MODERN POSSIBILITIES FOR CORRECTING CONSTIPATION IN POSTPARTUM WOMEN
- Authors: Orlova D.1
-
Affiliations:
- Altai State Medical University
- Issue: Vol 10 (2021): Материалы XVII Международной Бурденковской научной конференции 22-24 апреля 2021 года
- Pages: 29-32
- Section: Акушерство и гинекология
- URL: https://new.vestnik-surgery.com/index.php/2415-7805/article/view/6336
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Abstract
Relevance: The frequency of constipation during puerperia is 10-50% and is one of the reasons for the complicated course of the postpartum period. However, this problem is rarely discussed by specialists; the algorithm for managing patients with intestinal dysfunction after physiological and surgical delivery has not yet been developed.
Objective of the study: to assess the clinical efficacy and tolerability of the Enema Klin enema in puerperas with constipation after spontaneous and surgical delivery, to determine the adherence of patients to this type of therapy.
Materials and methods: 26 puerperas (16 after spontaneous and 10 after surgical delivery) with no spontaneous emptying of the intestines for more than 3 days. The method of therapy is a disposable enema Enema Klin (laxative). Before use and one day after the use of the enema, a survey of patients was carried out according to the author's questionnaire about the effectiveness, tolerance and adherence of patients to this method of therapy for constipation.
Results: in patients with constipation during puerperia, constipation before pregnancy occurred in 50%, pregnancy - in 63.4%. In addition to stool retention for more than 3 days, clinical symptoms of constipation in the form of a feeling of discomfort in the intestines (34.6%), distention (26.9%) and / or pain (19.2%) in the anus were significantly more frequent in patients after spontaneous delivery than after surgery. The use of a disposable enema laxative Enema Klin led to a soft discharge of formed feces in 92.3%, the presence of a feeling of complete bowel movement in 73.1% of cases. Adverse events in the form of discomfort, pain or itching in the anal area on the first day after the enema were registered only in the group of patients after spontaneous childbirth. This type of therapy for constipation was recognized as comfortable in 73.1% of cases, 92.3% of patients are ready to use it in the future, 96.2% of patients are ready to introduce relatives and friends.
Conclusion: Enema Wedge enema is one of the effective and safe methods for correcting constipation in postpartum women, regardless of the method of delivery.
Full Text
Relevance: Constipation is one of the common complications of the gastrointestinal tract in women in the postpartum period [5]. It is known that the violation of intestinal motility and constipation in the postpartum period can be the cause of a complicated course of puerperium in the form of incompetence of the sutures in the perineum, the development of purulent-septic pathology of various levels and degrees of damage, up to obstetric peritonitis [5]. If the hypotonic state of the intestine during pregnancy is a physiological protective reaction of the body, which maintains the excitability of the uterus within acceptable limits [2], then in the postpartum period, normally, intestinal function is activated [1]. In the case when normal intestinal motility is not restored, constipation is observed. Constipation entails intestinal dysbiosis, which is a risk factor for the growth of opportunistic microflora, which plays a leading role in the development of postpartum purulent-septic complications, maternal morbidity and mortality [3]. Despite the importance of the problem we are considering for obstetric practice, it is little discussed in the professional community due to the misconception that constipation is only a patient's problem, inconvenience and a slight deterioration in the quality of life of women in childbirth. To solve the problem, most often resort to non-drug therapy in the form of normalization of the diet with an increase in fluid and food intake with a high fiber content, the inclusion of bran and other food additives in the diet, and an increase in physical activity [2]. If it is necessary to use drug therapy, the question arises of the selection of laxatives, which are sufficient on the pharmaceutical market, but not the entire arsenal of drugs is allowed for use by pregnant women and women in childbirth, especially those with perineal injuries or in those delivered by cesarean section [5].
Saline laxatives are one of the types of drug therapy for constipation permitted for use in the postpartum period [3]. Enema Kleen is a saline laxative, the action of which is based on increasing water retention in the intestinal lumen using osmotic processes. The accumulation of fluid in the intestine leads to increased peristalsis and subsequent bowel cleansing. The time of the onset of the effect: 5–7 minutes after administration [9].
Objective of the study: to assess the clinical efficacy and tolerability of the Enema Klin enema in puerperas with constipation after spontaneous and surgical delivery, to determine the adherence of patients to this type of therapy.
Materials and methods: a monocentric prospective open interventional study was carried out in a small clinical group: 26 puerperas (16 after independent and 10 after operative delivery). Inclusion criteria for the study: the postpartum period after spontaneous (group 1 - 16 patients) or surgical delivery (group 2 - 10 patients) in the absence of independent stool for more than 3 days, the presence of complaints of discomfort in the intestine or the presence of sutures on the perineum, before removal of stitches, informed consent to participate in the study. Exclusion criteria: rectal trauma, anal fissures, acute hemorrhoids. All patients were offered to use a laxative to solve the problem - Enema Klin enema. Composition of the preparation: sodium hydrogen phosphate heptahydrate (7.2 g), sodium dihydrogen phosphate monohydrate (19.2 g) - (active substances); phosphoric acid (g.s. to pH5), sodium bezonate (0.48 g) and water 120 ml. Release form - solution for rectal administration. In a plastic bottle with a plastic tip (enema), equipped with a one-way pass valve and a protective cap, 120 ml. 1 enema in a PE-bag in a cardboard box [6].
Before use and one day after the use of the drug, a survey of all patients was carried out according to the author's questionnaire.
Statistical processing of the material was carried out on a personal computer using computer programs Statistica 11.0 Microsoft Excel 2010. Continuous values are presented as M ± m, where M is the sample mean and m is the standard error of the mean. Values of qualitative features are presented as observed frequencies and percentages. Taking into account the sample, the nonparametric Pearson χ2 test with Yates' correction and Fisher's exact test were used. The level of statistical significance when testing the null hypothesis was p <0.05.
