Published Online
on October 14, 2004

A more recent version of this article appeared on November 1, 2004

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Submitted on May 5, 2004
Revised on July 13, 2004
Accepted on August 9, 2004

Treatment of Constipation and Fecal Incontinence in Stroke Patients. Randomized Controlled Trial

Danielle Harari FRCP^*; Christine Norton PhD, RN; Linda Lockwood RN; and Cameron Swift PhD, FRCP

From the Department of Aging and Health (D.H., L.L.), Guys and St Thomas’ Hospital, London, UK; the Department of Healthcare of the Elderly (D.H., C.S.), Kings College, London, UK; and the St. Marks Hospital and Florence Nightingale School of Nursing and Midwifery (C.N.), Kings College, London, UK.

^* To whom correspondence should be addressed. E-mail: danielle.harari{at}kcl.ac.uk.

Background and Purpose--Despite its high prevalence in stroke survivors, there is little clinical research on bowel dysfunction in this population. This is the first randomized controlled trial to evaluate treatment of constipation and fecal incontinence in stroke survivors.

Methods--Stroke patients with constipation or fecal incontinence were identified by screening questionnaire (122 community, 24 stroke rehabilitation inpatients) and randomized to intervention or routine care (73 per group). The intervention consisted of a 1-off structured nurse assessment (history and rectal examination), leading to targeted patient/carer education with booklet and provision of diagnostic summary and treatment recommendations (after consultation with geriatrician) to patient’s general practitioner (GP)±ward physician.

Results--Percentage of bowel movements (BMs) per week graded as "normal" by participants in a prospective 1-week stool diary was significantly higher in intervention versus control patients at 6 months (72% versus 55%; P=0.027), as was mean number of BMs per week (5.2 versus 3.6; P=0.005). There was no significant reduction in fecal incontinence, although numbers were small. At 12 months, intervention patients were more likely to be modifying their diets (odds ratio [OR], 3.1 [1.2 to 8.0]) and fluid intake (OR, 4.2 [1.4 to 12.2]) to control their bowels and to have visited their GP for their bowel problem (OR, 5.0 [1.4 to 17.5]). GP prescribing of laxatives and suppositories was significantly influenced at 12 months.

Conclusions--A single clinical/educational nurse intervention in stroke patients effectively improved symptoms of bowel dysfunction up to 6 months later, changed bowel-modifying lifestyle behaviors up to 12 months later, and influenced patient-GP interaction and physician prescribing patterns.

Key words: constipation • fecal incontinence • randomized controlled trial • stroke

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