation

OBJECTIVES

First-line recommendations for the management of functional constipation include nutritional-hygienic measures. We previously showed that a natural mineral water rich in sulphates and magnesium (Hépar) is efficient in the treatment of functional constipation. The aim of this study was to consolidate those first results and determine a precise time to respond to Hépar.

METHODS

This multicenter, randomized, double-blind, controlled study of the effect of Hépar on stool consistency and frequency in functional constipation included 226 outpatients. After washout, patients used 1.5 L of water daily, including 1 L of Hépar or of low-mineral water, during 14 d. In addition to a daily reporting of stool consistency by the patient, an expert investigator blindly analyzed stool consistency (Bristol stool scale) based on photographs taken by the patient.

RESULTS

The primary endpoint was met. Treatment response was more frequent in the Hépar arm than in the control group at day 14 (50% versus 29%, respectively; P = 0.001). Mean time to treatment response was shorter in the Hépar group (6.4 d) than in the control arm (7.3 d; P = 0.013). Concomitant stool scoring was available for 60% of the patients. Scores given to 79% of the stools were similar between the patient and the expert (differences ≤1). Safety analyses showed excellent results.

CONCLUSION

This study confirms the efficacy and safety of Hépar in the treatment of functional constipation and shows that it is associated with a response within 7 d. Hépar could be a safe response to the current absence of first-line medication in the treatment of functional constipation.

The effect of lifestyle modification on severity of constipation and quality of life of elders in nursing homes at Ismailia city, Egypt

Background:

Constipation has a significant impact on the quality of life (QOL). Lifestyle modification is widely accepted and recommended by experts as first-line therapy.

Aim:

This study aimed at using education on lifestyle modification to improve the QOL of the elderly in nursing homes suffering from functional constipation (FC).

Materials and Methods:

This study was conducted in nursing homes in Ismailia city, Egypt. It involved 23 elderly patients suffering from FC, who were randomly selected according to the sample equation. They fulfilled the inclusion criteria of being ≥60 years age and according to Rome II criteria. Participants completed personal characteristics and lifestyle questionnaire, the Patient Assessment of Constipation Symptom questionnaire (PAC-SYM) to assess the severity of symptoms, and the Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) to assess pre- and post-intervention. The intervention was conducted in three sessions, of 30 min each, 2 weeks apart using group discussions to educate the sample about dietary pattern, fluid intake, regular physical activity, and the use of laxatives. Statistical analysis: Data were analyzed using a statistical package for social sciences (SPSS version 20).

Results:

The lifestyle modification education on constipation significantly reduced the severity of symptoms as measured by PAC-SYM, including its total score and subscores (P < 0.001). It also improved the QOL of elderly suffering from constipation as measured by PAC-QOL and reduced total scores of dissatisfaction (P = 0.001) with the exception of the psychosocial subscale. It also significantly increased the satisfaction subscale of PAC-SYM (P < 0.001).

Conclusion:

Education on lifestyle modification leads to an improvement in the severity of the symptoms of constipation and the QOL of the elderly in nursing homes.