Assessment and treatment options for patients with constipation

The effect of combined fig-Walnut syrup on functional constipation in pregnant women: a randomized controlled trial

BACKGROUND

Constipation is one of the most common gastrointestinal complaints during pregnancy. Consuming fruits and vegetables is often the first line of treatment due to their fiber content. Therefore, the purpose of the present study was to determine the effect of combined fig-walnut syrup on functional constipation (FC) and quality of life (QoL) in pregnant women.

METHODS

In this double-blind, randomized controlled clinical trial, 90 pregnant women with FC were randomly assigned to receive combined fig-walnut syrup, fig syrup, or placebo (n = 30 in each group) using block randomization. Participants received 15 ml of syrup once daily at night, half an hour before bedtime, for 14 days and were followed up for 2 weeks after the end of the intervention. The FC, quality of life-gravidity (QOL-GRAV), and food frequency questionnaires (FFQ) were used to collect data. The questionnaires were completed once before the intervention and then the FC questionnaire was completed once a week for four weeks and the QoL questionnaire was completed at the end of the fourth week. To compare the outcomes among the study groups, one-way AONOVA, ANCOVA, Mann- Whitney U test, and Kruskal- Wallis test were used.

RESULTS

Following the intervention, although there was no statistically significant difference in the number of defecations between the combined fig-walnut syrup group and the fig syrup group (P > 0.05) at every four weeks, there was a statistically significant difference compared to the placebo (P < 0.05). Combined fig-walnut syrup (adjusted mean difference (AMD): -3.4; 95% confidence interval: -0.7 to -6.1; P = 0.008) and fig syrup (AMD: -5.8; 95% CI: -3.1 to -8.6; P < 0.001) improved QoL compared to the placebo group and there was no statistically significant difference between the combined fig-walnut and fig syrup (AMD: 2.4; 95% CI: 5.2 to -0.3; P = 0.104).

CONCLUSION

The consumption of fig-walnut syrup and fig syrup may help improve constipation symptoms and enhance QoL during pregnancy. Further studies are needed to reach a conclusive determination.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT2012071801032N79. Date of registration: 07.12.2023.

Impact of Constipation on Health Outcomes in Medically Hospitalized Patients: A Prospective Study on Laxative Use and Health Care Outcomes

Background and Objectives: Constipation affects health-related quality of life and increases hospital visits. We conducted this prospective cohort study to assess laxative use, health outcomes of constipation in medically hospitalized patients, and related health outcomes. Materials and Methods: A prospective single-center study included all adult patients admitted under the General Internal Medicine Unit from 1 February 2022, to 31 August 2022. Constipation was defined using the Constipation Assessment Scale (CAS). Patients were assessed for 28 days during their hospital stay and up to 90 days post-discharge. Result: Among the included patients, 62.45% experienced constipation, which was associated with poor health outcomes including delirium (p = 0.048), intensive care admission (p < 0.01), cardiopulmonary arrest (p < 0.01), inpatient mortality (p < 0.01), longer hospital stay (p < 0.01), 90-day mortality (p < 0.01), and 90-day hospital readmission (p < 0.01). Laxative treatment was administered to only 33.93% of patients with constipation and was more commonly used among older patients (p < 0.01), those with high CAS scores (p < 0.01), longer hospital stays (p < 0.01), and critically ill patients (intensive care admission) (p = 0.01), as well as those who had cardiopulmonary arrest (p < 0.01) and high inpatient mortality (p < 0.01). Conclusions: This study identified several associations between constipation and poor health outcomes and highlighted the underutilization of laxatives in treating constipation. It is vital to interpret our results with caution. Therefore, we believe that a randomized controlled trial will help enhance our understanding of the interaction between constipation, laxative use, and poor health outcomes.

Assessment and management of constipation in post-operative patients in the spinal surgery ward: a best practice implementation project

INTRODUCTION AND OBJECTIVE

Constipation is a common complication following spinal surgery that can result in distension, abdominal pain, infection, and even intestinal perforation. This study reports on an evidence-based implementation project to reduce the incidence of constipation in spinal surgery wards.

METHODS

The project was conducted in the spinal surgery ward of a general tertiary hospital in Changsha City, China, from March to August 2022. We used the JBI Implementation Framework and the JBI Model of Evidence-Based Healthcare for audits and feedback. Data were collected and analyzed using JBI's Practical Application of Clinical Evidence System (PACES) software. Seven audit criteria were developed based on the best practice recommendations summarized by JBI. A baseline audit was conducted with 20 nurses and 50 patients in the spinal surgery ward, and a follow-up audit was conducted using the same sample size and setting.

