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Biomedical subjects

Christine Norton

Publications and source records attributed to Christine Norton.

12 recordsLinked to original sources
PubMed2006

Randomized, controlled trial of anal electrical stimulation for fecal incontinence.

PURPOSE: Anal electric stimulation has been described as effective for fecal incontinence in several case series, but no study has addressed possible mechanism of benefit. We wished to examine whether anal electric stimulation, using an anal probe electrode, used on a daily basis at home for eight weeks, in the absence of any adjunctive exercises or advice, would improve symptoms of fecal incontinence and anal sphincter pressures when compared with "sham" electric stimulation. METHODS: Ninety patients (9 males, 81 females), with median age of 55 (range, 30-77) years were randomized, 47 to active anal stimulation at 35 Hz and 43 to "sham" stimulation at 1 Hz. Outcome measures included a one-week bowel diary, symptom questionnaire, manometry, and patients' evaluation of outcome. RESULTS: Seventy patients completed the study. On an intention-to-treat analysis, there was no difference between the two groups on any of the outcome measures after eight weeks. Of those who completed stimulation, 44 (63 percent) felt the stimulation had improved their continence. Those with intact anal sphincters were not likely to rate their change more positively than those with sphincter disruption (P=0.71). Median patient rating of bowel control increased from 3 of 10 before stimulation to 5 of 10 after stimulation (P=0.001). CONCLUSIONS: Eight weeks of anal electric stimulation was rated by patients as having improved their bowel control to a modest extent. There was no statistically significant difference detected between the groups, suggesting that 1 Hz was as effective as 35 Hz. This raises the possibility that the main effect is not sphincter contraction but sensitization of the patient to the anal area, or simply the effect of intervening per se. Home electric stimulation is a relatively cheap and generally well-tolerated therapy in the conservative treatment of fecal incontinence.

Adult↗
PubMed2005

Patients' views of a colostomy for fecal incontinence.

INTRODUCTION: Formation of a permanent stoma often is seen as a last resort when all other interventions for fecal incontinence have failed. However, no previous study has examined patients' views of a colostomy to manage fecal incontinence. METHODS: People who had a colostomy to manage fecal incontinence were recruited via an advertisement in the magazine of the British Colostomy Association or from those operated at a specialist colorectal hospital. Four questionnaires were sent, asking about the stoma, previous incontinence, anxiety and depression, and quality of life. RESULTS: A total of 69 replies were received. Respondents were 11 males and 58 females with a median age of 64 years and a median of 59 months since the operation. Rating their ability to live with their stoma now on a scale of 0 to 10, the median response was 8 (range, 0-10). The majority (83 percent) felt that the stoma restricted their life "a little" or "not at all" (a significant improvement from perceived restriction from former incontinence, P = 0.008). Satisfaction with the stoma was a median of 9 on a scale of 0 to 10 (range, 0-10). Eighty-four percent would "probably" or "definitely" choose to have the stoma again. Quality of life (SF-36) was poor, but neither depression nor anxiety was a prominent feature. CONCLUSIONS: The majority of previously incontinent people were positive about the stoma and the difference it had made to their life. However, a few had not adapted and disliked the stoma intensely. Health care professionals should discuss a stoma as an option with patients whose lives are restricted by fecal incontinence.

Adult↗
PubMed2004

Treatment of constipation and fecal incontinence in stroke patients: randomized controlled trial.

BACKGROUND AND PURPOSE: Despite its high prevalence in stroke survivors, there is little clinical research on bowel dysfunction in this population. This is the first randomized controlled trial to evaluate treatment of constipation and fecal incontinence in stroke survivors. METHODS: Stroke patients with constipation or fecal incontinence were identified by screening questionnaire (122 community, 24 stroke rehabilitation inpatients) and randomized to intervention or routine care (73 per group). The intervention consisted of a 1-off structured nurse assessment (history and rectal examination), leading to targeted patient/carer education with booklet and provision of diagnostic summary and treatment recommendations (after consultation with geriatrician) to patient's general practitioner (GP)+/-ward physician. RESULTS: Percentage of bowel movements (BMs) per week graded as "normal" by participants in a prospective 1-week stool diary was significantly higher in intervention versus control patients at 6 months (72% versus 55%; P=0.027), as was mean number of BMs per week (5.2 versus 3.6; P=0.005). There was no significant reduction in fecal incontinence, although numbers were small. At 12 months, intervention patients were more likely to be modifying their diets (odds ratio [OR], 3.1 [1.2 to 8.0]) and fluid intake (OR, 4.2 [1.4 to 12.2]) to control their bowels and to have visited their GP for their bowel problem (OR, 5.0 [1.4 to 17.5]). GP prescribing of laxatives and suppositories was significantly influenced at 12 months. CONCLUSIONS: A single clinical/educational nurse intervention in stroke patients effectively improved symptoms of bowel dysfunction up to 6 months later, changed bowel-modifying lifestyle behaviors up to 12 months later, and influenced patient-GP interaction and physician prescribing patterns.

Aged↗
PubMed2004

Long-term results of repeat anterior anal sphincter repair.

