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The Effect of Abdominal Massage on Constipation and Quality of Life

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This study was a randomized controlled trial aimed to find the impact of abdominal massage application on constipation and quality of life among patients. The sample included 30 intervention (abdominal massage) and 30 control subjects. To collect data, the following were utilized: Patient Information Form, Gastrointestinal Symptom Rating Scale, Constipation Severity Instrument, Bristol Scale Stool Form, Patient Assessment of Constipation Quality of Life (PAC-QOL) Scale, and European Quality of Life Instrument (EQ-5D). The data were collected from among patients in the morning and evening on the fourth, fi fth, and sixth days postoperatively. No signifi cant fi ndings were discovered between experimental and control groups in terms of individual characteristics and characteristics that might influence constipation (p >.05). It was found that patients who received abdominal massage application defecated more often following their surgery than patients in the control group, which led to a statistically high level of signifi cant difference between the groups (p ≤.001). It was also found that the experimental group displayed higher average PAC-QOL and EQ-5D scores on discharge. Findings indicated that abdominal massage applied to patients diagnosed with postoperative constipation reduced symptoms of constipation, decreased time intervals between defecation, and increased quality of life.
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48 Copyright © 2016 Society of Gastroenterology Nurses and Associates Gastroenterology Nursing
massage is used in patients with constipation by nurses,
patients defecate early, less pharmacological agents are
used, and the quality of life improves ( Richards, 1998 ).
Background
The frequency of constipation ranging from 2% to
28% is a problem peculiar to the gastrointestinal (GI)
system. Women compared with men and elderly com-
pared with young experience more frequent complaints
of constipation ( Kaya, Kaya, Turan, S¸irin, & Gülog˘lu,
2013 ; Lamas et al., 2010; Turan et al., 2011 ; Yurdakul,
2004 ). The symptoms include scybalum (hard stool
mass) and defecation less than three times a week,
abdominal and rectal pain, decrease in intestinal noise,
rectal fullness, pressure in rectum, stress and pain
while defecation, feeling full, loss of appetite, head-
ache, fatigue, and hemorrhoid ( Kaya, 2011 ; H. Kaya,
2012 ; Yurdakul, 2004 ).
Constipation may be brought on by a change in
diet, medication, daily routine, exercise patterns, acute
emotional stress, surgery, medication, or disease pro-
cesses ( H. Kaya, 2012 ; McClurg, Hagen, Hawkins, &
Lowe-Strong, 2011 ; Sinclair, 2011 ). Constipation also
has a significant impact on the person’s quality of life
and well-being and can range from a headache and
Constipation is a common problem that often
has a profound effect on patients’ well-being
and quality of life ( Lamas, Lindholm,
Stenlund, Engstrom, & Jacobsson, 2009 ;
Preece, 2002 ). The use of abdominal massage to help
relieve constipation has been an effective therapy for
several hundred years ( Preece, 2002 ). More recently,
interest in abdominal massage as an effective interven-
tion for constipation without known side effects has
resurfaced ( Harrington & Haskvitz, 2006 ). Abdominal
massage has been widely used by nurses recently ( Ayas¸,
Leblebici, Sözay, Bayramog˘ lu, & Niron, 2006 ; Emly,
Cooper, & Vail, 1998 ; Ernst, 1999 ). When abdominal
The Effect of Abdominal Massage on
Constipation and Quality of Life
ABSTRACT
This study was a randomized controlled trial aimed to fi nd the impact of abdominal massage application on consti-
pation and quality of life among patients. The sample included 30 intervention (abdominal massage) and 30 control
subjects. To collect data, the following were utilized: Patient Information Form, Gastrointestinal Symptom Rating
Scale, Constipation Severity Instrument, Bristol Scale Stool Form, Patient Assessment of Constipation Quality of Life
(PAC-QOL) Scale, and European Quality of Life Instrument (EQ-5D). The data were collected from among patients in
the morning and evening on the fourth, fi fth, and sixth days postoperatively. No signifi cant fi ndings were discovered
between experimental and control groups in terms of individual characteristics and characteristics that might infl uence
constipation ( p > .05). It was found that patients who received abdominal massage application defecated more often
following their surgery than patients in the control group, which led to a statistically high level of signifi cant difference
between the groups ( p .001). It was also found that the experimental group displayed higher average PAC-QOL
and EQ-5D scores on discharge. Findings indicated that abdominal massage applied to patients diagnosed with
postoperative constipation reduced symptoms of constipation, decreased time intervals between defecation, and
increased quality of life.
Nuray Turan , PhD, BSN
Türkinaz Atabek As¸tı , PhD, BSN
Received March 27, 2014; accepted May 21, 2014.
About the authors: Nuray Turan, PhD, BSN, is Assistant Professor,
Department of Fundamentals of Nursing, Florence Nightingale Faculty
of Nursing, Istanbul University, Istanbul, Turkey.
Türkinaz Atabek As¸tı, PhD, BSN, is Professor, Department of Nursing,
Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey .
The authors declare no conflicts of interest.
Correspondence to : Nuray Turan, PhD, BSN, Department of Fundamentals
of Nursing, Florence Nightingale Faculty of Nursing, Istanbul University,
Abide-i Hürriyet Cad, 34381, Istanbul/Turkey ( nkaraman@istanbul.edu.tr ).
DOI: 10.1097/SGA.0000000000000202
Copyright © 2016 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
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The Effect of Abdominal Massage on Constipation and Quality of Life
VOLUME 39 | NUMBER 1 | JANUARY/FEBRUARY 2016 49
fatigue to feelings of being bloated; experiencing loss
of appetite, nausea, and vomiting; and can exacerbate
other symptoms such as limb spasticity or bladder dys-
function ( Preece, 2002 ). Several studies have found
correlation between constipation and decreased health-
related quality of life ( Dedeli, Turan, Fadılog˘ lu, & Bor,
2007 ; Glia & Lindberg, 1997 ; O’Keefe, Talley,
Zinsmeister, & Jacobsen, 1995 ; Wald et al., 2007 ).
Constipation is also commonly known to be a prob-
lem for a range of orthopedic patients. Orthopedic
patients with reduced mobility and who have reduced
food or fluid intake, use opioid analgesic medications,
use a bedpan in the early postoperative period, and are
older than the average surgical patients are prone to
constipation ( Atabek, 1994 ; S¸ endir, Büyükyılmaz, As¸tı,
Gürpınar, & Yazgan, 2012 ).
Nurses have an important role in care and treatment
of constipation ( Kaya et al., 2013 ). However, constipa-
tion management in nursing care is problematic
because of the individual variability of bowel habits
( Kaçmaz & Kas¸ıkçı, 2007 ; Lamas et al., 2009 ).
Abdominal massage, which is an efficient way to man-
age constipation, is widely used by nurses, especially
recently ( Ayas¸ et al., 2006 ; Ernst, 1999 ; Resedence,
Brocklehurst, & O’Neil, 1993 ). Abdominal massage is
a noninvasive intervention stimulating peristalsis as a
result of administering patting, kneading, and vibra-
tion clockwise to the abdomen ( Sinclair, 2011 ; Tuna,
2011 ; Uysal, Es¸er, & Akpınar, 2012 ). Abdominal mas-
sage of the ascending, transverse, and descending
colons may be effective in regulating bowel movements
and decreasing medication used for constipation
through improvements in intestinal motility when per-
formed on a daily basis ( Harrington & Haskvitz,
2006 ; Kanbir, 1998 ; Kyle, 2011 ; Preece, 2002 ;
Richards, 1998 ).