RESULTS

The baseline audit revealed compliance below 46% for five of the seven criteria. Strategies developed to address poor compliance included educating nurses and patients, developing a post-operative constipation risk assessment sheet, organizing stakeholder focus group meetings, establishing a constipation management routine, and effective empowerment of nurses. The follow-up audit showed positive compliance results, with the highest rate for Criterion 7 (100%) and the greatest increase for Criterion 2 (from 0% to 78%). Furthermore, the incidence of post-operative constipation decreased from 48% to 16%.

CONCLUSION

The project improved compliance with audit criteria, reduced the incidence of constipation, and enhanced the efficiency of quality management in the spinal surgery ward.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A186.

Prevalence, Recognition, and Risk Factors of Constipation among Medically Hospitalized Patients: A Cohort Prospective Study

Background and Objective: Constipation is a prevalent gastrointestinal condition that has a substantial impact on individuals and healthcare systems. This condition adversely affects health-related quality of life and leads to escalated healthcare expenses due to an increase in office visits, referrals to specialists, and hospital admission. This study aimed to evaluate the prevalence, recognition, risk factors, and course of constipation among hospitalized patients in medical wards. Materials and Methods: A prospective study was conducted, including all adult patients admitted to the General Medicine Unit between 1 February 2022 and 31 August 2022. Constipation was identified using the Constipation Assessment Scale (CAS), and relevant factors were extracted from the patients' medical records. Results: Among the patients who met the inclusion criteria (n = 556), the prevalence of constipation was determined to be 55.6% (95% CI 52.8-58.4). Patients with constipation were found to be older (p < 0.01) and had higher frailty scores (p < 0.01). Logistic regression analysis revealed that heart failure (Odds ratio (OR) 2.1; 95% CI 1.2-3.7; p = 0.01), frailty score (OR 1.4; 95% CI 1.2-1.5; p < 0.01), and dihydropyridines calcium channel blockers (OR 1.8; 95% CI 1.2-2.8; p < 0.01) were independent risk factors for constipation. Furthermore, the medical team did not identify constipation in 217 patients (64.01%). Conclusions: Constipation is highly prevalent among medically hospitalized patients. To ensure timely recognition and treatment, it is essential to incorporate a daily constipation assessment scale into each patient's medical records.

Quantifying the impact of reduced opioid use in patients after emergency laparotomy

BACKGROUND

Emergency laparotomies have high rates of morbidity and mortality. The evaluation and management of pain are crucial, as poorly managed pain may contribute to postoperative complications and increase the risk of mortality. This study aims to describe the relationship between opioid use and opioid-related adverse effects and identify what constitutes appropriate dose reductions to elicit clinically relevant benefits.

METHODS

This was a retrospective, observational study of patients presenting for emergency laparotomy due to trauma from 2014 to 2018. The primary objective was to define clinical outcomes that may be significantly affected by changes in milligrams of morphine equivalent during the first 72 hours postoperatively; additionally, we sought to quantify the approximate differences in morphine equivalent that correlate with clinically meaningful outcomes such as hospital length of stay, pain scores, and time to first bowel movement. For descriptive summaries, patients were categorized into low, moderate, and high groups based on morphine equivalent requirements of 0 to 25, 25 to 50, and >50, respectively.

RESULTS

A total of 102 (35%), 84 (29%), and 105 (36%) patients were stratified into the low, moderate, and high groups, respectively. Mean pain scores for postoperative days 0 to 3 (P = .034), time to first bowel movement (P = .002), and nasogastric tube duration (P = .003) were the clinical outcomes found to be significantly associated with morphine equivalent. Estimated clinically significant reductions in morphine equivalent for these outcomes ranged from 194 to 464.

CONCLUSION

Clinical outcomes, such as pain scores, and opioid-related adverse effects, such as time to first bowel movement and nasogastric tube duration, may be linked with the amount of opioids used.

Cross-mapping medical records to NANDA-I to identify nursing diagnoses in a vulnerable population

PURPOSE

To assess the association between vulnerable populations and nursing care needs, using NANDA-I diagnostics, in the population of the Canary Islands, Spain.

METHODS

Nursing social epidemiology study. Cross Mapping of Medical Records to NANDA-I to Identify Nursing Diagnoses in a Population usinga medical, epidemiological follow-up study of a cohort of 7,190 people. The level of vulnerability of the participants was assigned, among those who were also assigned nursing diagnoses, using the "ICE index" to calculate the expected associations.

FINDINGS

The most prevalent nursing diagnosis in our sample was Sedentary lifestyle (60.5%), followed by Ineffective health self-management (33.8%) and Risk-prone health behaviour (28.7%). Significant differences were found by sex, age group and social class, with the nursing diagnoses included in the study being more prevalent among the most socio-economically disadvantaged social class.

