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Well-planned nursing interventions are essential to the success of any bowel program.
Prolonged use of laxatives, common with the elderly, can lead to altered blood chemistries, physical defects, dehydration, and dependence for evacuation.1 In addition, the use of drugs to control constipation, whether laxatives or stool softeners, may make it difficult for the aged individual to comply with his/her total medical regime because of increased financial expense and the number of medications that must be remembered, organized, and consumed.
In recent years, the importance of crude fiber in the diet as an aid to bowel elimination has been recognized. The addition of crude fiber to diets usually results in decreased colon transit time for greater ease and frequency of defecation.1 Bran cereal with two additional grams of fiber was added to the daily diet of chronically ill, elderly men on a neuropsychiatrie unit. This addition markedly increased the number of spontaneous bowel movements and decreased their use of cathartics, stool softeners, and enemas.2 In a study with severely demented, elderly men and women, consumption of high-bran bread decreased laxative consumption.3
Other reported effects of the addition of dietary fiber, such as bran, include reductions in: caloric density, digestion and absorption of protein, calcium, zinc, magnesium, and phosphorus secondary to the reduced transit time.4 These effects generally have been seen with relatively large amounts of dietary fiber. Levels did not change outside of the normal range in a study done by Battle and Hanna using 2.4 gm of dietary fiber.
In the Sandman study, postprandial blood glucose values and serum creatinine levels of elderly subjects were significantly reduced during the period of bran consumption.3 With the water-binding properties of dietary fiber, adequate fluid intake is most important.4
Although desirable, given the problems of poor dentition, anorexia, and dysphagia of many patients, it was viewed as unrealistic to try to modify the roughage of diets with fresh fruits, vegetables, and salads.
Our study sought to address two problems with bowel management in the elderly: (1) fecal incontinence with constipation, necessitating the establishment of a regular evacuation time as part of bowel retraining and (2) constipation with soft stool in the descending colon and/or rectum without the urge to defecate.
Bisacodyl, a contact-irritant laxative, stimulates the rectal...