PURPOSE: Anterior anal sphincter repair for obstetric trauma sometimes fails because of breakdown of the repair. The long-term results of repeating the overlapping repair are not known. METHODS: Twenty-three patients with repeat obstetric-related anterior sphincter repair had previously been assessed at a median of 20 months follow-up, at which time 13 patients (65 percent) felt 50 percent or greater improvement compared with their preoperative symptoms. Patients were reassessed at a median of 5 years (range, 48-86 months) using a questionnaire, an incontinence score, and telephone interview to determine current bowel function, continence, and restriction in activities of daily life and overall satisfaction with the results of surgery. RESULTS: Twenty-one of 23 patients (median age, 47 (range, 27-66) years) were contacted. One patient was lost to follow-up and one had died of an unrelated cause. Of 21 patients, one was fully continent and 12 more reported symptom improvement of 50 percent or more compared with preoperatively. Four were unchanged, and of the four whose symptoms had deteriorated, two had undergone further surgery for incontinence. Compared with the 20-month assessment, there was no significant change in continence scores (median, 12/20 (range, 1-20) vs. 7/20 (range, 2-19); 20 vs. 60 months), rating of improvement (median, 50 (range, 0-100) percent) at 20 and 60 months), or satisfaction (7/10 (range, 0-10) at 20 and 60 months). CONCLUSIONS: Repeat anterior sphincter repair results in improved continence for the majority of patients, with no substantial change between the short-term and long-term follow-up.

Adult↗
PubMed2004

Behavioral management of fecal incontinence in adults.

Biofeedback has been advocated as first-line therapy for patients whose symptoms of mild to moderate fecal incontinence have not responded to simple dietary advice or medication. Three main modalities have been described: (1) use of an intra-anal electromyographic sensor, a probe to measure intra-anal pressure, or perianal surface electromyographic electrodes to teach the patient how to exercise the anal sphincter; (2) use of a 3-balloon system to train the patient to correctly identify the stimulus of rectal distention and to respond without delay; and (3) use of a rectal balloon to retrain the rectal sensory threshold, usually with the aim of enabling the patient to discriminate and respond to smaller rectal volumes. Although a systematic review found that biofeedback eliminated symptoms in up to one half of patients and decreased symptoms in up to two thirds, these studies suffered from methodological problems, a lack of controls, and a lack of validated outcome measures. No studies have compared different exercise instructions, measured patient compliance with those instructions, or determined any trends in symptom response to the exercises prescribed. A recent study by the author suggests that patient-therapist interaction and patient coping strategies may be more important in improving continence than performing exercises or receiving physiological feedback on sphincter function. Better-designed randomized, controlled trials are needed to evaluate different exercise programs and different elements of biofeedback. Development and validation of outcome measures are important, and predictors of outcome and effects in patient subgroups, especially elderly and neurologically impaired patients, should also be investigated.

Adult↗
PubMed2004

Women's experiences of faecal incontinence: a study.

Community nurses are often involved in the assessment of symptoms of incontinence and the provision of continence aids. However, it is less clear to what extent they can and do provide ongoing support and discuss with their patients the everyday experience of living with incontinence. This article focuses on what it means to live with faecal incontinence and, based on the findings from a small study, discusses the range of experience women with this chronic condition have.

Adaptation, Psychological↗
PubMed2003

Randomized controlled trial of biofeedback for fecal incontinence.

BACKGROUND & AIMS: Behavioral treatment (biofeedback) has been reported to improve fecal incontinence but has not been compared with standard care. METHODS: A total of 171 patients with fecal incontinence were randomized to 1 of 4 groups: (1) standard care (advice); (2) advice plus instruction on sphincter exercises; (3) hospital-based computer-assisted sphincter pressure biofeedback; and (4) hospital biofeedback plus the use of a home electromyelogram biofeedback device. Outcome measures included diary, symptom questionnaire, continence score, patient's rating of change, quality of life (short-form 36 and disease specific), psychologic status (Hospital Anxiety and Depression scale), and anal manometry. RESULTS: Biofeedback yielded no greater benefit than standard care with advice (53% improved in group 3 vs. 54% in group 1). There was no difference between the groups on any of the following measures: episodes of incontinence decreased from a median of 2 to 0 per week (P < 0.001). Continence score (worst = 20) decreased from a median of 11 to 8 (P < 0.001). Disease-specific quality of life, short-form 36 (vitality, social functioning, and mental health), and Hospital Anxiety and Depression scale all significantly improved. Patients improved resting, squeeze, and sustained squeeze pressures (all P < 0.002). These improvements were largely maintained 1 year after finishing treatment. CONCLUSIONS: Conservative therapy for fecal incontinence improves continence, quality of life, psychologic well-being, and anal sphincter function. Benefit is maintained in the medium term. Neither pelvic floor exercises nor biofeedback was superior to standard care supplemented by advice and education.

Adult↗
PubMedDate not supplied

Nurses, bowel continence, stigma, and taboos.

This article explores why fecal incontinence remains a taboo subject and why it is often so difficult for patients to discuss their bowel symptoms. People's attitudes toward feces are complex and rooted in arbitrary social rules and conventions. It is difficult to encompass the full implications of fecal incontinence to those with this problem within a traditional medical model of illness and with cure as the goal of intervention. Many individuals are not cured, despite our best efforts. By recognizing the social dimension of this problem and by incorporating knowledge about coping and control into patient teaching and clinical practice, nurses may better meet the needs of those with fecal incontinence.

Adaptation, Psychological↗
PubMedDate not supplied

Constipation in older patients: effects on quality of life.

Constipation, often related to diet, physical immobility, concurrent illness or multiple medication use, is common in older people. Despite potential for serious complications, constipation may often be overlooked. Management of constipation is a critical part of the care of older patients with chronic conditions. Risk assessment and appropriate nursing interventions and/or medication should mean that constipation can be minimized, preventing additional medication burden and reducing the risk of non-adherence. The relationship between quality of life and constipation has been assessed in numerous studies, showing that patients with constipation generally have an impaired quality of life compared with the general population, although studies in older patients are limited. In long-term survivors of colorectal or anal carcinoma, constipation is one of the factors that has the most negative impact on quality of life. Strategies for prevention and minimization of constipation have the potential to substantially improve quality of life for older people.

Aged↗