A systematic review of the effectiveness of bowel management strategies for constipation in adults with stroke

Objective: Constipation is one of the most common medical complications of acute stroke. Currently, management strategies to guide clinical practice are limited. This review aimed to examine the effectiveness of bowel management strategies for constipation in adults with stroke. Design: A systematic review of randomised controlled trials or other quantitative research designs in the absence of randomised controlled trials was undertaken. Data sources: A comprehensive search of major electronic databases and all reference lists of relevant articles in the English language were performed from January 1990 up to March 2011. Review methods: Data were extracted and assessed by two independent reviewers. Due to differences in the study designs, the findings are presented in narrative form. Results: There were a total of three studies (two randomised controlled trials and one quasi-experimental study). One of the randomised controlled trials examined a single (once-only) structured nurse-led intervention and the other randomised controlled trial evaluated four bowel management programmes. Both, studies yield improvements respectively in symptoms of bowel dysfunction and bowel training efficiency when the programme corresponded with the subjects' bowel patterns before the stroke onset. The quasi-experimental study compared the effectiveness of daily digital stimulation versus every other day and found higher bowel regularity with daily digital stimulation. Conclusion: Constipation management strategies are limited. This review suggests that structured bowel programmes and nurse-led intervention in bowel care have a significant effect in improving bowel evacuations. (C) 2012 Elsevier Ltd. All rights reserved.