Management Of Constipation In People Research Articles

Mu-opioid antagonists for opioid-induced bowel dysfunction in people with cancer and people receiving palliative care.

Mu-opioid antagonists for opioid-induced bowel dysfunction in people with cancer and people receiving palliative care.

Constipation management in people with intellectual disability: A systematic review.

Constipation can lead to serious health issues and death. This systematic review summarizes international research pertaining to the management of constipation in people with intellectual disability. Studies published from 1990 to 2017 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests and cross-citations. Studies were reviewed narratively in relation to identified themes. Eighteen studies were reviewed in relation to three themes: laxative receipt; interventions (dietary fibre, abdominal massage and macrogol); and staff issues (knowledge and training). Laxative polypharmacy was common. Studies report positive results for dietary fibre and abdominal massage although study quality was limited. The main management response to constipation in people with intellectual disability is laxative use despite limited effectiveness. An improved evidence base is required to support the suggestion that an individualized, integrated bowel management programme may reduce constipation and associated health conditions in people with intellectual disability.

Laxatives for the management of constipation in people receiving palliative care.

This article describes the second update of a Cochrane review on the effectiveness of laxatives for the management of constipation in people receiving palliative care. Previous versions were published in 2006 and 2010 where we also evaluated trials of methylnaltrexone; these trials have been removed as they are included in another review in press. In these earlier versions, we drew no conclusions on individual effectiveness of different laxatives because of the limited number of evaluations. This is despite constipation being common in palliative care, generating considerable suffering due to the unpleasant physical symptoms and the availability of a wide range of laxatives with known differences in effect in other populations. To determine the effectiveness and differential efficacy of laxatives used to manage constipation in people receiving palliative care. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library), MEDLINE, EMBASE, CINAHL and Web of Science (SCI & CPCI-S) for trials to September 2014. Randomised controlled trials (RCTs) evaluating laxatives for constipation in people receiving palliative care. Two authors assessed trial quality and extracted data. The appropriateness of combining data from the studies depended upon clinical and outcome measure homogeneity. We identified five studies involving the laxatives lactulose, senna, co-danthramer, misrakasneham, docusate and magnesium hydroxide with liquid paraffin. Overall, the study findings were at an unclear risk of bias. As all five studies compared different laxatives or combinations of laxatives, it was not possible to perform a meta-analysis. There was no evidence on whether individual laxatives were more effective than others or caused fewer adverse effects. This second update found that laxatives were of similar effectiveness but the evidence remains limited due to insufficient data from a few small RCTs. None of the studies evaluated polyethylene glycol or any intervention given rectally. There is a need for more trials to evaluate the effectiveness of laxatives in palliative care populations. Extrapolating findings on the effectiveness of laxatives evaluated in other populations should proceed with caution. This is because of the differences inherent in people receiving palliative care that may impact, in a likely negative way, on the effect of a laxative.

Effectiveness of Non-Surgical Management Strategies for Constipation in Adults with Stroke: A Systematic Review

Effectiveness of Non-Surgical Management Strategies for Constipation in Adults with Stroke: A Systematic Review

Long-term efficacy and cost-effectiveness of polyethylene glycol 3350 plus electrolytes in chronic constipation: a retrospective study in a disabled population

ABSTRACTObjectives: The efficacy and safety of treatments for constipation in severely intellectually disabled patients and their associated cost-effectiveness are an underinvestigated area of clinical practice. Aiming to address this, the objectives of the study were to evaluate the efficacy and tolerability of polyethylene glycol 3350 plus electrolytes (Movicol; PEG+E) by comparing clinical data collected before and after its introduction to a stable population of residents of a mental health care, long-stay institution. The study also attempted an economic evaluation of the use of PEG+E in this setting.* Movicol is a registered trademark of NorgineResearch design and methods: This was a retrospective study of 54/66 severely intellectually and physically disabled residents of a specialist unit at La Milétrie University Hospital, Poitiers, France, who suffered regularly from constipation. A total of 54 residents were treated with PEG+E (1–3 sachets a day) for 24 months. The number of stools, episodes of diarrhoea (defined as frequent stools, not necessarily watery), body weights and blood biochemistry were recorded. Data were compared with those recorded during the 21 months preceding the introduction of PEG+E for 16/54 residents who had been treated regularly with a range of other interventions for the relief of constipation. The monthly use and costs of laxatives, enemas and suppositories was obtained from hospital pharmacy records, and the total hospital costs before and after the introduction of PEG+E treatment was calculated.Results: The mean (± standard deviation) number of stools per patient per month was significantly greater following the introduction of PEG+E (24.9 ± 6.3) compared to before its use (12.4 ± 3.4) ( p < 0.001). The mean (± standard deviation) monthly number of episodes of diarrhoea per patient before and after the introduction of PEG+E was 0.1 ± 0.1 and 6.3 ± 2.9, respectively ( p < 0.001). Treatment with PEG+E was not associated with adverse effects on body weight or blood biochemistry values. Introduction of PEG+E and its increasing use reduced the total hospital medical ward expenditure on laxatives from 3788 to 1767 Euros per month.Conclusions: PEG+E is effective in the clinical management of constipation in an institutional setting. Furthermore, long-term intensive therapy with PEG+E was not associated with adverse effects on body weight or blood biochemistry values. Although the time periods over which the economic data and the efficacy and safety data were collected did not directly correspond, this study indicates that use of PEG+E in the management of constipation in people with severe intellectual disability may be cost-effective, reducing hospital laxative costs.

The management of constipation in people with advanced cancer.

Constipation represents a significant problem for people with advanced cancer. It ranks in the top three most uncomfortable symptoms experienced, causing pain and anorexia that ultimately result in misery. The negative impact upon the quality of life of the patient and their carers is significant. The key to the provision of effective care lies in the informed application of the nursing process, underpinned by a sound knowledge base in relation to the management of constipation. Theoretical knowledge enables appropriate preventative interventions to be planned in collaboration with other members of the multidisciplinary team. When preventative measures are not applied or are unsuccessful, informed assessment and care planning enables appropriate interventions to be applied in order to resolve constipation. This article will discuss the causes and management of constipation. The discussion focuses on assessment, setting goals with the patient and their carers, planning appropriate nursing interventions to support medical interventions and evaluating clinical outcomes.