Stroke: Bowel Dysfunction in Patients Admitted for Rehabilitation§

Abstract

Aim : to assess the prevalence of diminished frequency of bowel movements, lumpy or hard stools, intestinal constipation, straining, incomplete evacuation, incontinence (bowel dysfunctions) in patients with brain injury resulting from cerebrovascular accident, either self-reported or reported by their caregivers; to describe the type and frequency of such dysfunctions; and the prevalence of laxative use both before and after stroke.Method : cross-sectional study with 98 hospitalized patients admitted for rehabilitation between December 2009 and May 2010.Results : the prevalence of bowel dysfunctions before stroke was 23.96% whereas after the lesion it was 55.21% (p<0.0001). As reported by patients/caregivers, the chances of developing bowel dysfunctions increase sevenfold after stroke, 95% CI (2.44-24.26). The most frequent dysfunctions before stroke were intestinal constipation (73.91%) and diminished frequency of bowel movements (17.39%). After stroke, constipation remains to be the most frequent dysfunction reported (50%), followed by diminished frequency of bowel movements (26.79%), incomplete evacuation (12.50%), and lack of privacy (5.36%). The use of laxatives was 19,15% after the lesion, but not statisticaly significant (p=0.0736).Conclusion : Bowel dysfunctions increases significantly after stroke. Therefore, further studies are needed to better understand and characterize such dysfunctions, which are scarcely described in the literature.

Incidence of constipation in stroke patients

“…Four studies (632 patients) [18,21–23] were conducted in the acute stages of a stroke, and 5 studies (753 patients) [17,19–21,24] were conducted in phases of rehabilitation.…”

Visceral Mobilization and Functional Constipation in Stroke Survivors: A Randomized, Controlled, Double-Blind, Clinical Trial

“…Indeed, intestinal symptoms are very common in stroke survivors. The prevalence of functional constipation in this population ranges from 50% in the first month following a stroke to 30% after a mean of 36 weeks [4][5][6]. Moreover, this complication occurs independently of the side of the brain affected [7].…”

“…The causes of constipation include immobility, insufficient water intake, lowered consciousness, abnormal colon contractibility, and the side effects of medications. Among stroke survivors, this disorder has been explained by neurological impairment, dependence and a prolonged hospital stay as well as motor, cognitive and communicative impairments [3][4][5]. Moreover, studies have demonstrated that colon transit is significantly reduced in stroke survivors, which Mach attributes to the dysregulation of the central nervous system combined with abnormal passive movement of the visceral organs caused by limitations in body movements [3,8].…”

Konstipasi dan Tingkat Kenyamanan Pasien Stroke Non-Hemoragik

“…Stroke juga menjadi penyebab kecacatan nomor satu yang menyebabkan >20% penderitanya mengalami ketergantungan perawatan dan lebih dari 30% menderita kecacatan permanen (Ghani, Mihardja, & Delima, 2016;Smith, English, & Johnson, 2012). Immobilisasi pada pasien stroke mengakibatkan perubahan tingkat kenyamanan dan perubahan fungsi sistem tubuh seperti ganguan pada sistem gastrointestinal yaitu konstipasi (Engler et al, 2014).…”

“…Adanya cidera serebrovaskuler mengakibatkan gangguan fungsi neurologis pasien stroke mulai dari perubahan sistem kardiovaskuler, pernafasan, kemampuan mobilisasi, pencernaan maupun eliminasi. Gangguan sirkulasi di otak dapat menjadi suatu interupsi antara sistem saraf pusat dan sistem gastrointesinal yang berakibat konstipasi (brain-gut axis effect) (Engler et al, 2014). Perubahan brain-gut axis ini mempengaruhi sistem bowel yang dikontrol oleh sistem saraf enterik, sistem saraf otonom, sistem saraf volunter, hormon dan isi intestinal (Guyton & Hall, 2006;Sherwood, 2012).…”