Project Assistant Professor Manami Takaoka is a nurse turned researcher seeking best practices for managing the bowel movements of older adults in need of assistance. Based on her background and experience nursing geriatric and infirm patients in a hospital caregiving setting, she aims to build a dignified system for bowel management, to promote regular and comfortable relief for those who have difficulties communicating their needs.
Nursing and stools
Reshaping older-adult bowel care — in the image of ideal “banana” poop
TAKAOKA Manami
Project Assistant Professor, Graduate School of Medicine
Processes of elimination
I originally worked as a nurse in a hospital with a long-term care ward. Many of the chronically ill patients there were older adults, who were unable to feel the urge to pass stool and had difficulties communicating their will. So, we nurses monitored their bowel movements, and if the patients were constipated, we administered laxatives or used a procedure called digital disimpaction to remove trapped stool from the rectum with our finger. When those didn’t work, we resorted to giving them an enema.
When it comes to caring for patients’ elimination of bodily waste, the top priority for nurses is to prevent bowel obstruction, a blockage of the intestines with stool. Although we desperately tried to avert this worst-case scenario, we sometimes failed to adjust the dosage of laxatives properly, and as a result, patients got diarrhea. This often led to stool leakage from their diapers and soiling of their pajamas and sheets. Not only did this create great discomfort for the patients, but it also increased the workload for nurses and added to costs. I chose a path to be a researcher because I wanted to do something to stem this vicious cycle.
Various types of laxatives are available, such as stimulant and saline types, which are used to treat constipation. However, there are no guidelines on which laxative to administer for which patient. Nurses on the front lines rely on experience to adjust the dosage and timing of the medication. They care for patients, worrying about their well-being and seeking optimal bowel movements through trial and error. What kind of care is needed for patients to pass ideal stools? That is what I want to clarify and help understand. The Bristol Stool Chart is a scale used to assess stools, based on their consistency, shape, color and other factors. We are seeking to establish care practices that facilitate banana- or sausage-shaped stools, which are considered ideal.
No lax matter
Project Assistant Professor Takaoka analyzed data from 306 residents of special nursing homes for older adults, who were given laxatives to treat their chronic constipation. There are various types of laxatives available, such as saline and stimulant ones. The study found continuous use of the same medication, even when the bowel movement-related problem did not improve. (“n” denotes sample size.)
I investigated how constipation was being cared for at special nursing homes for older adults in Japan. And in my study, I analyzed data of about 2,000 residents in such facilities. I looked into the laxatives used at two different points in time, and verified that 74.5% of residents who were given the same laxative at both points developed chronic constipation; on the other hand, 14.3% of them suffered from chronic diarrhea. However, my research found that staff continued with the same laxative regimen, even if constipation remained to be a problem or chronic diarrhea developed. Furthermore, about a quarter of residents who had been given stimulant laxatives were taking them regularly. Stimulant laxatives promote bowel movements by forcibly inducing muscle contractions in the intestines. Its recommended use is for a short period or when symptoms occur. In the future, I would like to delve more into the proper use of laxatives.
I would like to analyze how the factors of timing and type of medication combined affect the condition of a person’s stool. Furthermore, I am interested in studying nonpharmacological therapy, like ingesting foods containing dietary fiber and the lactobacillus probiotic strain of bacteria, exercise and regular toilet habits.
The cooperation of people who work in facilities such as hospitals and nursing homes is critical for my research to progress. Those health care providers have daily duties that might not be recorded in the charts, such as how they adjust laxatives. I would like to be attentive in collecting such information, on top of available electronic health records. I would be delighted if anyone working in a hospital or nursing home would be interested and willing to cooperate in my research.