When abdominal massage is used, less pharmacologi-
cal agents are used and quality of life improves ( Kyle,
2011 ; Sinclair, 2011 ). A review of the literature in
Turkey shows that there were few studies about nursing
interventions related to the effect of abdominal massage
on constipation. This study therefore investigates, the
effect of abdominal massage on individuals with consti-
pation in regards to GI functions, quality of life, and the
use of laxatives.
Methods
The purpose of this experimental study is to identify
the effect of abdominal massage on constipation and
the quality of life of patients attending orthopedic and
trauma clinics who have undergone surgery. The
research hypotheses are as follows:
Hypothesis 1 (H1): The use of pharmacological agents is
less in patients with a constipation nursing diagnosis
who use abdominal massage than in patients who do
not use abdominal massage.
Hypothesis 2 (H2): Gastrointestinal functions are bet-
ter in patients with a constipation nursing diagnosis
who use abdominal massage than in patients who do
not use abdominal massage.
Hypothesis 3 (H3): The quality of life is better in pa-
tients with a constipation nursing diagnosis who use
abdominal massage than in patients who do not use
abdominal massage.
Ethical Permissions
Written consent was obtained from the Department of
Orthopedics and Traumatology in hospitals where
this research was conducted. Ethical approval was
obtained from the hospital ethics committee and nec-
essary permissions were taken from the local health
authority. The participant patients in experimental
and control groups were informed on the fourth day
following their surgery about the purpose of their
research, the duration and what would be expected
from them, and how and where the data obtained
would be used via a “volunteer information leaflet.”
Written permission was obtained from the patients
who chose to participate in the research.
Setting and Sample
This randomized controlled study was conducted
between March 2010 and June 2012 in Orthopedics
and Traumatology Clinics of university training and
research hospitals that are located in Istanbul. The
target population includes patients in orthopedics and
trauma clinics of training and research hospitals who
have not defecated in the first 3 days after their sur-
gery. The sample consisted of experimental and control
groups that were randomly chosen among those
patients who met the sample criteria. To do this, the
researcher wrote down “test” or “control” on pieces
of paper that were cut similarly, folded, and placed
into a nontransparent bag. For every patient who met
the sample criteria and agreed to participate in the
study, the researcher blindly chose a piece of paper
from the bag and determined the subject’s assignment
to the “experimental group” or “control group”.
Sample criteria for the patient included: (1) aged 18
years or older; (2) had no problem that hindered cogni-
tive, emotional, or verbal communication; (3) had
undergone a surgery in orthopedics and traumatology
clinics and was hospitalized for treatment; (4) had no
history of psychiatric disease, abdominal hernia, intes-
tinal cancer, or laparotomy; (5) had been unable to
defecate for the first 3 days following the surgery; (6)
had not used any pharmacological and nonpharmaco-
logical agents involving laxatives; and (7) was able to
have a treatment for at least 7 days.
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The Effect of Abdominal Massage on Constipation and Quality of Life
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The study was conducted with 60 subjects, 30 in the
experimental group and 30 in the control group. The
power of the research was calculated using the GPower
3.1 software program. For the Gastrointestinal
Symptom Rating Scale total score, the effect was found
to be 0.52. In this framework, when 30 observations
were made in a group, the power of the test was found
as (1- β ) 0.63 within a p = .05 level of significance. For
the Gastrointestinal Symptom Rating Scale Abdominal
Pain subdimension, the effect was found as 0.65. In this
framework, when 30 observations were made in group,
the power of the test was found as (1- β ) 0.80 within a
p = .05 level of significance. For the Gastrointestinal
Symptom Rating Scale Reflux subdimension, the effect
was found as 0.94. In this framework, when 30 obser-
vations were made in group, the power of the test was
found as (1- β ) 0.97 within a p = .05 level of
significance.
Data Collection Instruments
When collecting data, the Patient Information Form,
Gastrointestinal Symptom Rating Scale (GSRS),
Constipation Severity Instrument (CSI), Bristol Stool
Scale, Patient Assessment of Constipation Quality of
Life (PAC-QOL) Scale, and EuroQol European Quality
of Life Instrument (EQ-5D) were used.
Patient Information Form
The Patient Information Form was created in accord-
ance with existing literature ( Kaya & Turan, 2011 ; N.
Kaya, 2012 ; Kaya et al., 2013 ; Turan et al., 2011 ) and
involved questions regarding the patients’ age, gender,
body mass index, marital status, educational back-
ground, income status, and his/her hospital duration.
Gastrointestinal Symptom Rating Scale
The validity and reliability of the scale created by
Revicki, Wood, Wiklund, and Crawley (1998), which
aims to evaluate the common symptoms in patients
with GI system disorders, was translated to Turkish by
Turan and As¸tı (2011) . The GSRS a 5-score Likert scale
with 15 questions and options starting with “no prob-
lem” and ends with “severe discomfort.” In the GSRS,
the patient is questioned about how he or she felt
regarding any GI problems in the last week. The GSRS
has five dimensions: “diarrhea,” “indigestion,” “con-
stipation,” “abdominal pain,” and “reflux.” A high
score indicates that the symptoms were severe ( Kaya &
Turan, 2011 ; Revicki et al., 1998 ; Turan & As¸tı, 2011 ).
Constipation Severity Instrument
Turkish validity and reliability of the scale created by
Varma et al. (2008) was established by Kaya and
Turan (2011) . The Constipation Severity Instrument
aims to determine how often the patients defecate, the
volume of defecation, and how hard it is to defecate
for the patient. The Constipation Severity Instrument
has three dimensions: “obstructive defecation,”
“colonic inertia,” and “pain.” High scores indicate
that the symptoms were severe ( Kaya & Turan, 2011 ;
Turan et al., 2011 ; Varma et al., 2008 ).
Patient Assessment of Constipation Quality of Life
Developed by Marquis et al. (2005) to determine the
effect of constipation on the quality of life, the Patient
Assessment of Constipation Quality of Life scale has
established validity and reliability by Dedeli et al.
(2007) in Turkish. The scale consists of four dimen-
sions: “anxiety,” “physical discomfort,” “psychosocial
discomfort,” and “satisfaction.” As the scores from the
scale increase, it is assumed that the quality of life is
low ( Kaya & Turan, 2011 ; Turan et al., 2011 ).
EuroQol-General Health Scale
The EuroQol-General Health Scale consists of a system
that defines five different dimensions including “move-
ment,” “self-care,” “routine work,” “pain/discomfort,”
and “anxiety/depression.” Each dimension is rated as
follows: “no problem” = 1, “some problems” = 2,
“severe problems” = 3; subjects can choose only one.
The score received is indicated as EQ-5
DSKOR ( Bolol,
Ülgen, Turan, Kaya, & Kaya, 2010 ; Brooks, 1996 ).
Because the scale can be used in other countries, a
visual analog scale, which enables patients to express
their subjective health perceptions and is shaped like a
calibrated and vertical thermometer, is included in the
scale. This part of the scale is reflected as EuroQol
VAS
( Brooks, 1996 ).
