Effectiveness of Non-Surgical Management Strategies for Constipation in Adults with Stroke: A Systematic Review.

The objective of this review is to identify the effectiveness of non-surgical management strategies for constipation in adults with stroke. More specifically, the objectives are to identify: The effectiveness of non-surgical management strategies for constipation in stroke patients for: 1. promotion of successful bowel evacuation at defecation 2. reduction in time spent in bowel care 3. reduction in additional interventions or medications for bowel care. Inclusion criteria Types of participants This review will consider studies that include people of 18 years of age or more with stroke and symptoms of constipation. Constipation is defined using ROME II criteria as 2 or more of the following symptoms for at least 12 weeks, which need not be consecutive in the preceding 12 months: 1. 1/4 defecations 3. lumpy or hard stools in > 1/4 defecations 4. sensation of incomplete evacuation in >1/4 defecations 5. sensation of anorectal obstruction or blockage in > 1/4 defecations 6. manual manoeuvres to facilitate defecation > 1/4 defecations Types of interventions This review will consider studies that evaluate any types of non-surgical management of constipation in adult persons with stroke. Non-surgical management may include, but not be limited to, dietary and fluid manipulation, oral and rectal medications (bulking agents, osmotic laxatives, stool softeners, stimulant laxatives), bowel management programmes and assistive techniques (digital stimulation, manual evacuation and abdominal massage). Types of comparisons In comparing management strategies, the following comparisons will be made 1. A particular treatment versus placebo 2. A particular treatment versus another treatment 3. A combination of treatments versus a particular treatment. Types of outcomes This review will consider studies that include the following outcome measures: 1. Successful bowel evacuation at defecation 2. Reduction in time spent in bowel care 3. Reduction in additional interventions or medications for bowel care