Results: the study involved 26 puerperas aged 19 to 40 years, the average age was 29.7 ± 2.3 years and did not differ significantly in the comparison groups (29.5 ± 2.1 and 30.1 ± 1.1; p≥0.05). Most of the patients of both the first (75.0%) and the second group (70.0%) had a full 3 days after delivery. Every second (50%) patient had cases of constipation before pregnancy (43.8% and 60%; p = 0.65), during pregnancy the frequency of constipation increased by 13.4% and amounted to 63.4% (62.5% and 70.0%; p = 0.15). Every third patient (34.6%) had experience of taking laxative tablets, 7.7% of water enemas, tried to cope with the problem by following a diet, only one patient from the second group (3.8%), most of the patients in the comparison groups were just waiting natural solution of the problem (62.5% and 70.0%; p = 0.15), which once again confirms the fact that the problem of constipation is being hushed up by both patients and medical workers. The indication for the appointment of a laxative in the postpartum period was: absence of stool for more than 3 days in 61.5% of cases (62.5% and 60%; p = 0.9). It was especially necessary to empty the intestines to 11 (68.8%) patients with perineal trauma during labor, before removing the sutures on the perineum. It is well known that severe straining and difficulty in the act of defecation in patients with sutures in the perineal region can lead to tissue separation and the formation of postpartum ulcers and fistulas [2]. In addition to the above, every third patient (34.6%) before prescribing an enema felt discomfort in the intestinal region (25.0% and 50.0%; p = 0.2), every fourth (26.9%) discomfort (43, 7% and 0%; p = 0.02), every fifth (19.2%) pain in the anus (25.0% and 10.0%; p = 0.6). In general, in addition to the feeling of discomfort in the intestines, complaints were significantly more often recorded in the group of patients after spontaneous delivery (87.5% and 40.0%; p = 0.02), which is apparently associated with a decrease in general sensitivity against the background of the use of analgesics used in the first three days after the operative delivery.
After identifying the problem, all patients were offered an Enema Klin enema as a method of therapy, which 25 (96.1%) patients were able to apply independently, one patient from the first group needed the help of medical personnel. When setting an enema, pain was registered in 15.4% of cases (18.8% and 10%; p = 0.36), with an act of defecation in 11.5% (12.0% and 10.0%; p = 0, 4). In most cases, the stool was formed (92.3%), a feeling of complete bowel movement was present in 73.1% of cases, more often in patients of the first group (72.2% and 60%; p = 0.3). On the first day after the enema, adverse events were recorded only in 6 (23.1%) patients of group 1 in the form of discomfort (15.4%), pain (7.7%) or itching (3.8%), which once again confirms the fact of a decrease in general sensitivity in patients delivered by cesarean section. Most of the patients in the comparison groups (73.1%) answered that this method of constipation therapy was quite comfortable for them, 23.1% noted that there are "pros and cons" and only 1 (3.8%) patient considered this method not comfortable and not acceptable to oneself. In the event of constipation, 92.3% of patients (87.5% and 100.0%; p = 0.5) are ready to use the Enema Klin enema, 96.2% (93.8% and 100%) are ready to recommend this method to friends and relatives. , 0%; p = 1).
Conclusion:
1. Patients with constipation before and during pregnancy are at risk of developing constipation during puerperia.
2. Every second patient suffering from constipation does not have the knowledge and skills to solve this problem both outside and during pregnancy and does not discuss this problem with medical professionals.
3. Signs of impaired intestinal motility during puerperia, in addition to the absence of stool, are: a feeling of discomfort in the intestines (34.6%), distention (26.9%) and / or pain (19.2%) in the anus. Patients feel these symptoms more sharply after spontaneous childbirth.
4. The use of a disposable enema Enema Klin is a comfortable (73.1%) method of treating constipation in patients in the postpartum period, regardless of the mode of delivery and leads to a soft complete emptying of the intestine in 73.1% of cases, in 92.3% of cases in the form of a decorated chair.
5. Adverse events in the form of minor discomfort (15.4%), pain (7.7%) or itching (3.8%) in the anus were registered only in the group of patients after spontaneous childbirth.
About the authors
Daria Orlova
Altai State Medical University
Author for correspondence.
Email: fferyllydd73@gmail.com
ORCID iD: 0000-0002-2906-7546
student
Russian Federation, 656038, Россия, Барнаул, проспект Ленина, 40References
- Серова О.Ф., Соловьева А.В., Снапковская Л.В. Серьезный вопрос. StatusPraesens. Гинекология, акушерство, бесплодный брак. 2011;(2):63-69.
- А.В. Соловьева, К.С. Ермоленко: Запоры у беременных. Подходы к терапии. Медицинский советник 2020; (3): 44-47 с.
- И.В. Кузнецова, Ю.Б. Успенская: Заболевания кишечника и запоры в практике акушера-гинеколога. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2015. Т. 25. № 1. С. 30-36.
- Е.Б. Цивцивадзе, С.В. Новикова: Новые возможности в лечении беременных с эпизодическими запорами. Российский вестник акушера-гинеколога. 2018. Т. 18. №5. С. 88-91.
- О.И. Михайлова, Т.В. Кирсанова, Л.В. Тютюнник: Патогенез, клиника, лечение и профилактика запора в акушерской практике. Вопросы гинекологии, акушерства и перинатологии. 2011, т.10, №4, с. 44-55.
- Инструкция по применению слабительного средства Энема Клин: https://www.vidal.ru/drugs/enema_clean__29767#dosage