Bristol Stool Form Scale
Developed by a group of gastroenterologists at Bristol
University in England, the Bristol Stool Form Scale is
used to evaluate the shape of stool, indicate changes in
bowel habits, and collect information about potential
pathological entities. This scale is designed to classify
the bowel movements of an individual in seven differ-
ent categories. Type 1 and Type 2 indicate “constipa-
tion”; Type 3 and Type 4 indicate “normal defeca-
tion”; and Type 5, Type 6, and Type 7 indicate “diar-
rhea.” It is accepted that there is a direct correlation
between the form of stool and the period of time it
stays in the bowel ( Lewis & Heaton, 1997 ).
Procedure
Experimental Group
The patients hospitalized in Orthopedics and
Traumatology Clinics who had undergone a surgery
and met the sample criteria were identified. An experi-
mental group was randomly chosen among these
patients. Four days after surgery and in the morning,
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The Effect of Abdominal Massage on Constipation and Quality of Life
VOLUME 39 | NUMBER 1 | JANUARY/FEBRUARY 2016 51
the massage be undertaken daily with each session last-
ing 15 minutes ( McClurg et al., 2011 ; Richards, 1998 ).
Liquid petrolatum is used during the application in
order to enable the researcher to move his hands on the
skin of the patient easily and not cause any disturbance
to the patient. During massage application, the subject
was placed in a supine position with the head-of-bed
angle elevated at 30 ° –45 ° ( Emly, 2007 ; Preece, 2002 ;
Uysal et al., 2012 ).
The abdominal massage was applied in a clockwise
direction over the intestines on the abdominal wall.
Four basic strokes are typically used in abdominal
massage: stroking, effleurage, kneading, and vibration.
Stroking was applied over the dermatome of the vagus
nerve, iliac crests, and down both sides of the pelvis
toward the groin. This was repeated several times and
followed by effleurage. Effleurage strokes followed the
direction of the ascending colon, across the transverse
colon and down the descending colon. Kneading was
applied down the descending colon, up the ascending
the subjects were given the Patient Information Form,
GSRS, CSI, PAC-QOL, and EuroQol European Quality
of Life Instrument. Four days after surgery, consenting
subjects received abdominal massage for 3 days in the
morning and evening for 15 minutes and totaling
6 times. After the intervention, the subjects who defe-
cated in this period were administered the Bristol Stool
Form Scale and the stool was evaluated. Six days after
surgery, the GSRS was given to the subjects to evaluate
the effect of abdominal massage. At discharge from the
hospital, the PAC-QOL and EuroQol were adminis-
tered to the subjects ( Figure 1 ).
Abdominal Massage Application
According to “Abdominal Massage Application
Guideline” developed by Uysal et al. (2012), abdomi-
nal massage was applied to subjects who had not def-
ecated after surgery, and these subjects were given
abdominal massage 4 days after surgery for 3 days,
lasting 15 minutes twice a day. It is recommended that
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FIGURE 1. The research protocol.
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The Effect of Abdominal Massage on Constipation and Quality of Life
52 Copyright © 2016 Society of Gastroenterology Nurses and Associates Gastroenterology Nursing
colon, and down the descending colon. The massage
was concluded with vibration over the abdominal wall
( Preece, 2002 ; Uysal et al., 2012 ).
Control Group
Data from the subjects in the control group were col-
lected as in the experimental group. Four days after the
surgery, subjects were started on medication appropri-
ate for routine clinical treatment such as laxative sup-
pository and enema. Data were collected from both
groups in the same way ( Figure 1 ).
Data Analysis
When evaluating data, Statistical Package for the
Social Sciences (SPSS) for Windows 16 software was
used. Descriptive statistical methods (frequency, per-
centage, average, and standard deviation) were used.
To examine normal distribution, the Kolmogorov-
Smirnov distribution test was applied. To compare
qualitative data, Pearson Ki-Kare test was used. When
two groups were compared for quantitative data,
Whitney U test was used to compare parameters that
did not show normal distribution. For more than two
groups when quantitative data was compared, the
Kruskal-Wallis test was used for parameters that did
not show normal distribution and Mann-Whitney U
test was applied to find which group caused the differ-
ence. The results were evaluated with a 95% trust
confidence interval and alpha set at .05.alpha set at
.05.
RESULTS
Individual Characteristics of Patients
Facts regarding the individual characteristics of sub-
jects are shown in Table 1 .
Postoperative Day Four
Four days after the surgery, the experimental group
was determined to have a higher GSRS abdominal pain
dimension score scale (9.46 ± 2.64), the control group
was above (7.73 ± 2.67) score average, and both find-
ings were statistically significant ( p < .05). On the
GSRS Reflux dimension score scale, the dimension
score average (5.60 ± 3.32) of the experimental group
was higher than the control group score (3.16 ± 1.53)
( p .001) ( Table 2 ). At four days after surgery, there
was no meaningful statistical difference found between
the total score averages of the GSRS diarrhea, indiges-
tion, constipation dimensions, and nor GSRS total
score averages for the experimental and control groups
( p > .05).
Four days after the surgery, there was no statisti-
cally meaningful difference between experimental and
control groups regarding CSI, PAC-QOL, and EQ-5D
total scores and dimension score averages ( p > 05)
( Table 2 ).
Postoperative Day Six
Seventy percent of the subjects in the experimental
group ( n = 21) defecated on post-operative day four
while 46.7% of the subjects in the control group
defecated on the fifth day after surgery ( n = 14) for
the first time ( Figure 2 ). According to the Bristol
Stool Form Scale, the characteristics of stool in 40%
of the experimental group ( n = 12) was ( n = 12)
Type 2, while 43.3% of the control group ( n = 13)
was Type 1. A statistically meaningful difference was
detected between groups for this measure ( p < .05)
( Table 3 ).
Six days after the surgery, the total score average of
the GSRS in the experimental group was 42.36 ±
12.66; in the control group, the total score was deter-
mined as 37.20 ± 11.50. When GSRS dimensions were
compared, only the experimental group GSRS indiges-
tion dimension score average (8.00 ± 2.84) was lower
than the control group score average (11.00 ± 2.76)
and statistically significant ( p .001) ( Table 4 ).
When discharged from the hospital, the PAC-QOL
physical disturbance dimension score average in the
experimental group (7.20 ± 3.14) was lower than the
control group score average (9.60 ± 3.59) and statisti-
cally meaningful ( p < .01). The PAC-QOL psychoso-
cial disturbance dimension score average was lower
(13.33 ± 5.22) than the control group score average
(15.70 ± 6.15) and statistically meaningful ( p < .05)
( Table 5 ). According to the EQ-5D, when EQ-5D
SKOR
and EQ
VAS score averages were compared, no statisti-
cally significant difference was found between these
score averages ( p > .05) ( Table 5 ).
Four days after the surgery and after discharge, the
total score average of the PAC-QOL total score aver-
age was higher than at discharge and statistically sig-
nificant ( p .001). The average dimension scores for
the PAC-QOL physical discomfort and anxiety were
higher 4 days after the surgery in the experimental
group than the average scores at discharge, and this
difference was statistically significant ( p .001)
( Table 5 ).
