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Original Article

Characteristics of Constipation at Acute Phase of Cerebral Stroke

Youn-I Choi,*, So-I Kim,*, Seong-Eun Kim, Hye-Kyung Jung, Tae-Hun Kim
The Ewha Medical Journal 2015;38(1):22-29. Published online: March 26, 2015

Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author Seong-Eun Kim. Department of Internal Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel: 82-2-2650-2724, Fax: 82-2-2655-2076, kimse@ewha.ac.kr
*These two authors contributed equally to this work.
• Received: October 16, 2014   • Accepted: October 27, 2014

Copyright © 2015, The Ewha Medical Journal

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Objectives
    The prevalence of constipation is high after stroke. Multiple factors such as long-term bed-ridden status, comorbidity, medical illnesses are combined in this condition. However, the change of bowel movement during the early stage of stroke remains uncertain.
  • Methods
    Patients with first stroke who admitted in a single institute from 2008 to 2009 were reviewed retrospectively and 36 patients were enrolled. As a control group, 47 consecutive orthopedic patients needing bed rest without surgery in the same period were enrolled. Data of stroke associated factors, frequency of BM (bowel movement) during 5 weeks, use of gastrointestinal medications, and outcomes were collected from the medical records.
  • Results
    The cumulative incidence of decreased (<3/week) and severely decreased BM (<1/week) were 80.6% and 69.4% in stroke patients and 53.2% and 14.9% in control group (P<0.05). The cumulative incidence of increased BM (>3/day) was 38.9% in stroke and 14.9% in control group. In acute stroke, 58% of patient showed severely decreased BM in first week, and the proportion was rapidly decreased below 15% from second week. However, laxative use increased with hospital days. The occurrence of severely decreased BM in stroke patients was associated with National Institutes of Health Stroke Scale (NIHSS; P=0.004). Severely decreased BM was not associated with poor outcomes including death, morbidity, and stroke recurrence.
  • Conclusion
    Decreased BM is common in acute stroke. The occurrence of severely decreased BM is associated with NIHSS. However, the severe manifestation occurred mainly in the first week, and considered to be well controlled by laxatives.
  • Keywords: Constipation; Stroke
  • 1. Otegbayo JA, Talabi OA, Akere A, Owolabi MO, Owolabi LF, Oguntoye OO. Gastrointestinal complications in stroke survivors. Trop Gastroenterol 2006;27:127-130.
  • 2. Robain G, Chennevelle JM, Petit F, Piera JB. Incidence of constipation after recent vascular hemiplegia: a prospective cohort of 152 patients. Rev Neurol (Paris) 2002;158(5 Pt 1):589-592.
  • 3. de Jong G, van Raak L, Kessels F, Lodder J. Stroke subtype and mortality: a follow-up study in 998 patients with a first cerebral infarct. J Clin Epidemiol 2003;56:262-268.
  • 4. Ingeman A, Andersen G, Hundborg HH, Svendsen ML, Johnsen SP. Processes of care and medical complications in patients with stroke. Stroke 2011;42:167-172.
  • 5. Harari D, Coshall C, Rudd AG, Wolfe CD. New-onset fecal incontinence after stroke: prevalence, natural history, risk factors, and impact. Stroke 2003;34:144-150.
  • 6. Su Y, Zhang X, Zeng J, Pei Z, Cheung RT, Zhou QP, et al. Newonset constipation at acute stage after first stroke: incidence, risk factors, and impact on the stroke outcome. Stroke 2009;40:1304-1309.
  • 7. Bassotti G, Bellini M, Pucciani F, Bocchini R, Bove A, Alduini P, et al. An extended assessment of bowel habits in a general population. World J Gastroenterol 2004;10:713-716.
  • 8. Aslan E, Beji NK, Erkan HA, Yalcin O, Gungor F. The prevalence of and the related factors for urinary and fecal incontinence among older residing in nursing homes. J Clin Nurs 2009;18:3290-3298.
  • 9. Tong X, Kuklina EV, Gillespie C, George MG. Medical complications among hospitalizations for ischemic stroke in the United States from 1998 to 2007. Stroke 2010;41:980-986.
  • 10. Schaller BJ, Graf R, Jacobs AH. Pathophysiological changes of the gastrointestinal tract in ischemic stroke. Am J Gastroenterol 2006;101:1655-1665.
  • 11. Calignano A, Whittle BJ, Di Rosa M, Moncada S. Involvement of endogenous nitric oxide in the regulation of rat intestinal motility in vivo. Eur J Pharmacol 1992;229:273-276.
  • 12. Dooley CP, Mello WD, Valenzuela JE. Effects of aspirin and prostaglandin E2 on interdigestive motility complex and duodenogastric reflux in man. Dig Dis Sci 1985;30:513-521.
  • 13. Winge K, Rasmussen D, Werdelin LM. Constipation in neurological diseases. J Neurol Neurosurg Psychiatry 2003;74:13-19.
  • 14. Kovindha A, Wattanapan P, Dejpratham P, Permsirivanich W, Kuptniratsaikul V. Prevalence of incontinence in patients after stroke during rehabilitation: a multi-centre study. J Rehabil Med 2009;41:489-491.
  • 15. Sun TK, Chiu SC, Yeh SH, Chang KC. Assessing reliability and validity of the Chinese version of the stroke scale: scale development. Int J Nurs Stud 2006;43:457-463.
  • 16. Nakayama H, Jorgensen HS, Pedersen PM, Raaschou HO, Olsen TS. Prevalence and risk factors of incontinence after stroke: the Copenhagen Stroke Study. Stroke 1997;28:58-62.
  • 17. Cardin F, Minicuci N, Droghi AT, Inelmen EM, Sergi G, Terranova O. Constipation in the acutely hospitalized older patients. Arch Gerontol Geriatr 2010;50:277-281.
  • 18. Pare P, Ferrazzi S, Thompson WG, Irvine EJ, Rance L. An epidemiological survey of constipation in canada: definitions, rates, demographics, and predictors of health care seeking. Am J Gastroenterol 2001;96:3130-3137.
  • 19. Limmer S, Ittel TH, Wietholtz H. Secondary and primary prophylaxis of gastropathy associated with nonsteroidal antiinflammatory drugs or low-dose-aspirin: a review based on four clinical scenarios. Z Gastroenterol 2003;41:719-728.
  • 20. Towers AL, Burgio KL, Locher JL, Merkel IS, Safaeian M, Wald A. Constipation in the elderly: influence of dietary, psychological, and physiological factors. J Am Geriatr Soc 1994;42:701-706.
  • 21. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut 1999;45:Suppl 2. II43-II47.
Fig. 1