CONCLUSIONS

The cross-mapping method is useful to generate diagnostic information in terms of care needs, using the NANDA-I classification. The expected associations between high social vulnerability and care needs have been verified in a comprehensive and representative sample of the Canarian population (Spain).

IMPLICATIONS FOR NURSING PRACTICE

From an epidemiological perspective, identifying nursing diagnoses at the population level allows us to find the most prevalent needs in the different community groups and to focus appropriate nursing interventions for their implementation and impact assessment.

A nurse-led educational intervention for relieving idiopathic constipation: a retrospective study

BACKGROUND

Constipation is a common condition. Although numerous articles emphasise the importance of conservative interventions, none have set out a complete educational programme.

AIMS

To describe the results of an evidence-based, nurse-led educational intervention for functional constipation in adults.

METHODS

A retrospective study of patient records with an analysis of Wexner constipation scores and Bristol stool charts was carried out before and after a nurse-led educational programme on nutrition and bowel habits.

FINDINGS

Twenty-nine patients were enrolled (19 women and 10 men), with a median age of 61 (53-71) years, a mean BMI of 24.4±3.88 kg/m² and comparable baseline Wexner and Bristol scores. A statistically significant improvement in Wexner scores (P<0.001) and a clinically relevant but not statistically significant (P=0.682) improvement in Bristol scores were observed.

CONCLUSION

The results suggest this investigation should be repeated on a larger scale. An educational intervention could be included in all consultations on any issue that could affect bowel activity.

Diagnosis and management of fecal incontinence in children and adolescents

Fecal incontinence (FI) is a commonly occurring disease of high concern. It is characterized by voluntary and involuntary defecation in children and adolescents. It is not only a physical disease but also a psychological and behavioral disorder. FI poses a serious burden on individuals and their families and therefore has become a social problem. Unfortunately, the management of FI among children is still a challenge because the etiology varies widely. Constipation has been found to be the most common cause, while sphincter dysfunction and neurogenic abnormalities may also play a role. Currently, no consensus guidelines exist, and the criteria for selecting optional methods remain unclear. It is therefore necessary to improve the efficacy of diagnosis and management strategies of FI in children. This review focused on the classification and etiology, discussed the diagnosis and management methods of FI in children and adolescents, and aimed to guide future studies.

Consumption of Wheat Peptides Improves Functional Constipation: A Translational Study in Humans and Mice

SCOPE

Wheat peptides (WP) are rich in glutamic acid, glutamine, and other bioactive compounds that may benefit gut function and health. This study aims to evaluate the effects of regular consumption of WP on constipation-induced complications and gut microbiota in humans and mice.

METHODS AND RESULTS

A randomized trial of 49 functional constipation participants was conducted. The weekly amount of spontaneous bowel movements (SBM) increased by 2.09 per week after WP treatment, and by 0.40 per week among the placebo group (PL). Concomitantly, the secondary outcomes showed significant improvements in the quality of life-related to constipation, constipation severity, and satisfaction with the intervention. In the animal study, WP effectively alleviated constipation symptoms and affected the secretion of intestinal mobility-related neurotransmitters and gastrointestinal hormones in loperamide-induced constipation mice. Additionally, WP regulated the gene and protein expression levels of water-electrolyte metabolism and intestinal mobility. Furthermore, WP treatment decreased the abundance of several gut microbiota positively correlated to constipation (Turicibacter, Bacteroides_f_Bacteroidaceae, and Streptococcus) in mice.

CONCLUSION

WP ameliorated constipation in humans and mice, which could be partly explained by improving water-electrolyte metabolism, boosting intestinal motility, and reshaping gut microbiota. This article is protected by copyright. All rights reserved.

Nonrandomized Clinical Trial of the Effectiveness of a Laxative Treatment Protocol to Time of First Bowel Movement After Uterine Artery Embolization Procedure: A Pilot Study

PURPOSE

The purpose of this pilot study was to determine the efficacy of a proactive laxative protocol for constipation prevention in patients undergoing uterine artery embolization (UAE).

DESIGN

A nonrandomized clinical trial.

METHODS

A nonrandomized trial study design was piloted using a convenience sample of 35 patients undergoing UAE in the course of 1 year.

FINDINGS

There was a statistically significant difference (P < .0001) in time of first bowel movement after UAE when patients followed a proactive laxative protocol. A combination of senna and stool softener taken twice a day for 2 days preoperatively was associated with a shorter time to first bowel movement postoperatively.

CONCLUSIONS

This pilot study supports the benefits of a proactive laxative protocol in helping achieve procedural recovery uncomplicated by constipation in patients undergoing UAE.