Four days after the surgery and at discharge, the
EQ5D
SKOR score average was low compared with the
discharge score average. The increase in EQ-5D
SKOR
score was statistically significant ( p .001). Similarly,
in the control group, 4 days after the surgery, the
EQ-5D
SKOR score average was lower than the dis-
charge score average, and the difference was statisti-
cally significant ( p .001). Four days after the surgery,
the average score of the EQ
VAS in the experimental
group was determined to be lower than the discharge
score average. The increase in EQ
VAS scores was
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TABLE 1. Individual Characteristics of Subjects ( N = 60)
Experimental ( n 30) Control ( n 30)
χ
2 , MW, p n % n %
Age groups, y
19-34 2 6.7 3 10 χ
2 = 2.097
35-50 5 16.7 9 30 p = .553
51-66 14 46.7 12 40
67 930 620
Average age ( ± SD)
(minimum–maximum)
57.26 ± 14.05
(minimum = 19, maximum = 79)
54.00 ± 13.69
(minimum = 25, maximum = 77)
MW = 383
p = .322
Gender
Female 25 83.3 25 83.3
Male 5 16.7 5 16.7
BMI
Thin 1 3.3 0 0 χ
2 = 1.077
Normal 6 20 7 23.3 p = .783
Overweight 9 30 9 30
Obese 14 46.7 14 46.7
BMI average ( ± SD)
(minimum–maximum)
29.10 ± 5.73
(minimum = 18, maximum = 42)
29.23 ± 5.85
(minimum = 19, maximum = 40)
MW = 445
p = .941
Marital status
Single 4 13.3 5 16.7 χ
2 = 0.131
Married 26 86.7 25 83.3 p = .718
Level of education
Illiterate 7 23.3 3 10 χ
2 = 2.473
Literate 3 10 2 6.7 p = .781
Primary school 15 50 18 60
Secondary school 2 6.7 3 10
High school 2 6.7 3 10
College 1 3.3 1 3.3
Level of income
Able to meet the
expenses 8 26.7 9 30 χ
2 = 0.082
Unable to meet the
expenses 22 73.3 21 70 p = .774
Duration of hospital stay
7-9 d 6 20.7 7 23.3 χ
2 = 0.287
10-12 d 13 43.3 11 36.7 p = .866
13 d 11 36.7 12 40.0
Type of surgery
Major 28 93.3 27 90 χ
2 = 0.218
Minor 2 6.7 3 10 p = .640
Note . χ
2 = Chi-squared test; BMI = body mass index; MW = Mann-Whitney U test; SD = standard deviation.
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The Effect of Abdominal Massage on Constipation and Quality of Life
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statistically significant ( p .001); however, the control
group’s EQ
VAS score average was found than the dis-
charge score average on the fourth day after surgery,
and this difference was statistically significant ( p
.001) ( Table 5 ).
DISCUSSION
This study was conducted to determine the effect of
abdominal massage on constipation and quality of life
for hospitalized patients who have undergone orthope-
dic or trauma surgery. Nurses play a pivotal role in
management of constipation. There are few studies
about the efficiency of abdominal massage in prevent-
ing constipation, despite the benefits as an alternative
method in constipation treatment ( Lamas et al., 2009 ;
Uysal et al., 2012 ).
This study suggests that abdominal massage, com-
pared with laxative, suppository, and enema, decreases
the symptoms of constipation in patients who are diag-
nosed with postoperative constipation and shortens
the defecation period and improves the quality of life.
To evaluate the efficiency of abdominal massage and
medicine appropriate for clinic routine (such as laxa-
tive, suppository, or enema), the GI symptoms in
experimental and control groups; seriousness of consti-
pation; and the characteristics of the quality of life and
general health should be similar. For this purpose, 4
days after the surgery, data obtained from the GSRS,
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TABLE 2. Comparison of GSRS, CSI, PAC-QOL, and EQ-5D Points of Subjects in Experimental
and Control Groups on the Fourth Day of Surgery
Experimental ( n 30) Control ( n 30)
MW p X
SD X
SD
GSRS
Abdominal pain 9.46 ± 2.64 7.73 ± 2.67 288 .015
Reflux 5.60 ± 3.32 3.16 ± 1.53 224 .001
a
Diarrhea 4.80 ± 2.17 4.16 ± 2.00 368 .183
Indigestion 12.46 ± 6.43 12.96 ± 5.63 410 .548
Constipation 10.03 ± 5.36 9.16 ± 4.99 417 .618
GSRS total 30.20 ± 9.87 34.36 ± 5.67 331 .077
CSI
Obstructive defecation 9.66 ± 8.22 9.83 ± 7.18 424 .698
Colonic inertia 9.06 ± 7.06 8.73 ± 6.56 437 .841
Pain 0.33 ± 1.49 0.33 ± 1.64 450 .999
CSI total 19.06 ± 14.79 18.90 ± 13.14 430 .761
PAC-QOL
Physical disturbance 10.70 ± 3.68 9.60 ± 4.90 360 .178
Psychosocial disturbance 16.86 ± 6.38 16.60 ± 6.95 432 .784
Anxiety 27.00 ± 10.80 24.40 ± 11.61 381 .297
Satisfaction 21.90 ± 3.29 19.96 ± 5.86 398 .431
PAC-QOL total 76.46. ± 15.53 70.56 ± 21.68 323 .060
EQ-5D
EQ-5D
SKOR 0.03 ± 0.28 0.05 ± 0.29 449 .982
EQ
VAS 61.50 ± 15.76 59.83 ± 16.73 416 .601
Note . CSI = Constipation Severity Instrument; EQ-5D = EuroQol European Quality of Life Instrument; GSRS = Gastrointestinal
Symptom Rating Scale; MW = Mann-Whitney U test; PAC-QOL = Patient Assessment of Constipation Quality of Life.
a Correlation is significant at the .01 level (two-tailed).
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VOLUME 39 | NUMBER 1 | JANUARY/FEBRUARY 2016 55
CSI, PAC-QOL, and EuroQol scales applied to the
comparison groups show that the experimental and
control groups correlate.
The fact that most of the subjects in the experimen-
tal group first defecated on the fourth day of surgery
and the subjects in the control group defecated on the
fifth day after surgery indicates that the application of
abdominal massage had more effects on the patients
than routine medications such as laxatives, supposito-
ry, and enema. Abdominal massage increases peristal-
sis and thus could be helpful for increasing bowel
function and decreasing constipation ( Lamas et al.,
2009 ). Jeon and Jung (2005) conducted an experimen-
tal survey with a group of paralyzed patients, and the
period of defecation was shortened in those in the
experimental group who received abdominal massage
( n = 15) compared with a control group ( n = 15). On
the contrary, laxatives are the most common strategy
for managing constipation. However, long-term use of
some laxatives may be associated with harmful side
effects including increased constipation and fecal
impaction ( Sinclair, 2011 ).
When the characteristics of stool from the experi-
mental and control groups were compared, it was
found that most of the subjects in the experimental
group have Type 2 and the subjects in the control group
have Type 1 stools according to the Bristol Stool Form
Scale. The Bristol Stool Form Scale is an easy to use and
dependable tool when identifying stool ( Lane,
Czyzewski, Chumpitazi, & Shulman, 2011 ). According
Copyright © 2016 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
FIGURE 2. The first day of defecation for comparison groups after the surgery.
