THE EFFECT OF DIETARY FIBER ON BOWEL FUNCTION FOLLOWING RADICAL HYSTERECTOMY - A RANDOMIZED TRIAL

Objective. To assess the effect of high-fiber dietary instruction in r elieving chronic constipation, a known and accepted complication of ra dical hysterectomy (RH). Methods. Thirty-five women with a diagnosis o f cervical cancer who were scheduled for RH were randomized into group s that followed either a high-fiber diet plan or their usual diet. Dat a were gathered using a validated subjective bowel function questionna ire (SBFQ); a typical day's intake form and food frequency tool; and a diary used to record food, medication, bowel, and exercise informatio n. Patients were evaluated at 1, 4, and 7 months after surgery. Result s. Postoperatively, the dietary fiber intake was significantly higher for the treatment (T) group (22.9 g) than the control (C) group (12.4 g) (P = 0.007). With regard to intergroup comparisons, there were few differences at the first follow-up. By the second visit, the T group r eported taking medications to achieve regularity less often (P = 0.026 9), straining less often (P = 0.0210), having pain with bowel movement (BM) less often (P = 0.0116), and having crampy abdominal pain less o ften (P = 0.123) than the C group. Four significant positive changes o ccurred in the T group, whereas only one occurred in the C group. With regard to intragroup comparison, the significant changes in bowel fun ction in the T group were generally positive, whereas all of the C gro up's significant changes were negative. According to summary questions on the SBFQ, the T group reported a significant change in the frequen cy of BM (P = 0.0096); however, the C group reported no significant ch anges. Analysis of bowel function records showed clearer differences. The T group took less time to defecate (P < 0.001) but had more BMs ac companied by gas (P < 0.001). The C group had significantly more BMs w ith cramps (P < 0.001), straining (P < 0.001), and retention (P < 0.00 1) and significantly more BMs, which were hard (P < 0.001). Two C pati ents dropped out of the study because of severe bowel dysfunction desp ite maximum medication. Conclusion. Dietary management seems to be an inexpensive effective therapeutic intervention for addressing bowel dy sfunction associated with RH. (C) 1997 Academic Press.