Incidence of constipation in stroke patients

What is your doctors' protocol to prevent constipation?  Or are you being left to figure this out yourself?  I was pretty badly stopped up in the hospital, no preventative treatment but suppository after the fact.  When the incidence is almost 50% and your doctor does nothing, that to me is incompetence.

Incidence of constipation in stroke patients

A systematic review and meta-analysis

Jianxiang Li, MD,^a,b Mengguo Yuan, MMed,^a Yunfang Liu, MMed,^a Yang Zhao, MD, PhD,^b Jingqing Wang, MD, PhD,^b and Weifeng Guo, MD, PhD^a,∗

Monitoring Editor: Bappaditya Ray.

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Abstract

There is growing awareness of a link between the gut and cardiovascular disease. Constipation is common among individuals who have had a stroke, and it negatively affects social functioning and quality of life. However, no systematic study on the incidence of constipation in stroke patients has been reported.

We selected studies included in Medline, Embase, Cochrane database, and Web of Science. Studies were included if they reported the incidence in stroke patients. Two authors selected the studies, extracted the data independently, and assessed these. Subgroup analyses were conducted according to the stroke subtype and stage of stroke.

After detailed evaluations, 8 studies (n  =  1385 participants) were found that contained data that were suitable for meta-analytic synthesis. A forest plot showed that the incidence of constipation was 48% (95% confidence interval [CI]  =  33%–63%). In the analysis of the type of stroke subgroup, the incidence of constipation in patients who had had a hemorrhagic stroke (66% [95% CI  =  40–91%]) was higher than that in patients who had experienced an ischemic stroke (51% [95% CI  =  27%–75%]). The incidence in the acute stage (45% [95% CI  =  36%–54%]) was lower than that in the rehabilitation stage (48% [95% CI  =  23%–73%]).

Constipation after a stroke event occurs frequently. This finding may raise awareness about bowel complications to allow correct evaluation and proper management.

Keywords: constipation, incidence, meta-analysis, stroke, systematic review

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1. Introduction

Stroke is a leading cause of death and disability worldwide, representing an important public health burden with an associated heavy economic burden for healthcare systems.^[1] Report reveals that there were 33 million stroke survivors and 5.9 million stroke-related deaths in 2010.^[2] Stroke produces a wide range of neurological impairments, including problems of balance, movement, speech, swallowing, urination, and defecation, all of which contribute to global public health concerns.^[3]

Constipation is a common symptom among patients with central nervous system diseases, including stroke,^[4] and it can lead to increased morbidity and mortality. This complication is a major cause of death in the acute and subacute stroke phases and can persist in survivors many years after the events.^[5–7] Currently, constipation receives substantially less attention, but this non-neurological bowel complication following a stroke is associated with increased length of hospital stay, poor neurological outcome, the development of further complications, and even death.^[4]

There is growing awareness of a link between the gut and cardiovascular disease.^[8–10] Brain injuries, particularly stroke, have been well established as a cause of gastrointestinal disorders. The mechanism of gastrointestinal disorders in neurological disease is multifactorial. The brain–gut axis relates primarily with the association between neurology and the gastrointestinal system.^[11,12] It is the complicated neuroendocrine network including central nervous system, enteric nervous system, and autonomic nervous system, which could maintain brain–gut interactions and the communications for information of each system.

Although constipation is a common symptom among patients with central nervous system diseases and it negatively affects social functioning and quality of life, the presence and incidence of constipation in patients with stroke remain poorly investigated.^[13,14] No systematic study on the incidence of constipation in stroke patients has been reported thus far.

In this paper, we present the first systematic review and meta-analysis of the incidence of constipation after a stroke and highlight the bowel dysfunction of strokes.

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