TABLE 3. The Characteristics of Stool in Test and Control Groups According to Bristol Stool Scale
Experimental ( n 30) Control ( n 30) Total ( n 60)
2 , p n % n % n %
Characteristics of stool
Type 1 4 13.3 13 43.3 17 28.3 χ
2 = 11.837
Type 2 12 40 8 26.7 20 33.4 p = .019
a
Type 3 4 13.3 7 23.3 11 18.3
Type 4 9 30 2 6.7 11 18.3
Type 5 1 3.4 0 0.0 1 1.7
a Correlation is significant at the .05 level (two-tailed).
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The Effect of Abdominal Massage on Constipation and Quality of Life
56 Copyright © 2016 Society of Gastroenterology Nurses and Associates Gastroenterology Nursing
to the scale, classification of Type 1 and Type 2 is
defined as “constipation” ( Lewis & Heaton, 1997 ).
Stool aspect was correlated to intestinal transit time and
not to the frequency of bowel movements. The form
and frequency of stool give important indications about
many important diseases ranging from GI symptoms to
infections ( Chumpitazi et al., 2010 ). In Rasmussen’s
study (2010), most patients were also detected as hav-
ing Type 1 or Type 2 stool characteristics.
When GI symptoms were compared on the sixth
day of after surgery, symptoms such as abdominal
pain, reflux, diarrhea, and constipation (but not indi-
gestion) decreased compared with the fourth day, sug-
gesting that both abdominal massage and routine
medications were effective on patients. The facts
obtained from this study are parallel to the findings of
the research by Lamas et al. (2009) . There is only a
difference between comparison groups for indigestion.
This fact from the study suggests the application of
abdominal massage is as effective as the use of phar-
macological agents and has no other side effects. In
addition, when the principle of maximizing benefit and
doing no harm is taken into consideration, it is widely
known that each pharmacological agent certainly has
a side effect.
The fact that the quality of life in the experimental
group related to constipation is lower on the physical
discomfort and psychosocial discomfort dimensions
than the control group suggests the positive effects of
abdominal massage on constipation and its symptoms.
Abdominal massage affects the abdominal muscles and
bowels; in addition, it stimulates the abdominal neural
network and changes the tone of bowels. In this way,
the pain and discomfort caused by constipation
decreases ( Kyle, 2011 ; Sinclair, 2011 ; Tuna, 2011 ). In
the study conducted by Preece (2002) with a single
group ( n = 15), the symptoms of 11 of the patients
who received abdominal massage decreased. In another
study conducted by McClurg et al. (2011) with a
group of 30 patients, the researchers suggest that
application of abdominal massage obviously heals con-
stipation and its symptoms.
The fact that there was no difference in general
health condition between groups when they were dis-
charged suggests that the application of abdominal
massage and the other clinical treatments have a posi-
tive effect on subjects’ overall health and increases
their quality of life. Abdominal massage may signifi-
cantly improve quality of life: it decreased constipation
and associated abdominal discomfort in patients
( Harrington & Haskvitz, 2006 ; Preece, 2002 ). Since,
long-term use of some laxatives may be associated
with harmful side effects including increased constipa-
tion and fecal impaction ( Sinclair, 2011 ), abdominal
massage is a valuable intervention.
The increase in the quality of life of subjects in the
experimental group from the fourth day until they were
discharged indicates that the application of abdominal
massage has an effect on constipation and its symptoms,
and this condition has a positive effect on their health.
In the research by Albers et al. (2006) on paraplegic
patients, it was also shown that the application of
abdominal massage increases the comfort level of
patients. In research by Ayas¸ et al. (2006), 24 patients
with spinal cord injury were applied abdominal massage
for 15 minutes. For these patients, the period when stool
was in the bowel, abdominal distension, and fecal incon-
tinence decreased and the frequency of defecation
increased. For the current study’s control group, there
was no significant difference between the fourth day of
surgery and discharge, which suggests that the medicine
used in for treatment of constipation does not have the
same effect abdominal massage has on quality of life.
In the evaluation of general state of health in both
groups, the increase from the fourth day until discharge
from the hospital is similar to patients who are hospi-
talized because of orthopedic problems and can be
explained by their discharge after their problems or
discomfort regarding constipation is resolved.
CONCLUSION
This study shows that abdominal massage decreases the
symptoms of constipation compared with medication
such as laxatives, suppository, and enema; shortened the
period of defecation; and increased the quality of life.
When managing constipation, nurses have an impor-
tant role. For surgical patients experiencing constipa-
tion, nurses need to be informed about the application
of abdominal massage, one of the nonpharmacological
Copyright © 2016 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
TABLE 4. Comparison of GSRS Scores
Between Groups at 6 Days After Surgery
Experimental
( n 30)
Control
( n 30)
MW p X
SD X
SD
Abdominal
pain 5.40 ± 2.74 6.16 ± 2.30 341 .103
Reflux 3.60 ± 2.09 3.13 ± 1.57 423 .665
Diarrhea 4.66 ± 1.64 4.60 ± 1.90 417 .613
Indigestion 8.00 ± 2.84 11.00 ± 2.76 190 .000
a
Constipation 8.53 ± 4.13 9.46 ± 2.96 358 .168
GSRS total 42.36 ± 12.66 37.20 ± 11.50 340 .102
Note . GSRS = Gastrointestinal Symptom Rating Scale;
MW = Mann-Whitney U test.
a Correlation is significant at the .01 level (two-tailed).
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The Effect of Abdominal Massage on Constipation and Quality of Life
VOLUME 39 | NUMBER 1 | JANUARY/FEBRUARY 2016 57
methods used effectively for nursing treatment of con-
stipation. In-service training programs should be
organized to educate nurses about this technique and
its use for treating constipation. Patients with a diag-
nosis of constipation and their families should be
encouraged to cooperate with a dietician and physical
therapist to create a nutrition and exercise program
useful for managing postoperative constipation. We
also suggest that different experimental studies includ-
ing nonpharmacological methods that can ease or
Copyright © 2016 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
TABLE 5. Comparison of PAC-QOL and EQ-5D Scores Between Comparison Groups 4 Days
After Surgery and at Discharge From the Hospital
Experimental ( n 30) Control ( n 30)
MW p X
SD X
SD
PAC-QOL
Physical disturbance (before
abdominal massage)
10.70 ± 3.68 9.60 ± 4.90 360 .178
Physical disturbance
(at discharge)
7.20 ± 3.14 9.60 ± 3.59 270 .007
a
p = .000
b p = .999
Psychosocial disturbance
(before abdominal massage)
16.86 ± 6.38 16.60 ± 6.95 432 .784
Psychosocial disturbance
(at discharge)
13.33 ± 5.22 15.70 ± 6.15 311 .038
a
p = .000
b p = .134
Anxiety (before abdominal
massage)
27.00 ± 10.80 24.40 ± 11.61 381 .297
Anxiety (at discharge) 21.56 ± 7.38 24.03 ± 9.47 399 .447
p = .002
a p = .508
Satisfaction (before abdominal
massage)
21.90 ± 3.29 19.96 ± 5.86 398 .431
Satisfaction (at discharge) 21.73 ± 2.82 20.00 ± 3.90 335 .087
p = .591 p = .968
PAC-QOL total (before
abdominal massage)
76.46 ± 15.53 70.56 ± 21.68 323 .060
PAC-QOL total (at discharge) 63.83 ± 13.99 69.33 ± 16.53 362 .190
p = .000
b p = .891
EQ-5D
EQ-5D
SKOR (before abdominal
massage)
003 ± 0.28 0.05 ± 0.29 449 .982
EQ-5D
SKOR (at discharge) 0.48 ± 0.27 0.51 ± 0.26 411 .552
p = .000
b p = .000
b
EQ
VAS (before abdominal
massage)
61.50 ± 15.76 59.83 ± 16.73 416 .601
EQ
VAS (at discharge) 82.16 ± 10.96 79.96 ± 11.53 379 .283
p = .000
b p = .000
b
Note . EQ-5D = EuroQol European Quality of Life Instrument; MW = Mann-Whitney U test; PAC-QOL = Patient Assessment of
Constipation Quality of Life.
a Correlation is significant at the .05 level (two-tailed).
b Correlation is significant at the .01 level (two-tailed).
