Constipation in the elderly in a Japanese long-term medical facility: An ultrasonographic investigation

Abstract

This study aims to assess the fecal retention in elderly patients using colonic ultrasonography (US) in Japanese long-term care facility and determine the correlation between nutrition management methods and the fecal retention by US. This cross-sectional, single-center study was conducted in a long-term care facility in Japan. Patients with chronic constipation fulfilled the Rome III criteria for the diagnosis of functional constipation. US was performed on constipation patients with 4-day fecal retention before starting the standard management of constipation. After patients had defecated, nurses checked the outside of feces using King's Stool Chart and Bristol Stool Chart. All of 32 patients underwent the management of suppository laxative, the daily life independence level in grade C. In all cases, the King's Stool Chart did not detect > 200 g of fecal matter; the Bristol Stool Chart revealed type 5-7 in 56.2% of patients. The total parenteral nutrition and tube feeding did not completely detect type 1-2 in 0%. While the fecal retention groups comprised 15.6%, the non-fecal retention groups comprised 84.4%. The total parenteral nutrition did not completely detect the fecal retention in 0%. In the non-fecal retention groups, the King's Stool Chart indicated < 100 g in 81.8%, and the Bristol Stool Chart indicated type 5-7 in 100%. In conclusion, fecal properties of elderly constipation patients with the long-term parenteral nutrition should be assessed in follow-up examination by US, which is possible for personalized medical care by US, to avoid the administered regular management of constipation.

Safety and efficacy of a defecation care algorithm based on ultrasonographic bowel observation in Japanese home‐care settings: a single‐case, multiple‐baseline study

“…Therefore, it is unlikely that the knowledge on defecation care or this algorithm affected the intervention. In our previous study at a long‐term care facility, although 56.3% of the patients assessed for constipation actually had loose stools, all patients received suppository doses as routine care . Furthermore, individualized intervention reportedly improves symptoms related to constipation .…”

“…In our previous study at a long-term care facility, although 56.3% of the patients assessed for constipation actually had loose stools, all patients received suppository doses as routine care. 15 Furthermore, individualized intervention reportedly improves symptoms related to constipation. 22 Further studies at long-term care facilities or hospitals where routine care is carried out to treat constipation are required to show the efficacy of individualized defecation care based on US assessment.…”

“…In all patients, the colorectum was scanned by nurses, using a systematic scanning method. 8,[13][14][15] Colonic and rectal US images were captured by transverse scan.…”

Can irritable bowel syndrome be detected by ultrasound?

“…suggested that stool retention can be confirmed by observing the hyperechoic region of the rectum. Furthermore, it has been reported that a hyperechoic region is also found in the rectum of patients with functional constipation (30)(31)(32). The strong hyperechoic region with acoustic shadow in the rectum indicates the presence of hard stool and has been suggested to be able to identify IBS.…”

A Literature Review of Defecation Care to Prevent Faecal Incontinence in Elderly Individuals with Irritable Bowel Syndrome

“…Therefore, we will consider whether objective indicators can be used to predict and prevent faecal incontinence in unconscious patients in advance. In recent years, it has been reported that faecal retention can be objectively and noninvasively evaluated using ultrasound imaging equipment [42][43][44][45]. In addition, another previous study using ultrasound reported that gallbladder contraction was higher in the IBS group than in the control group, both in the fasted state and after dietary stress [46,47].…”