Stroke is a common and intractable disease that seriously endangers human health and life safety. Constipation is one of the common complications of stroke, and the results of research studies show that the cumulative incidence of constipation 4 weeks after stroke is 55.31%, and constipation after stroke has a negative impact on the prognosis of some patients.
Constipation can lead to fluctuations in blood pressure, which can lead to re-stroke in stroke patients. In particular, constipation is a common cause of rebleeding in patients with hemorrhagic stroke. Therefore, clinical work should pay attention to the changes of intestinal function in stroke patients to prevent constipation, promote patients’ recovery, prevent re-stroke, and thus improve their prognosis.
Constipation is defined as a decrease in the frequency of bowel movements, less than two to three times in seven days, low stool volume, hard stool and difficulty in passing stool. Constipation occurs in stroke patients, and patients often have to strain to defecate because of the dryness of the stool, which can easily cause an increase in blood pressure and intracranial pressure, leading to aggravation of the original disease and, in some patients, re-stroke, induced rebleeding, and even life-threatening.
Stroke patients have the following reasons for constipation
1, psychological factors
Most of the sudden onset of stroke, resulting in tension, anxiety, panic, depression, partly due to the site of the stroke caused by hallucinations, delusions, can cause constipation by inhibiting the peripheral autonomic innervation of the large intestine.
2.Insufficient intake
Stroke patients are affected by the disease and cannot eat normally or refuse to eat, so the food intake is insufficient, resulting in less food residue entering the gastrointestinal tract, and the remaining food residue absorbed by the gastrointestinal tract exerts too little pressure on the colon wall to cause a defecation reflex. In addition, insufficient water intake can also lead to slow colonic transmission and dry and hard stools, difficult to discharge.
3.Long-term bed rest and reduced activity
Patients with stroke are often bedridden for a long time and cannot move on their own due to coma, cerebral hemorrhage and hemiplegic limb dysfunction. Reduced activity and a general decrease in intestinal motility have been reported. Slowed gastrointestinal motility and reduced function are common causes of constipation.
4.Change in defecation environment and defecation posture
Most stroke patients have different degrees of paralysis, inconvenient toileting or due to the requirements of disease treatment, patients need to defecate in bed, due to the unsuitable defecation environment, defecation posture is not accustomed to, patients often anxiety, panic and other emotions, some researchers reported that anxiety can increase the tension of the pelvic floor muscle groups, thus causing contradictory movement of the anorectum during defecation, resulting in constipation. Furthermore, patients have the psychology of minimizing the burden on their companions and often hold back their bowel movements, which develops the habit of constipation.
5, drug influence
Certain drugs used clinically can cause gastrointestinal adverse reactions, such as antibiotics, hormones, etc., can cause patients with gastrointestinal dysfunction, causing constipation.
6, lack of knowledge
In particular, patients with cerebral hemorrhage reduce food and rely on laxatives for a long time because they are afraid that defecation will cause re-bleeding and aggravate their condition. Long-term use of laxatives makes the intestinal movement form a dependence on “external assistance”, weakening the voluntary movement, reducing the sensitivity of rectal pressure receptors, which can cause the normal defecation reflex to weaken or even disappear, thus further aggravating constipation.
The current clinical care interventions
1.Psychological care
Patients with stroke have a sudden onset of the disease and feel nervous and fearful about what will happen to them, and lose confidence in their future work and life. Nursing staff should treat patients with enthusiasm, make them familiar with the environment as soon as possible, perform all operations patiently and carefully, and introduce successful cases to encourage patients to establish confidence in overcoming the disease. Establish good communication with patients, actively promote knowledge about the disease, analyze and explain to patients the causes of constipation, explain to patients who have concerns about defecation in bed the necessity of defecation in bed, actively give psychological guidance, meet the reasonable requirements of patients as far as possible, and relieve patients’ worries and shyness.
2.Eating care
(1) Firstly, explain the relationship between diet and defecation, diet and disease recovery to the patients and their families, and formulate a reasonable diet according to the condition, so that the patients and their families can actively cooperate.