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The Effect of Abdominal Massage on Constipation and Quality of Life
58 Copyright © 2016 Society of Gastroenterology Nurses and Associates Gastroenterology Nursing
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ACKNOWLEDGMENTS
The authors are grateful to the Scientifi c Research Project
Unit at Istanbul University and Associate Professor
Nurten Kaya, PhD, BSN, for their contributions
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... Constipation can be a symptom or a disease, and it is necessary to be examined due to its long-term complications as well as its impact on the quality of life [10]. Older adults experience severe constipation with more complications due to their physiological changes associated with aging, inactivity, excessive use of medicines, hypotension, and inattention to the disease [11]. ...
... It is worth mentioning that the researchers conducted follow-up telephone calls every day. In the abdominal massage group, the patients were provided with abdominal massage at a depth of 2 cm with 18 ml of sweet almond oil for 15 minutes at specific times (i.e., [8][9][10][11] A.M.). This was done through seven sessions held every other day over a two-week period. ...
... The present study results showed a significant increase in the quality of life of the elderly participants in the oral consumption group compared to the abdominal massage and control groups after the intervention. Many studies have revealed a strong correlation between cured constipation and quality of life [10,13,46]. For instance, Turan and Atabek reported that abdominal massage played a vital role in improving patients' quality of life [10]. ...
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Background: Constipation is a common digestive disorder in the elderly population, which has a considerable impact on various aspects of their lives. Traditional and complementary medicines are two common treatments for constipation. This study was aimed at comparing the effects of abdominal massage and oral administration of sweet almond oil on constipation and quality of life among elderly people. Methods: In this single-blind study, 90 eligible elderly people were randomly selected according to ROME IV diagnostic criteria from October 2020 to May 2021 and were divided into three groups using block randomization (n = 30). In the oral consumption group, 126 ml sweet almond oil was administered during seven sessions held over two weeks (18 ml every other day). The abdominal massage group was provided with abdominal massage with the same amount of sweet almond oil during seven sessions in two weeks. Finally, the third group (i.e., the control group) received no interventions. Constipation was measured using the Constipation Assessment Scale (CAS) and the Bristol Stool Form Scale (BSFS) at baseline and on the 15th day of the intervention. Patient Assessment of Constipation-Quality of Life (PAC-QOL) was also applied before and after the intervention (day 15). The data were entered in to the SPSS 22 software and were analyzed using chi-square t-test, paired t-test, independent t-test, and ANOVA. p ≤ 0.05 was considered statistically significant. Results: The results revealed a significant decrease in the CAS score in the oral consumption group (i.e., oral administration of sweet almond oil; from 7.81 ± 2.62 to 1.15 ± 1.08, p < 0.0003) compared to the abdominal massage group (i.e., abdominal massage; from 8 ± 2.57 to 2.26 ± 1.81, p < 0.0002) and the control group (from 7.73 ± 2.53 to 6 ± 2.74, p < 0.0002). Additionally, the stool consistency score in BSFS was significantly higher in the oral consumption group in comparison to the two other groups (p < 0.0003) before and after the intervention. Furthermore, the quality of life score decreased more significantly in the oral consumption group (from 75.04 ± 7.66 to 28.15 ± 3.30, p < 0.0003) than in the abdominal massage group (from 81.15 ± 5.15 to 43.26 ± 4.13, p < 0.0001) and the control group (from 79.62 ± 4.76 to 62.31 ± 6.40, p < 0.0008). Conclusion: Since the oral administration of sweet almond oil and abdominal massage was highly influential in the participants' constipation scores and quality of life, these cost-effective methods with low complication rates are recommended to be used alongside other treatments in managing constipation among older adults.
... [18][19][20] Abdominal massage is a non-pharmaceutical method for controlling and treating constipation. 5,21,22 Several studies have addressed the effect of abdominal massage as an inexpensive and non-aggressive method for treatment of constipation. [23][24][25] In many studies, traditional oils for abdominal massage have been used for patients with constipation. ...
... 13 Other studies conducted in this regard have also shown that abdominal massage alleviated or reduced the symptoms of constipation. 21,23,37 In the control group, the mean score of constipation increased from before the intervention to after that. This implies that lack of complementary intervention caused the condition to deteriorate. ...
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Purpose Opioid-induced constipation is one of the heath problems with a negative impact on the quality of life. This randomized-controlled trial aimed to investigate the effects of acupressure therapy on the management of opioid-induced constipation in patients with cancer. Methods The trial was conducted on 140 cancer patients, who were assigned to the acupressure (n = 70) and the control groups (n = 70). In addition to routine care, patients in the acupressure group received 8-min acupressure from the Zhongwan (CV12), Guanyuan (CV4), and Tianshu (ST25) acupoints once a day for 4 weeks. The outcomes included Defecation Diary (DD), Visual Analog Scale Questionnaire (VASQ), and Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL). Results We found a statistically significant difference between the acupressure and control groups in terms of stool consistency (2.22 ± 0.49 vs 1.80 ± 0.55) (p = 0.001), straining (1.98 ± 0.71 vs 2.91 ± 0.37) (p = 0.001), incomplete evacuation (0.37 ± 0.29 vs 0.61 ± 0.43) (p = 0.001), stool amount (0.93 ± 0.14 vs 0.95 ± 0.20) (p = 0.001), and the number of defecations (0.70 ± 0.22 vs 0.46 ± 0.29), (p = 0.001) measured at the fifth week. Besides, with the exception of stool amount, the DD scores obtained by the acupressure group significantly increased in the fifth week. Inter-group comparison of the pre-test and post-test scores showed that acupressure group obtained statistically significantly lower scores from the PAC-QOL (p = 0.0001). Conclusions Findings of this trial suggested that a 4-week acupressure was an effective way to improve the quality of life and to reduce both the subjective and the objective constipation symptoms in patients with opioid-induced constipations. Clinical Trial Number: NCT 04876508
... e massage was performed 2 times a day for 15 minutes in 3 consecutive days for each patient at 8:30AM and 08:30PM. Massage hours were set so that the massage was performed at regular intervals and does not interfere with the patient's sleep hours [36]. In KMU Traditional Medicine school, one of the assistant professors of Traditional Medicine taught the first researcher how to perform the abdominal massage during 8 hours (four sessions) and approved his skill for educating abdominal massage to the patient's companion. ...
