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LONG‐TERM FOLLOW UP OF THE EFFICACY OF A MULTIDISCIPLINARY APPROACH TO THE MANAGEMENT OF CHRONIC CONSTIPATION
Author(s) -
Leung R.W.C.,
Meng W.C.S.,
Fung B.K.Y.,
Lee W.S.,
Chan D.,
Lau P.Y.Y.,
Yip W.C.
Publication year - 2007
Publication title -
surgical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.109
H-Index - 10
eISSN - 1744-1633
pISSN - 1744-1625
DOI - 10.1111/j.1744-1633.2007.00349_3.x
Subject(s) - medicine , constipation , defecation , biofeedback , chronic constipation , physical therapy , bowel management , defecography , multidisciplinary team , pelvic floor , surgery , nursing
Standard measures for the management of constipation include adequate dietary fibre and fluid intake, regular exercise, and biofeedback training. However, there is no documentation on the effects of the above in Hong Kong. Purpose: To evaluate the long‐term efficacy of the rehabilitative programme in the management of constipation in Hong Kong. Methods: Patients diagnosed with chronic constipation using the Rome II criteria were recruited. A clinician, dietitian and physiotherapist assessed the patients. Anorectal physiology investigations and defecation proctography were performed prior to and after the treatment programme. The treatment programme involved consultation by the dietitian, postural re‐education, and pelvic floor re‐education on a proper defecation pattern. Patients were followed up in alternate weeks for the first 3 months and monthly for another 3 months. Telephone follow up was followed 3 years after the programme. Results: 24 patients completed the program in the years 2002 and 2003. The mean age was 48.1 ± 12.8 years. There were five males and 19 females, with a median follow up of 46 months (36–48). On completion of the programme, there was significant improvement in average straining time, median bowel frequency per week, Bristol score and fibre intake.Pretreatment Post‐treatmentAverage straining time (min) 14.8 ± 2.2 10.6 ± 2.2 P = 0.029 Median bowel frequency per week 2.0 (0–42) 6.0 (0–42) P = 0.027 Bristol score 2.0 ± 0.5 2.9 ± 0.4 P = 0.006 Fibre intake (g) 10.5 ± 4.0 15.5 ± 7.4 P = 0.007Post‐treatment Post‐treatment 3 yearsAverage straining time 10.6 ± 2.2 10.0 ± 2.6 P = 0.633 Median bowel frequency per week 6.0 (0–42) 4.5 (0–26) P = 0.016 Bristol score 2.9 ± 0.4 3.4 ± 0.8 P = 1.000 Fibre intake 15.5 ± 7.4 8.46 ± 3.2 P = 0.001 Subjective improvement 45.2% 43.0% P = 0.615Conclusions: Rehabilitative programme for constipation can significantly improve the symptoms of constipation including straining time, bowel frequency and Bristol score. This was a long‐term effect and the decrease in average straining time was persistent at 3 years post‐treatment. Change of lifestyle was more difficult. Hence, there was a tendency for patients to have decreased fibre intake again after the therapy and this contributed to the subsequent decrease in bowel frequency. Fortunately, the overall subjective improvement in constipation was persistent on long‐term follow up.