title: Conservative Measures for Managing Constipation in Patients Living With a Colostomy.
abstract: OBJECTIVE
  The purpose of this study was to determine the effect of a conservative regimen for the treatment of constipation in persons living with a colostomy.
  
  
  METHODS
  Prospective, noncontrolled, single-center study.
  
  
  METHODS
  The study sample comprised 35 patients with a colostomy who were diagnosed with constipation. Subjects with morphologic changes causing constipation such as stomal stenosis and neoplastic and inflammatory changes were excluded. The study was conducted in the Proctology and Stoma Outpatient Clinic at Poznan University of Medical Sciences.
  
  
  METHODS
  Patients at our Stoma Outpatient Clinic underwent baseline evaluation, and those with symptoms of constipation (prolonged periods between bowel movements, passage of pasty or hardened fecal effluent, and associated symptoms such as abdominal discomfort or bloating, flatulence, and pain with passage of effluent into the stoma) received individualized dietary recommendations that typically included an increase in dietary fiber and fluid intake, along with increased fluid intake. The outcomes of dietary changes were evaluated during a follow-up visit 3 months later. If dietary changes alone did not improve constipation symptoms, we prescribed a psyllium-based bulk-forming agent, an osmotic stool softener, and a probiotic, with or without a prokinetic agent such as metoclopramide taken 3 times daily.
  
  
  RESULTS
  Dietary interventions alone were deemed successful in 60% of study subjects (n = 21); the remaining 14 patients required additional treatment.
  
  
  CONCLUSIONS
  Dietary modifications alone relieved constipation in more than half of a group of 35 patients with constipation. We therefore recommend a trial of dietary modifications prior to the initiation of pharmacotherapy in patients with a colostomy.
authors.affiliation: Barbara Kuczynska, MSc, Department of General, Endocrinological Surgery and Gastroenterological Oncology, and Center of Intestinal Failure, Poznan University of Medical Sciences, Poznan, Poland. Adam Bobkiewicz, MD, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland. Adam Studniarek, MD, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland. Krzsztof Szmyt, MD, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland. Łukasz Krokowicz, MD, PhD, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland. Konrad Matysiak, MD, PhD, Department of General, Endocrinological Surgery and Gastroenterological Oncology, and Center of Intestinal Failure, Poznan University of Medical Sciences, Poznan, Poland. Jacek Szmeja, MD, PhD, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland. Jarosław Walkowiak, MD, Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland. Michał Drews, MD, PhD, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland. Tomasz Banasiewicz, MD, PhD, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kuczynska
authors.forename: Adam
authors.initials: A
authors.lastname: Bobkiewicz
authors.forename: Adam
authors.initials: A
authors.lastname: Studniarek
authors.forename: Krzsztof
authors.initials: K
authors.lastname: Szmyt
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Krokowicz
authors.forename: Konrad
authors.initials: K
authors.lastname: Matysiak
authors.forename: Jacek
authors.initials: J
authors.lastname: Szmeja
authors.forename: Jarosław
authors.initials: J
authors.lastname: Walkowiak
authors.forename: Michał
authors.initials: M
authors.lastname: Drews
authors.forename: Tomasz
authors.initials: T
authors.lastname: Banasiewicz
mesh_terms: D000368:Aged; D003125:Colostomy / Q000009:adverse effects*; D003248:Constipation / Q000178:diet therapy / Q000209:etiology* / Q000451:nursing; D004043:Dietary Fiber / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D054368:Laxatives / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D004043:Dietary Fiber; D054368:Laxatives