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Objective: The aim of this study was to determine the effect of abdominal massage with and without Salvia officinalis on nausea and vomiting in patients with cancer undergoing chemotherapy. Methods: In this randomized clinical trial, 60 patients undergoing chemotherapy were placed in one of two intervention groups or in a control group. Abdominal massage with and without Salvia officinalis was performed for 15 minutes twice a day for 3 consecutive days by the patient's companion. The rate of nausea and vomiting was measured with a Visual Analog Scale. Results: Findings showed that immediately after the intervention, the mean score of nausea in abdominal massage with Salvia officinalis group was lower than that of the control group. The mean score of nausea was not different between abdominal massage and control groups. One week after the intervention, the mean score of nausea was not different among the three groups. In addition, the frequency of vomiting was not different among the three groups. Conclusion: Abdominal massage with/without Salvia officinalis as a complementary medicine has not considerable effect on reducing nausea and vomiting in patient with cancer undergoing chemotherapy. More studies are needed to achieve better and more accurate results.
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Nurses can improve outcomes of patient care by integrating complementary and alternative therapies with traditional medical practices. Among the non-pharmacological methods that can be used in geriatrics and gerontology are massage, aromatherapy, relaxation, meditation , therapeutic touch, biofeedback (neurotherapy), guided affective imagery (creative psychotherapy), reflexology, acupressure, and naturopathy. Massage therapy attracts the attention of healthcare professionals, patients, and families because it improves many symptoms, it has no side effects, it is easy to learn and apply, and is safe, effective, and economical. Massage therapy is used in geriatric patients for various purposes. For instance, it is effective in the management of pain, agitation, stress, anxiety, worry, and depression, it relieves constipation and improves the range of motion of the joints. Massage therapy together with pharmacological treatments reduces many symptoms of neurological diseases and neurological disease-associated risks, and it has a safe, supportive and positive effect. It is thought that this review, based on the effects of massage therapy, can be a guide especially for nurses working with elderly patients in the neurology clinic.
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Background Today, the use of complementary therapies to control or reduce the severity of constipation is of particular importance. Aim The aim of this study was to determine the effect of abdominal massage on the severity of constipation in elderly patients with fractures. Methods In this randomized clinical trial study, 60 elderly patients admitted to orthopedic referral hospital in Guilan, Iran who were suffering from constipation were selected and placed in two intervention and control groups. Abdominal massage was performed for 3 days, twice a day, for 15 min. Both groups were evaluated using the Constipation Assessment Scale (CAS) and the Bristol Stool Scale (BSS). Results The results showed that after the educational intervention, a statistically significant difference was observed between the two groups in BSS (p < 0.05). Also, the mean scores of CAS in the intervention group decreased from 10.74 to 4.51 after intervention and in the control group, it decreased from 10.20 to 7.37. There was a statistically significant difference between the two groups in CAS (p < 0.05). Conclusion The results of the study showed the positive effect of abdominal massage on stool shape and reduction of severity constipation.
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Purpose Opioid-induced constipation is one of the heath problems with a negative impact on the quality of life. This randomized-controlled trial aimed to investigate the effects of acupressure therapy on the management of opioid-induced constipation. Methods The trial was conducted on 140 patients, who were assigned to the acupressure (n = 70) and the control groups (n = 70). In addition to routine care, patients in the acupressure group received 8-min acupressure from the Zhongwan (CV12), Guanyuan (CV4) and Tianshu (ST25) acupoints once a day for 4 weeks. The outcomes included Defacationa Diary (DD), Visual Analog Scale Questionnaire (VASQ) and Patient assessment of constipation quality of life questionnaire (PAC-QOL). Results DD scores obtained by the acupressure and the control groups. There was a statistically significant difference between the acupressure and control groups in terms of stool consistency (2.22 ± .49 vs 1.80 ± .55) (p = 0.001), straining (1.98 ± .71 vs 2.91 ± .37) (p = 0.001), incomplete evacuation (0.37 ± .29 vs 0.61 ± .43) (p = 0.001), stool amount (0.93 ± .14 vs .95 ± .20) (p = 0.001) and the number of defecations (0.70 ± .22 vs 0.46 ± .29), (p = 0.001) measured at the fifth week. Besides, with the exception of stool amount, there was a statistically significant increase in the DD scores obtained by the acupressure group between the first and the fifth weeks. Inter-group comparison of the pre-test and post-test scores showed that acupressure group obtained statistically significantly higher scores from the PAC-QOL (p = .0001). Conclusions Findings of this trial suggested that 4-week acupressure was an effective way to improve the quality of life and reduce both subjective and objective constipation symptoms in patients with opioid-induced constipations.
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This study was a randomized controlled trial aimed to compare the effects of acupressure and abdominal massage on constipation development for patients with TKA. The patients were randomly assigned to each group: control group (n = 31), acupressure group (n = 30), and abdominal massage group (n = 30). The finding showed that the severity of constipation and straining stool consistency of the groups in which acupressure and abdominal massage was applied are significantly better than the control group (p < .05). When the first defecation times of the groups are analyzed, it is seen that the patients to whom acupressure and abdominal massage are applied defecate significantly earlier than the control group (p < .05). It has been concluded that safe non-invasive acupressure and abdominal massage that can be easily applied by health professions, healthy individuals, and patients is effective on patients with total knee arthroplasty for the prevention of constipation.
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The purpose of this methodological study is to investigate the validity and reliability of the Turkish version of the Gastrointestinal Symptom Rating Scale (GSRS). The scale was adapted to the Turkish language via backward translation. Content validity was examined by referring to experts. Reliability was examined via test-retest reliability and internal consistency, and validity was examined with divergent and convergent validity. The Epworth Sleepiness Scale (ESS) and the Marlowe-Crowne Social Desirability Scale (MCSDS) were used for divergent validity. As for convergent validity, the Constipation Severity Instrument (CSI) and the Patient Assessment of Constipation Quality of Life Scale (PAC-QOLQ) were utilized. The relationship between the GSRS and the health-related quality of life (36-item short-form health survey [SF-36]) was also analyzed. The study population consisted of patients in orthopedic clinic who volunteered to participate. Test-retest reliability was examined with the participation of 30 patients; internal consistency and validity were examined with 150 patients. Test-retest reliability correlation coeffcients of the GSRS varied from 0.39 to 0.87 for all items. For internal consistency, the GSRS's item total correlation was found to be 0.17-0.67, and Cronbach α was 0.82 for all items. There was a positive linear signifcant correlation between the GSRS, CSI, and PAC-QOLQ. There was no signifcant correlation between the GSRS, MCSDS, and ESS. Higher GSRS scores inversely correlated with general quality of life (SF-36). The Turkish version of the GSRS has been found to be a reliable and valid instrument for assessing patients' gastrointestinal symptoms. Therefore, this instrument can be confdently used with Turkish individuals.
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Background. Preventing constipation is very important for patients in neurosurgery clinics and especially for those who had cerebral hemorrhage and brain tumor surgery as it might lead to elevated intracranial ressure. Therefore, it is necessary to diagnose constipation especially in individuals in neurosurgery clinics. Aim. This study has been designed as a descriptive and a cross-sectional study intending to identify constipation risk and the factors affecting it in neurosurgery patients. Material and methods. The population of the study consists of patients who stayed at a university hospital in Turkey between April 2011 and April 2012, and the sample population consists of 231 people selected by random sampling method. Data were collected using a Patient Information Form, Constipation Severity Instrument (CSI) and Constipation Risk Assessment Scale (CRAS). Data were analyzed using the SPSS version 11.5 for Windows Results. 55,4% of the patients in the study were women and the average age was 43,80±13,65. CSI Total score average of the patients at admission was low (14,27±11,28). According to CRAS, 14,3% of the patients at admission, 40,7% of the patients on the 3rd day of surgery, and 32,5% of the patients at discharge were in medium and high risk group in terms of constipation. It has been determined that women, old people, people who use analgesics, and people who stay long at a hospital are at higher constipation risk. Conclusions. As result of the data gathered in the study, it has been concluded that nurses working in neurosurgery clinics should not ignore preoperative and postoperative constipation risk in order to be able to give integrated care.
