Daily intestinal massage, 20 minutes daily can be very effective for constipation. It can lead to total or partial constipation relief in 90% of patients.
Figures courtesy of Guy’s and St Thomas’ NHS Trust
- Stroke upwards 3 times.
- Stroke towards the bottom of your tummy 3 times
- Effleurage or circular stroking
- Palmer kneading (one hand performs a circular movement, quickly followed by the other, moving down the stomach)
- As Step 4 but moving up the stomach
- Repeat steps 4 and 5
- Hand vibrations over the belly button area
- Optimize fluid and fiber intake to help achieve desired stool consistency
- Fiber accelerates colon transit time, protects the microbiota, softens stool, and reduces straining
- Fiber supplementation using psyllium and Miralax helps to prevent fecal incontinence
- Start with 2 teaspoons of whole psyllium husks daily (1 lb.costs roughly $10)
- And 1 teaspoon of PEG 3350 (4.25grams) daily (the brand name is MiralaxR). Alternative to using psyllium is to use Methylcellulose fiber (CitrucelR)
- Slowly increase the PEG (MiralaxR) dose by ¼ teaspoon every three days until daily bowel movements are achieved up to a maximum of 4 teaspoons (or one capful; 17 grams) daily.
- During titration, use a rectal suppository or enema if a bowel movement has not occurred in two days
- Start by daily digital removal of stool with an index finger, prior to using a daily sup.
For patients with adequate rectal tone
- Daily Glycerin and bisacodyl [brand name is Dulcolax] suppositories are often effective.
- Small volume rectal enemas with docusate, work better than glycerin or bisacodyl suppositories.
- Phosphate enemas can be used when fecal impaction occurs. Such enemas are not to be used regularly.
For patients with poor rectal tone
- For patients with poor rectal tone and have failed rectal suppositories and traditional enemas, a Transanal Irrigation Enema (TAE) is typically very effective.
- TAE is a high volume enema that reaches beyond the rectum, which is combined with balloon mechanism in the rectum that plugs the outlet and prevents the fluid from leaking out the rectum.
- We prefer the Peristeen® (Coloplast, Minneapolis, MN) all-in-one device. It includes a water bag connected to a hand control unit with a pump for regulating both the catheter balloon inflation and the water infusion (see Figure on right). A 500ml to 1000ml bag of tap water is then gravity drained through the catheter into the rectum. Median evacuation time takes roughly 60 minutes.