Nonpharmacological Clinical Effective Interventions in Constipation: A Systematic Review

Abstract

Constipation is a health condition that presents a significant problem to the people suffering from it, generally defined as fewer than three bowel movements per week, and with great prevalence and impact on quality of life in adults and elderly people (Bub, Brinckmann, Cicconetti, & Valentine, 2006;Rao et al., 2015). It affects the overall well-being of individuals, has a multifactorial character, and can be influenced by physical, psychological, physiological, emotional, and environmental factors. Studies have reported an incidence of constipation among ambulatory adult patients over 65 old of 26% in men and 34% in women. Incidence is considerably higher in people living in nursing homes and hospitals than in those people living in the community (Lim & Childs, 2013). Dementia and acute stroke and palliative cancer patients are particular clinical conditions cited by researchers for constipation (Bub et al.Abstract Purpose: To identify nonpharmacological clinically effective interventions for constipation in adults. Methods: A systematic review of experimental studies of nonpharmacological interventions addressing participants' management of constipation using samples of adults over 18 years of age was conducted. In evaluating the methodological quality of the eligible studies, we used the assumptions of the Cochrane Collaboration, and for the reporting of items in the systematic review we used the Model of Preferential Reporting Items for Systematic Reviews and Meta-Analyses. The protocol of this review was recorded in the International Prospective Register of Systematic Reviews of the University of York under number 43693. Results: This review included 12 randomized controlled trials. Nonpharmacological effective interventions for the resolution of constipation were identified: individualized intervention based on the participant's modifiable risk factors of constipation promoting literacy in health; educational measures in dietary modification and lifestyle; and abdominal massage. Conclusions: Specific nonpharmacological interventions are crucial for nurses' clinical practice and of major importance for clients and families.Evidence on these interventions in resolving constipation is still scarce and fails to provide evidence-based data to support nursing clinical practice. Clinical Relevance: Personal lifestyles, comorbidities, medication, and sedentary habits are likely to be risk factors in constipation. Thus, it is important to invest in nonpharmacological interventions that promote changes in behavior regarding prevention or resolution of constipation. Moreover, nursing researchers worldwide should conduct research for clinical practice regarding the fundamentals of care.

Factors associated with non-response to naldemedine for opioid-induced constipation in cancer patients: A subgroup analysis

“…Previous studies have clarified that risk factors for constipation include female sex, advanced age, medications (e.g., anticholinergics, antipsychotics), diets, comorbidities, and mental states [10][11][12]. We also showed that the risk factors of OIC were high body mass index (BMI), chemotherapy including a taxane within 1 month of evaluation of laxative effect, no use of naldemedine, and addition or switching due to insufficient prior laxatives in advanced cancer patients [9].…”

“…Variables associated with potential risk factors for OIC were extracted from electronic medical records and used for regression analysis. Variables extracted were factors considered as potentially affecting OIC based on previous studies [1,[9][10][11][12][13] or clinically rational mechanisms, including demographic data (age, BMI, body surface area [BSA]), clinical data (Eastern Cooperative Oncology Group performance status [ECOG-PS], and stage of cancer), medicationrelated data (chemotherapy administered within 1 month of the evaluation of naldemedine effect, anti-cancer drugs administered within 1 month of the evaluation of naldemedine effect, types of opioids, daily dose of opioid in milligrams of morphine-equivalents, concomitant laxative, concomitant use of the serotonin 5-hydroxytryptamine-3 (5-HT3) receptor antagonists, naldemedine prescription within 2 days of opioid initiation, and addition of or switching to naldemedine due to insufficient efficacy of prior laxatives), and cancer type.…”

Effect of Acupressure and Abdominal Massage on Constipation in Patients with Total Knee Arthroplasty: A Randomized Controlled Study

“…For the prevention and treatment of constipation, patients are trained about fluid and fiber intake and lifestyle changes at the first stage, and if constipation complaint persists, laxatives are recommended (Berman et al, 2016; Fritz, 2017; Huang et al, 2015). Laxatives, enemas, suppositories, and surgical treatments used in the treatment of constipation are expensive (Pinto et al, 2020). It is estimated that 28% of laxative users are not satisfied with them and the cost of treatment reaches 800 million dollars annually (Blesser et al, 2005; Müller-Lissner et al, 2013).…”

Constipação Intestinal: abordagem terapêutica pelo farmacêutico com foco na eficácia e segurança.

“…Revisão sistemática que avaliou a efetividade de intervenções não farmacológicas concluiu que, apesar dos estudos primários apresentarem amostras pequenas e com baixa evidência que permitiria a comparação entre os grupos, essa forma de manejo pode ser efetiva, principalmente, se houver envolvimento dos pacientes 15 .…”