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In this pilot study the effects of exercise and abdominal massage on intestinal transit time, bowel habit, faecal incontinence and the use of laxatives and enemas were determined in 12 immobile, longstay patients for 12 weeks. Daily records of bowel habit, faecal incontinence and the use of laxatives and enemas were made for six weeks before and for 12 weeks during the programme. No significant differences (p = 0.26) were found in the transit times before and after treatment. Episodes of faecal incontinence were significantly decreased (p = 0.0002), with a significant increase in the number of bowel motions (p = 0.0006). The number of enemas given was reduced (p < 0.0001) and just one patient took one laxative. In the absence of a control group, these results could simply be due to discontinuing bowel medication, rather than exercise and massage. Further definitive research should be carried out to establish the effectiveness of exercise and abdominal massage in treating constipation in the continuing care unit.
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Objective: This methodological study was conducted in two stages with the aim of providing Turkish equivalence and determining reliability and validity of Constipation Severity Scale (CSS).Material and Methods: Linguistic equivalence of CSS was verified with translation-backward translation method, content validity with expert opinion; reliability by testing stability and internal consistency; validity using divergent- incoherent and consistent validity methods. Gastrointestinal Symptom Grading Scale (GSGS) and Constipation Quality of Life Scale (CQLS) were used for consistent validity and Epworth Sleepiness Scale (ESS) and Marlow-Crowne Social Desirability Scale (MCSDS) were used for divergent-incoherent validity. Also the relationship between CSS and general quality of life (SF-36) was analyzed. Sample of the first research was composed of students from a School of Nursing and sample of the second research was composed of the patients hospitalized in orthopedics clinic.Results: Test-retest correlation coefficients of CSS were found to be 0.20-0.84; item-total score correlations were found to be 0.40-0.82 and Cronbach alpha coefficient was found to be between 0.92 and 0.93. While a statistically significant correlation was found between CSS and CQLS, GSGS scores, a statistically significant correlation coefficient could not be reached between CSS and ESS, MCSDS scores. A statistically significant inverse relationship was detected between CSS scores and general quality of life (SF-36).Conclusion: Obtained results indicated that Turkish version of CSS is a reliable and valid scale for determination of constipation problem and assessment of the severity.
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Constipation is a common, unpleasant and often distressing symptom that can happen to anyone at any time. Yet the treatment is often far from satisfactory. This article discusses the evidence base for both non-pharmacological and pharmacological management of constipation.
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Introduction: In clinical practice constipation is often an overlooked aspect of patient care and first gains attention when it has become a severe problem for the patients. Constipation increases the risk for postoperative complications, can prolong hospital stay, increase financial cost, and staff nursing care time. Material and method: A prospective descriptive design was used. One hundred and thirty nine patients participated in the study from February to June 2006. On admission, day of discharge, and 30 days after surgery patients normal and actual defecation pattern, stool consistency, and if they experienced problems with defecation was assessed by a structured interview. North America Nursing Diagnosis Associations (NANDA's) general definition of constipation was used as a frame of reference for this study. The Bristol Stool Scale was used to measure stool consistency. Prolonged and difficult evacuation and defecation pattern was recorded on a self-composed scale. Results: Fifty per cent of patients developed constipation during the first postoperative period and their normal pattern of defecation was re-established 17 days after discharge. Nearly one third of the patients reported that their daily life was affected by constipation after discharge. Conclusion: The results imply that further studies are needed to prevent constipation and to help patients to cope with this side effect of surgery after discharge. The results of this study also suggest that acute and chronic constipation might be two different disorders.
Chapter
The usual treatment for chronic constipation is laxatives and in many cases laxative polypharmacy. 1 Long-term use leads to further constipation and impaction.2 Abdominal massage has no known adverse side effects and a treatment programme may re-educate normal bowel activity. 3,4The massage, by altering intra-abdominal pressure, has a mechanical and reflex effect on the gut, thus encouraging peristalsis.5 The effectiveness of abdominal massage may be further enhanced by utilising the mass movement of the gut, so increasing the strength of the contraction, and therefore its propulsive force. A massage programme may reduce gastrointestinal transit time, soften stool and load the rectum.6 Abdominal massage has been found to be effective in people with chronic constipation and/or faecal incontinence, altered abdominal muscle tone, abdominal pain due to cramps or flatulence, and problems with defaecation. It is not recommended where there is a history of malignant bowel obstruction or abdominal tumours, inflammatory disease of the intestine, spastic colon with irritable bowel syndrome, unstable spinal column, or pregnancy. Hollis7 lists general contraindications to massage. Abdominal massage should never be used in isolation but only as part of a holistic bowel management strategy8.
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Background Associated with decreases in quality of life, constipation is a relatively common problem. Abdominal massage appears to increase bowel function, but unlike laxatives with no negative side effects. Because earlier studies have methodological flaws and cannot provide recommendations, more research is needed.
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This study is a randomized controlled trial aimed at determining the effects of abdominal massage on high gastric residual volume seen in patients intermittently fed with enteral nutrition through a nasogastric tube. The study also investigated consequent abdominal distension and vomiting complications. The study was carried out in a university hospital between January and December 2009. The sample included 40 intervention (abdominal massage) and 40 control subjects. Findings demonstrated that 2.5% of the subjects in the massage group and 30.0% of the subjects in the control group developed high gastric residual volume from enteral nutrition through a nasogastric tube. Abdominal circumference measurements of subjects on the first and last days demonstrated that 20% of the subjects in the control group and only 2.5% of the subjects in the massage group developed abdominal distension (p = .044). Vomiting was observed in 10% of the control subjects; no vomiting was observed in the intervention group. Findings suggest that nurses should apply abdominal massage to subjects receiving enteral feedings intermittently to prevent high gastric residual volume and abdominal distension.
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This descriptive, correlational study was conducted to describe constipation risk assessment and the affecting factors of constipation risk of patients who have undergone major orthopedic surgery. Data were collected using a patient information form and the Constipation Risk Assessment Scale (CRAS) on the second postoperative day. Data were analyzed using the SPSS version 11.5 for Windows. The mean age of the 83 patients studied was 53.75 ± 21.29 years. Subjects were hospitalized in the orthopedic wards for 14.39 ± 15.17 days, and their current bowel habit was 2.18 ± 1.80 stools per week. Of the sample, 63.9% were female, 69.9% of the patients had a history of previous surgery, 45.8% had hip/knee arthroplasty surgery, and 55.4% had bowel problems during the hospitalization period. Patients had a medium risk for constipation according to the CRAS subscale (gender, mobility, and pharmacological agents). Total CRAS score was 12.73 ± 4.75 (medium risk) on the second postoperative day. In addition, age, marital status, educational level, having a history of surgery, and bowel elimination problems did have a significant effect on constipation risk. On the basis of the findings from this study, nurses must learn the postoperative constipation risk of orthopedic patients to implement safe and effective interventions.