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long‐term Follow Up of the Efficacy of a Multidisciplinary Approach to the Management of Chronic Constipation

Abstract

ADJUVANT RADIOTHERAPY IS AN INDEPENDENT RISK FACTOR FOR SMALL BOWEL OBSTRUCTION AFTER CURATIVE RECTAL CANCER SURGERYAim: Small bowel obstruction (SBO) as a complication is not uncommon after curative rectal cancer surgery; adjuvant radiotherapy (RT) may have a contributory role. This study aimed at determining the prevalence and risk factors for this complication. Methods:The medical records of 260 consecutive patients with rectal cancer (excluding rectosigmoid cancer) who underwent curative surgery at our institution between January 1995 and December 2000 were retrospectively reviewed to determine the prevalence of SBO requiring hospitalization and intervention. Possible risk factors for SBO were recorded and analysed using univariate and multivariate analysis. Results: The median duration of follow up was 76.1 months (range, 3.3-141.8 months). Forty-four patients (16.9%) developed SBO and 19 of them required surgical intervention. Three patients (6.8%) died as a consequence of SBO. Seventy-eight patients (30%) received adjuvant RT with a median dose of 50 Gy (range 30-64 Gy). Patients receiving RT were more likely to develop SBO (25.6% vs 13.2%, P = 0.014). The median duration between adjuvant RT and the first episode of SBO was 23.5 months (range, 5.7-99.4 months). Multivariate analysis showed that adjuvant RT was the only independent risk factor for SBO (OR = 2.27, 95% CI = 1.17-4.42, P = 0.016). Gender, operative approach (open vs laparoscopic), abdominoperineal resection, perioperative blood transfusion, postoperative intra-abdominal sepsis, tumour stage, and disease recurrence were not associated with the development of SBO. Conclusion: Adjuvant RT is the only independent risk factor for SBO after curative surgery for rectal cancer. Patients should be well informed of this potential complication when they are offered adjuvant RT.2 J.C.

Effects of abdominal massage on constipation in palliative care patients – a pilot study

“…Poza jatrogennym skutkiem farmakologicznego leczenia bólu, i w jego wyniku osłabienia odruchowej perystaltyki jelit, do wtórnych przyczyn zaparć w grupie pacjentów objętych opieką paliatywną zalicza się, m.in. zmniejszenie aktywności fizycznej [5,[10][11][12], ograniczenie ilości spożywanego pokarmu i płynów lub niewłaściwy ich rodzaj, a także brak intymności i samodzielności podczas aktu defekacji, prowadzący do ignorowania uczucia parcia na stolec i powstawania zaparcia [5,6,13]. Brak możliwości przyjęcia wyższych pozycji, częsty u pacjentów hospicjum, również sprzyja zaleganiu mas kałowych [5,6,[14][15][16][17].…”

“…Rola fizjoterapeuty jest istotna także w odniesieniu do reedukacji posturalnej w trakcie oddawania stolca i w życiu codziennym, gdyż może to ułatwić proces wypróżniania [12]. Jeśli przejście do siadu nie jest możliwe, należy nauczyć pacjenta wypróżniania się w pozycji leżącej, najlepiej na lewym boku ze zgiętą lewą kończyną dolną [5].…”

“…Zatem fizjoterapeuta, posiadający Apart from constipation, opioid treatment is accompanied by a number of symptoms in the digestive system, such as dry mouth, lack of appetite, gastroparesis, gastroesophageal reflux disease, abdominal cavity disorders and flatulence [7][8][9]. Apart from iatrogenic effects of pharmacological pain treatment resulting in weak peristalsis, secondary factors leading to constipation in the group of patients under palliative care include, inter alia, lower physical activity [5,[10][11][12], limited amount of food and liquids intake, inadequate diet or the lack of intimacy and independence during defecation, which leads to ignoring the urge to defecate and, as a result, to constipation [5,6,13]. An inability to sit up, which is common among the patients of hospices, also leads to fecal loading [5,6,[14][15][16][17].…”

“…The role of a physiotherapist is also significant when it comes to postural re-education during defecation and during everyday activities as it may facilitate the process of defecation [12]. If a sitting position is not possible, the patient should be taught to defecate in a supine position, particularly on the left side with a bent left lower limb [5].…”