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Introduction: Constipation is a delay in the transit of faeces through the colon and rectum and is often associated with difficulty in defecation. It has been defined as defecation occurring less than three times a week (Whitehead et al, 1989;Wolfsen et al, 1993).The incidence is higher in people with neurological conditions, elderly people, and nursing home residents, in comparison to the general population. Constipation is frequently observed in patients with neurological diseases involving intrinsic and/or extrinsic nerves of the gut as well as the central nervous system (Johanson et al, 1992).There is no full understanding of the mechanisms through which neurological diseases can cause constipation. It is known that physical disability and impaired mobility increase constipation (Donald, 1985). Other common causes include a diet insufficient in fibre, poor fluid intake, repressing the urge to defecate and side-effects of some medications.
Chronic constipation may cause somatic symptoms such as headaches, fatigue, nausea, decreased appetite, and abdominal and sometimes rectal pain. Moreover, faecal impaction is an extremely distressing and potentially dangerous complication.This study was designed to evaluate the efficacy and safety of macrogol 3350 (Movicol) for the treatment of constipation of nursing home residents with neurological disease, compared with the existing laxative regimen.
The residents in this study had severe physical disabilities.The majority were suffering from constipation as a result of a neurological condition, immobility and receiving medications with constipating side-effects such as analgesia, muscle relaxants, antidepressants and medication for bladder dysfunction.They were a very vulnerable group with varying difficulties in communication, but most had full understanding.
The majority were using multiple laxative regimens, a combination of both oral and rectal preparations.These were frequently ineffective, and manual evacuation would be performed on a regular basis for four of the residents. There was no existing laxative protocol, and the rectal administration of two or three enemas a week had become routine.The residents had their bowel movements recorded on a chart, but this gave little indication as to frequency, size or consistency of stool.
There was a pressing need for an effective laxative regimen.A reduction in the use of invasive rectal procedures was the main objective, as the residents found these degrading, undignified, and distressing. Long-term use of enemas can result in tolerance to the procedure, a sluggish or...