title: Randomized controlled trial of laxative use in postcolostomy surgery patients.
abstract: OBJECTIVE
  We compared a standardized postoperative laxative protocol to laxatives provided on an ad hoc basis by the surgical team.
  
  
  METHODS
  Forty-five patients who underwent colostomy surgery participated in the study. The research setting was 2 acute care facilities in south-eastern Sydney, New South Wales, Australia.
  
  
  METHODS
  A randomized controlled trial was conducted. The intervention group (n 5 19) received a standardized laxative protocol postsurgery. Two types of laxatives were selected for first-line treatment: sterculia and frangula bark (Normacol Plus), a bulking agent and stimulant; and liquid paraffin (Agarol), a stool softener. An iso-osmotic polyethylene glycol macrogel (Movicol) was chosen as second-line treatment. The comparison group (n = 26) received laxative intervention(s) as preferred by the surgical team. Constipation, measured as fecal loading on plain abdominal film, stomal therapy nurse activity, patient comfort, and length of hospital stay were compared between intervention and control groups.
  
  
  RESULTS
  The presence of fecal loading favored the intervention group (1 episode in the treatment group vs 7 episodes in the comparison group; χ5 = 3.8; P = .05). This finding suggests that the laxative protocol given to the treatment group was more likely to prevent fecal loading/constipation when compared to the ad hoc laxative group. Stomal therapy nurse activity in terms of the number of empty bag changes was significantly higher in the comparison group (F 5 4.8; P 5 .03).
  
  
  CONCLUSIONS
  The findings of this study support the benefits of a standardized laxative protocol for prevention of constipation. Data collection was discontinued after 3 years due to a contamination effect developing, because our surgeons observed the utility of the laxative protocol and incorporated it into their routine practice. Further experimental research is needed to explore the best constipation prevention approaches for postcolostomy surgery patients.
authors: Stomal Therapy Nursing, Stomal Therapy Department, Prince of Wales Hospital, Sydney, New South Wales, Australia. carol.stott@sesiahs.health.nsw.gov.au
authors: Carol
authors: C
authors: Stott
authors: Lisa
authors: L
authors: Graaf
authors: Patricia
authors: P
authors: Morgan
authors: Julia
authors: J
authors: Kittscha
authors: Greg
authors: G
authors: Fairbrother
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D003125:Colostomy / Q000009:adverse effects / Q000451:nursing*; D003248:Constipation / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D009517:New South Wales; D010232:Paraffin / Q000627:therapeutic use; D017060:Patient Satisfaction; D008517:Phytotherapy; D028321:Plant Preparations / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011182:Postoperative Care / Q000379:methods / Q000451:nursing; D012015:Reference Standards; D031955:Rhamnus; D032361:Sterculia
chemical_list: D054368:Laxatives; D028321:Plant Preparations; D011092:Polyethylene Glycols; D010232:Paraffin