Is Constipation Associated with Worse Functioning in Adult Women? A Cross-Sectional Study

OBJECTIVE

The aim of this study is to analyze the relationship between intestinal constipation and functioning in adult women living in a municipality in the interior of northeast Brazil.

MATERIALS AND METHODS

This is a cross-sectional study conducted with 195 adult women in the city of Santa Cruz-RN. Constipation was diagnosed using the Rome III criteria. Functioning was measured through WHODAS 2.0. Social conditions, habits and lifestyle were also investigated. Inferential analysis was performed using the chi-squared test and the Mann-Whitney U-test, and the effect size was determined by eta squared (η2). Multivariate analysis was performed using multiple linear regression to analyze the relationship between the WHODAS total score and constipation, being adjusted by covariates with p≤0.20 in the bivariate. A statistical significance level of p<0.05 was considered.

RESULTS

Most of the participants in this study were aged 19 to 39 years (69.7%) and had an income of up to 1 minimum monthly salary (79.5%). WHODAS scores showed that women with constipation had more disability in the cognitive (p <0.001), mobility (p <0.002), self-care (p <0.001), and participation (p <0.001) domains, as well as the total score (p <0.001). After multiple linear regression analysis, the total WHODAS score remained associated with constipation (p <0.001), in which this condition increases the score by nine points.

CONCLUSION

The results of this study show that there is a reduction in functioning associated with the presence of constipation in adult women, mainly affecting the cognition, mobility, self-care and participation domains, in addition to the total score.

Effects of Hemp seed soft capsule on colonic ion transport in rats

AIM

To investigate the effect of Hemp seed soft capsule (HSCC) on colonic ion transport and its related mechanisms in constipation rats.

METHODS

Sprague-Dawley male rats were randomly divided into three groups: normal group, constipation group and HSSC group. Rats in the constipation and HSSC groups were administrated loperamide 3 mg/kg per day orally for 12 d to induce the constipation model. Then, the HSSC group was given HSSC 0.126 g/kg per day by gavage for 7 d. The normal and constipation groups were treated with distilled water. After the treatment, the fecal wet weight and water content were measured. The basal short-circuit current (Isc) and resistance were measured by an Ussing Chamber. Besides the in vivo drug delivery experiment above, an in vitro drug application experiment was also conducted. The accumulative concentrations of HSSC (0.1 mg/mL, 0.5 mg/mL, 1.0 mg/mL, 2.5 mg/mL, 5.0 mg/mL, 10.0 mg/mL and 25.0 mg/mL) were added to the normal isolated colonic mucosa and the Isc was recorded. Further, after the application of either ion (Cl^- or HCO₃^-) substitution, ion channel-related inhibitor (N-phenylanthranilic acid, glybenclamide, 4,4-diisothiocyano-2,2-stilbenedisulfonic acid or bumetanide) or neural pathway inhibitor [tetrodotoxin (TTX), atropine, or hexamethonium], the Isc induced by HSSC was also measured.

RESULTS

In the constipation group, the fecal wet weight and the water content were decreased in comparison with the normal group (P < 0.01). After the treatment with HSSC, the fecal wet weight and the water content in the HSSC group were increased, compared with the constipation group (P < 0.01). In the constipation group, the basal Isc was decreased and resistance was increased, in comparison with the normal group (P < 0.01). After the treatment with HSSC, the basal Isc was increased (P < 0.05) and resistance was decreased (P < 0.01) in the HSSC group compared with the constipation group. In the in vitro experiment, beginning with the concentration of 1.0 mg/mL, differences in Isc were found between the experimental mucosa (with HSSC added) and control mucosa. The Isc of experimental mucosa was higher than that of control mucosa under the same concentration (1.0 mg/mL, P < 0.05; 2.5-25 mg/mL, P < 0.01). After the Cl^- or HCO₃^- removal and pretreated with different inhibitors (cAMP-dependent and Ca²⁺-dependent Cl^- channels, Na⁺-K⁺-2Cl^- cotransporter (NKCC), Na⁺-HCO₃^- cotransporter or Cl^-/HCO₃^- exchanger inhibitor), there were differences between experimental mucosa and control mucosa; the Isc of experimental mucosa was lower than that of control mucosa under the same concentration (P < 0.05). Meanwhile, after pretreatment with neural pathway inhibitor (TTX, atropine, or hexamethonium), there were no differences between experimental mucosa and control mucosa under the same concentration (P > 0.05).

CONCLUSION

HSSC ameliorates constipation by increasing colonic secretion, which is mediated via the coaction of cAMP-dependent and Ca²⁺-dependent Cl^- channels, NKCC, Na⁺-HCO₃^- cotransporter or Cl^-/HCO₃^- exchanger.