(2) Increase the intake of high-fiber foods. Food fiber is hydrophilic, can absorb water, make food residue swell and form lubricating gel, easy to push in the intestine, the residue can stimulate intestinal peristalsis, which is conducive to stimulating bowel movement and defecation reflex. Maintain normal bowel movements of adults food fiber intake of 20g per day.
(3) Adequate intake of water. Encourage patients to drink more water to ensure that the daily fluid intake is about 2-3L, preferably 1 cup of warm water early in the morning, which can be drunk as soon as possible to increase blood volume, which has the effect of stimulating intestinal peristalsis and can effectively improve constipation.
(4) For patients with swallowing difficulties and impaired consciousness, a gastric tube should be placed as soon as possible according to the condition to give nasal feeding, adding appropriate amount of fiber to the tube feeding food, small amount of multiple meals, giving sufficient nutrients, ensuring the intake of vitamins and energy supply.
3. Care of defecation time and environment
For patients with stroke who need to be bedridden for a long time, encourage them to develop the habit of defecation in bed and on time, whether they feel like defecating or not. Focus your attention during defecation, do not listen to music or read newspapers or magazines, and eliminate any bad habits that distract you and prolong defecation time. There are reports that defecation should be as far as possible after breakfast every day, because after breakfast easy to cause stomach – colon reflex, at this time training defecation easy to establish the conditioned reflex, each defecation time is generally 10 ~ 20min is appropriate. When defecating in bed, if the condition permits, the head of the bed can be shaken 20° to 30° to make the patient comfortable and tell him not to hold his breath. Provide patients with a concealed environment for defecation, such as giving screens to protect patients’ privacy, deal with excretion sounds and odors, and the insulation of the commode and the application of comfort items should be suitable for patients.
4.Appropriate exercise
According to the specific situation of patients, increase the amount of exercise appropriately, such as daily gymnastics, walking exercise, etc., to promote rectal blood supply and intestinal peristalsis, in order to facilitate defecation. Long-term bedridden, should encourage bed exercise, in addition to daily functional exercise of paralyzed limbs, should also be regularly given abdominal massage, by the nurse or guide the family, patient operation, massage can be used to show the fingers, middle finger, ring finger overlap in the abdomen, according to the direction of intestinal travel, from the ascending colon to the transverse colon, descending colon to sigmoid colon to do clockwise circular massage, 2 to 3 times a day, 15-20min each time, can To stimulate intestinal peristalsis, help defecation.
5.Guiding patients to use laxatives correctly
Long-term bed-ridden patients should be given mild laxatives with mild effects, such as doxorubicin and cecropia. Geng Xiuyun et al [6] showed that the use of corkage to help defecation, with a disposable catheter inserted into the anus 20-30 cm, injected into the corkage, can achieve better results, and the operation is simple, convenient, and painless for patients. For stroke patients with a history of previous constipation, senna leaves can be used to make water for drinking. A study [7] showed that 4 g of senna leaves steeped in 400 ml of boiling water for 15 min and then consumed has a significant effect in the treatment of constipation. In general, laxatives should not be used for a long time, as they may cause the intestine to lose its function of defecation, which may aggravate constipation. Therefore, the application of laxatives to “temporary”, “intermittent”, “alternate” is good.
6, manual fecal care
Constipation patients, should be as soon as possible to pull out the dry hard fecal mass. To understand the anatomy and physiology of the anus when emptying the stool, because physical stimulation is likely to cause bleeding. When taking stool, assist the patient to lie on his side and flex his legs, wear latex gloves, and apply soap and water or paraffin oil and other lubricants on the finger, slowly reach into the patient’s anus and slowly remove the fecal stone, while asking the patient to open his mouth and exhale, the action should be gentle so as not to damage the intestinal mucosa. If the patient feels pain, pale and sweating, he should rest for a moment before pulling out.
7.Other methods
Some people use rhubarb powder 5g twice flushing Flushing has significant efficacy in the treatment of constipation, and rhubarb powder flushing, in addition to being able to relieve constipation, can also reduce intracranial pressure, reduce cerebral edema, prevent cerebrovascular accident patients combined with stress ulcer bleeding and other effects.
The use of biofeedback training for constipation, with the advantages of painless, non-invasive, no adverse drug reactions, coupled with a strong psychological guidance, can achieve good results. Some proprietary Chinese medicines, you can also try.