title: The effect of dietary fiber on bowel function following radical hysterectomy: a randomized trial.
abstract: OBJECTIVE
  To assess the effect of high-fiber dietary instruction in relieving chronic constipation, a known and accepted complication of radical hysterectomy (RH).
  
  
  METHODS
  Thirty-five women with a diagnosis of cervical cancer who were scheduled for RH were randomized into groups that followed either a high-fiber diet plan or their usual diet. Data were gathered using a validated subjective bowel function questionnaire (SBFQ); a typical day's intake form and food frequency tool; and a diary used to record food, medication, bowel, and exercise information. Patients were evaluated at 1, 4, and 7 months after surgery.
  
  
  RESULTS
  Postoperatively, the dietary fiber intake was significantly higher for the treatment (T) group (22.9 g) than the control (C) group (12.4 g) (P = 0.007). With regard to intergroup comparisons, there were few differences at the first follow-up. By the second visit, the T group reported taking medications to achieve regularity less often (P = 0.0269), straining less often (P = 0.0210), having pain with bowel movement (BM) less often (P = 0.0116), and having crampy abdominal pain less often (P = 0.123) than the C group. Four significant positive changes occurred in the T group, whereas only one occurred in the C group. With regard to intragroup comparison, the significant changes in bowel function in the T group were generally positive, whereas all of the C group's significant changes were negative. According to summary questions on the SBFQ, the T group reported a significant change in the frequency of BM (P = 0.0096); however, the C group reported no significant changes. Analysis of bowel function records showed clearer differences. The T group took less time to defecate (P < 0. 001) but had more BMs accompanied by gas (P < 0.001). The C group had significantly more BMs with cramps (P < 0.001), straining (P < 0. 001), and retention (P < 0.001) and significantly more BMs, which were hard (P < 0.001). Two C patients dropped out of the study because of severe bowel dysfunction despite maximum medication.
  
  
  CONCLUSIONS
  Dietary management seems to be an inexpensive effective therapeutic intervention for addressing bowel dysfunction associated with RH.
authors.affiliation: Department of Clinical Nutrition, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: L
authors.initials: L
authors.lastname: Griffenberg
authors.forename: M
authors.initials: M
authors.lastname: Morris
authors.forename: N
authors.initials: N
authors.lastname: Atkinson
authors.forename: C
authors.initials: C
authors.lastname: Levenback
mesh_terms: D003248:Constipation / Q000517:prevention & control*; D003672:Defecation; D004043:Dietary Fiber / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010353:Patient Education as Topic; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000601:surgery