‘Fiber 7’ supplement as an alternative to laxatives in a nursing home

Khaja, Masi; Thakur, Chantrapal; Bharathan, T.; Baccash, E; Goldenberg, Gregory

doi:10.1111/j.1741-2358.2005.00061.x

Cited by 12 publications

(10 citation statements)

References 17 publications

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“…The greater volume and firmness of stool due to fiber enhances the likelihood that the threshold for first sensation can be reached in a timely fashion and may also decrease the likelihood of leakage. Fiber supplementation in NH residents has led to less constipation and use of laxatives, and the data reported in this study suggest that it may help with FI 12–14 …”

Section: Discussionmentioning

confidence: 54%

“…These data may provide a plausible explanation for the potential usefulness of treatment protocols designed to increase nonliquid stool volume in NH residents (e.g., fiber supplement). 13,14 The greater volume and firmness of stool due to fiber enhances the likelihood that the threshold for first sensation can be reached in a timely fashion and may also decrease the likelihood of leakage. Fiber supplementation in NH residents has led to less constipation and use of laxatives, and the data reported in this study suggest that it may help with FI.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] The underlying mechanisms of FI and other problems related to stool discharge and evacuation are poorly understood, and management of these conditions remains problematic. Typically, a plethora of medications is advised, including laxatives, 5,6 laxative and stool softener preparations, 7 sorbitol, 8 lactulose, 9,10 a senna-fiber combination, 9 bulk fibers, [11][12][13][14] herbal supplements, 15 and an intestinal secretagogue, 16 but there is little evidence to support the efficacy of any of these medications. Prompted-voiding toileting interventions, which increase the frequency of toileting, are also recommended and help compensate for the risk factors of immobility and dementia common to urinary incontinence (UI) and FI.…”

mentioning

confidence: 99%

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A Controlled Trial of an Intervention to Improve Urinary and Fecal Incontinence and Constipation

Schnelle

Leung

Rao

et al. 2010

J American Geriatrics Society

105

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Objectives-Evaluate effects of a multi component intervention on fecal (FI) and urinary incontinence (UI) outcomes Design-Randomized controlled trial Setting-Six nursing homes Participants-One hundred and twelve Nursing Home (NH) residentsIntervention-Intervention subjects offered toileting assistance, exercise, and choice of food / fluid snacks every 2 hours for 8 hours per day over 3 months.Measurements-Frequency of UI and FI and rate of appropriate toileting as determined by direct checks from research staff. Anorectal assessments were completed on subset of 29 residents.Results-Intervention significantly increased physical activity, frequency of toileting and food/ fluid intake Urinary incontinence improved (p<.05) as did frequency of bowel movements (p<.01) and percent of bowel movements (p <.01) in toilet. The frequency of fecal incontinence did not Corresponding Author: John F. Schnelle, PhD, Professor of Medicine, Vanderbilt University Medical Center, Director, Center for Quality Aging, 1161 21st Ave. South, S-1121 Medical Center North, VUMC, Nashville, TN 37232-2400. Alternate corresponding author: Sandra Simmons, PhD, sandra.simmons@vanderbilt.edu Conflict of Interest:Dr. Felix W. Leung: Oceanic therapeutics and produces constipation medication.Author Contributions: Each author contributed to study concept, data analyses, interpretation of data, and/or manuscript preparation. JFS, SFS and LB -Study concept and design, acquisition of subjects and/or data, analysis and interpretation of data, and preparation of manuscript. FWL and SSCR -Study concept and design, analysis and interpretation of data, and preparation of manuscript. EK and JWC -Analysis and interpretation of data, and preparation of manuscript. change. Most subjects (89%) who underwent anorectal testing showed a dyssynergic voiding pattern which could explain the lack of efficacy of this intervention program alone on fecal incontinence. Conclusion-The multi-component intervention significantly changed multiple risk factors associated with fecal incontinence and increased bowel movements without decreasing fecal incontinence. The dyssynergic voiding pattern and rectal hyposensitivity suggest that future interventions may have to be supplemented with bulking agents (fiber) and/or biofeedback therapy to improve bowel function.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

A Controlled Trial of an Intervention to Improve Urinary and Fecal Incontinence and Constipation

Schnelle

Leung

Rao

et al. 2010

J American Geriatrics Society

105

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“…Staff time requirements need to be documented. The addition of simple behavioral modification of advice to refrain from straining, so as not to trigger the development of sphincter dyssynergia, and the use of bulking agents [47,48] combined with scheduled toileting [11,29] should be compared with usual laxative prophylactic management. Finally, the role that inadequate staffing and staff management have in contributing to incontinence in so many residents should continue to be documented until policy level changes are made in how nursing homes are reimbursed and evaluated.…”

Section: Future Researchmentioning

confidence: 99%

Urinary and Fecal Incontinence in Nursing Home Residents

Leung

Schnelle

2008

Gastroenterology Clinics of North America

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Urinary and fecal incontinence (UI, FI) are co-morbid conditions affecting over 50% of nursing home residents. Both forms of incontinence are risk factors for elderly persons to be placed in the nursing home, and such institutionalization itself is a risk factor for developing incontinence. Management should focus on identifying and treating underlying causes, such as detrusor instability, urinary tract infections, diet-or medication-induced diarrhea, constipation and fecal impaction. Despite appropriate management, residents may remain incontinent because of dementia and health or restraint-related immobility. Nursing homes lack the staff and financial resources to provide residents with sufficiently frequent toileting assistance (including prompted voiding). Use of special undergarments and absorbent pads is the usual practice. The article reviews the results of studies that have documented how prompted voiding programs can significantly reduce UI and FI, particularly if the intervention includes dietary and exercise components. Recent systematic anorectal testing of nursing home residents with FI has documented impaired sphincter function (risk factor for FI), decreased rectal sensation and sphincter dyssynergia (risk factor for constipation and impaction). The data suggest that the use of laxatives and stool softeners for prophylaxis against constipation and impaction related to underlying dyssynergia may have produced sufficient fluidity in the stool to predispose the residents with impaired sphincter function to manifest FI. Documentation of noninvasive and efficacious interventions by RCT and the labor costs of implementing these measures can lead to changes in how nursing home care is provided and funded.

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“…Constipation is a common problem in elderly persons, with prevalence ranging up to 50% to 70 % of nursing home residents (1). It results from a combination of risk factors, such as reduced fibre and fluid intake, less physical activity due to chronic diseases, altered eating habits and from multiple medications (2).…”

Section: Introductionmentioning

confidence: 99%

Use of fiber instead of laxative treatment in a geriatric hospital to improve the wellbeing of seniors

Sturtzel

Mikulits

Gisinger

et al. 2009

The Journal of nutrition, health and aging

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‘Fiber 7’ supplement as an alternative to laxatives in a nursing home

Abstract: Use of 'Fiber 7' allowed discontinuation of laxatives in 63 of 92 nursing home residents. The fibre supplement was a safe and convenient alternative to laxatives and decreased the cost of medical care.

Cited by 12 publications

References 17 publications

A Controlled Trial of an Intervention to Improve Urinary and Fecal Incontinence and Constipation

A Controlled Trial of an Intervention to Improve Urinary and Fecal Incontinence and Constipation

Urinary and Fecal Incontinence in Nursing Home Residents

Use of fiber instead of laxative treatment in a geriatric hospital to improve the wellbeing of seniors

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