Constipation and the preached trio: diet, fluid intake, exercise

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Abstract

A survey of 90 older community-dwelling people's constipation experience is reported in part. The focus is the participants’ efforts to use diet, fluid intake and exercise as preventive strategies. Most feel that they have been preached to in this regard. However, constraints may prevent full adherence to the trio and although some have gained from diet adjustment, the majority is disillusioned about these strategies.

Nurses should be aware that scientific and medical literature is discussing evidence that dietary fibre intake preventing constipation is not proven, that fluid intake does not necessarily determine stool bulk or speed colon transit time, and that there is no proven link between exercise levels and chronic constipation.

Introduction

An 8-month research project completed in April 2001 sought to illuminate the complex issue of constipation amongst community-dwelling older people. The main aim was primarily to inform advice-giving on the subject and intervention selection for nurses and other health professionals. The research was a qualitative and partly quantitative descriptive survey of 90 older people where data were collected by in-depth, semi-structured, individual interviews (interview schedule Appendix A). Two pilot studies (Koch and Hudson, 1999; Hyde et al., 1999), one in the UK, the other in Australia, identified the need for this comprehensive study on the relevant experiences and preferences of older people living within the community who use laxatives or other remedies in an effort to overcome constipation.

Overall, the participants’ composite story is of a strong imperative to self-management of constipation and a fervent search for solutions. This seeking of a solution is fraught with difficulty. The most common solution found and tried is use of a laxative, but laxative use can be like a mire. These older people experience a frustrating lack of readily identifiable and accessible services that could help them navigate successfully through or around this mire. ‘Through the mire’ would be the appropriate use of suitable laxatives with nil to minimal side effects consequent. ‘Around the mire’ would be the gaining of useful solutions that are other than laxative use, including strategies to prevent constipation.

A full report of the research with all findings is available elsewhere (Annells, 2001). This paper presents and discusses the findings pertaining to just one of the research objectives—the seeking of understanding how the trio of constipation-preventing strategies that are diet (especially dietary fibre), fluid intake and exercise influence the constipation experience of the participants. Firstly, the significance of this research focus is discussed and the research method summarised.

Section snippets

Significance

Constipation can lower quality of life for older people (De Lillo and Rose, 2000) and faecal soiling secondary to faecal impaction commonly contributes to older people being moved from their homes to care institutions (Wald, 2000). Estimations are that 80% of district nurses in the UK focus on constipation treatment (especially faecal impaction) for a total of half a day per week (Poulton and Thomas, 1999). Bowel management is often delegated by doctors to district and other nurses, sometimes

Method

Approval from the ethics committee of the district nursing service was gained prior to participant recruitment commencing. The research protocol was evaluated according to the Australian National Health & Research Council guidelines for ethical research involving human participation.

The trio—dietary fibre, fluid intake, exercise

A strong theme within data is that the participants, who are almost all aware of this trio of ‘solutions’ to supposedly prevent constipation, tend to have a less than enthusiastic attitude to these options overall, or as separate entities. Most have heard or read about this trio many times and many feel as if they have been preached to in this regard, with some feeling quite annoyed in response. The advice comes from ‘everywhere’, including doctors, nurses, pamphlets, guest speakers at clubs,

Discussion and implications for practice

Although most of the participants in this study had continuing problems with constipation and other aged persons may be helped by simple measures, the results do suggest that there is a need for nurses to question the common practice of advising older people to increase dietary fibre, drink 1.5–2 l of fluid, and to take regular exercise in order to prevent constipation. As presented to follow, scientific and medical literature suggests evidence that the case for dietary fibre preventing

Implications for practice

From a discussion of the results in perspective of recent empirical research, there is a need for nurses to question the common practice of advising older people to increase dietary fibre, drink 1.5–2 l of fluid, and to take regular exercise in order to prevent constipation. The scientific and medical literature suggest that evidence for dietary fibre preventing constipation is scant, that fluid intake does not determine stool bulk or encourage colon transit time, and that there is no proven

Acknowledgements

The project was funded by the Australian Commonwealth Department of Health & Aged Care through a Quality Use of Medicines Evaluation Program Grant.

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