Using abdominal massage in bowel management

Abstract

This article describes the introduction of abdominal massage techniques by a community team as part of a total bowel management programme for people with learning disabilities. A trust-wide audit of prescribed laxative use by this client group raised concerns, and led to a more systematic approach to managing constipation in people with learning disabilities. An education programme for carers proved to be successful. Some reported that adopting abdominal massage provided further opportunity to develop the therapeutic relationship.

Constipation management in people with intellectual disability: A systematic review

“…The type of laxatives used by participants is outlined in seven quantitative descriptive studies (Böhmer, Taminiau, Klinkenberg‐Knol, & Meuwissen, ; Connor, Hunt, Lindley, & Adams, ; Ganesh, Potter, & Fraser, ; van der Heide et al., ; Joos, Mehuys, Remon, Van Winckel, & Boussery, ; Van Winckel et al., ; Veugelers et al., ). The highest quality study found that the most commonly used laxatives in children with severe generalized cerebral palsy mostly living in the family home were disaccharide (24.3% of 152 children) and polyethylene glycol (macrogol) (13.2% of 152 children) (Veugelers et al., ).…”

“…Macrogol combinations were also the most frequently prescribed laxative for adults and children with profound intellectual and multiple disabilities (PIMD) living in institutions in the Netherlands (30% of 254 people with PIMD) followed by bisacodyl (29%) and lactulose (14%) (van der Heide et al., ). An earlier study in England found only four of 181 people living in community‐based care homes (2.2%) to be taking macrogol, with the most frequent being lactulose (46 of 181; 25.4%) and senna (27 of 181; 14.9%) (Connor et al., ).…”

“…A number of people with intellectual disability receive rectal laxatives, enemas or suppositories, with figures reported being 22.4% of 152 children with severe generalized cerebral palsy living mainly in the family home (Veugelers et al., ), 5.5% of 181 residents living in a community‐based care homes in one trust area (Connor et al., ), 10% of 215 adults and children with intellectual disability living in institutions (Böhmer et al., ), 57.9% of 38 adults with profound intellectual disability in one institution (Ganesh et al., ), at least 10% of 254 adults and children with PIMD in institutions (10% received sodium phosphate enemas, 3% docusate sodium but it is not possible to tell if these figures are mutually exclusive) (van der Heide et al., ), and 12.4% of 420 adults and children with intellectual disability living in institutions (Van Winckel et al., ). One study found that in one institution, despite adult men and women having similar disabilities, most of those receiving suppositories were women and it is suggested that this may reflect different practice on the wards (Ganesh et al., ).…”

“…Of 149 adults and children with constipation living in institutions, 34.2% used two laxatives and 9.4% used three laxatives (figures include sodium phosphate enemas) (Böhmer et al., ). Of 65 community‐based care home residents taking laxatives in one trust area, 30.8% used two laxatives, 15.4% used three laxatives and 4.6% used more than three (figures include enemas/suppositories) (Connor et al., ).…”

“…In an area of England where abdominal massage was implemented as part of a total bowel management programme, a questionnaire consisting of open‐ended questions was sent to families and carers to gain feedback on the experiences of adults and children with intellectual disability living in the community and their carers with regard to abdominal massage (Connor et al., ). All feedback was positive and included ease of learning and implementation; bowel movement changes; improvements in pain, mood or behaviour; reduction of laxatives; and providing opportunities to develop the therapeutic relationship.…”