Bowel habit change of the enrolled patients during hospital days. The cumulative incidence of decreased (<3/wk) BF (bowel frequency) are 80.6% in stroke patients and 53.2% in orthopedics patients.

emj-38-22-g001.jpg
Fig. 2

Incidence of constipation according to hospital period. In acute stroke, 58% of patient show severe constipation in first week, and the proportion of this condition is rapidly decreased below 20% from second week.

emj-38-22-g002.jpg
Table 1

Characteristics of the study groups

ASA, American Society of Anesthesiologists physical status classification; ACE, angiotensin-converting enzyme.

*P<0.05.

emj-38-22-i001.jpg
Table 2

Univariate analysis for evaluating the association between clinical characteristics with constipation at acute stage of stroke (N=29)

CI, confidence interval; ASA, American Society of Anesthesiologists physical status classification; NIHSS, National Institute of Health Stroke Scale; ACE, angiotensin-converting enzyme.

*P<0.05.

emj-38-22-i002.jpg
Table 3

Multivariate analysis for evaluating the association between clinical characteristics with constipation at acute stage of stroke

NIHSS, National Institute of Health Stroke Scale; ASA, American Society of Anesthesiologists physical status classification.

*P<0.05.

emj-38-22-i003.jpg

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Occurrence of Constipation during the Rehabilitation Stage in Patient with Cerebral Vascular Disease
      Dongsoon Shin, Sunglim Kim, Insook Jang, YoungJi Kim, Joohwan Han, Eunyoung Kim, Naryeong Do, Youngshin Song
      Journal of Korean Academy of Fundamentals of Nursing.2017; 24(3): 200.     CrossRef

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    Characteristics of Constipation at Acute Phase of Cerebral Stroke
    Ewha Med J. 2015;38(1):22-29.   Published online March 26, 2015
    DOI: https://doi.org/10.12771/emj.2015.38.1.22
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    Characteristics of Constipation at Acute Phase of Cerebral Stroke
    Ewha Med J. 2015;38(1):22-29.   Published online March 26, 2015
    DOI: https://doi.org/10.12771/emj.2015.38.1.22
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    Figure

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    Characteristics of Constipation at Acute Phase of Cerebral Stroke
    Image Image
    Fig. 1 Bowel habit change of the enrolled patients during hospital days. The cumulative incidence of decreased (<3/wk) BF (bowel frequency) are 80.6% in stroke patients and 53.2% in orthopedics patients.
    Fig. 2 Incidence of constipation according to hospital period. In acute stroke, 58% of patient show severe constipation in first week, and the proportion of this condition is rapidly decreased below 20% from second week.

    Fig. 1

    Fig. 2

    Characteristics of Constipation at Acute Phase of Cerebral Stroke

    Characteristics of the study groups

    ASA, American Society of Anesthesiologists physical status classification; ACE, angiotensin-converting enzyme.

    *P<0.05.

    Univariate analysis for evaluating the association between clinical characteristics with constipation at acute stage of stroke (N=29)

    CI, confidence interval; ASA, American Society of Anesthesiologists physical status classification; NIHSS, National Institute of Health Stroke Scale; ACE, angiotensin-converting enzyme.

    *P<0.05.

    Multivariate analysis for evaluating the association between clinical characteristics with constipation at acute stage of stroke

    NIHSS, National Institute of Health Stroke Scale; ASA, American Society of Anesthesiologists physical status classification.

    *P<0.05.
    Table 1 Characteristics of the study groups

    ASA, American Society of Anesthesiologists physical status classification; ACE, angiotensin-converting enzyme.

    *P<0.05.

    Table 2 Univariate analysis for evaluating the association between clinical characteristics with constipation at acute stage of stroke (N=29)

    CI, confidence interval; ASA, American Society of Anesthesiologists physical status classification; NIHSS, National Institute of Health Stroke Scale; ACE, angiotensin-converting enzyme.

    *P<0.05.

    Table 3 Multivariate analysis for evaluating the association between clinical characteristics with constipation at acute stage of stroke

    NIHSS, National Institute of Health Stroke Scale; ASA, American Society of Anesthesiologists physical status classification.

    *P<0.05.

    Table 1

    Table 2

    Table 3

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