Effect of abdominal binder on constipation in the early puerperium period: A pilot study

Ashwini Bulbuli; Megina Dawadi

doi:10.4103/ijptr.ijptr_53_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 4 | Issue : 2 | Page : 150-154

Effect of abdominal binder on constipation in the early puerperium period: A pilot study

Ashwini Bulbuli, Megina Dawadi
Department of OBG Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Submission	08-Apr-2022
Date of Decision	08-Dec-2022
Date of Acceptance	12-Dec-2022
Date of Web Publication	19-Jan-2023

Correspondence Address:
Dr. Megina Dawadi
KAHER Institute of Physiotherapy, Belagavi - 590 010, Karnataka
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijptr.ijptr_53_22

Abstract

Context: Constipation being one of the most common and exasperating postpartum problems in Female population, i.e., defined as a large bowel problem leading to pain while defecating, hard and lumpy stools resulting in strain, and a sense of incomplete evacuating. It impacts the quality of life of every individual.
Aim: To investigate the effect of abdominal binder on constipation in early puerperium period.
Setting and design: The department of OBG physiotherapy at KLE Hospital in Belagavi. Karnataka India did a pilot study.
Methods and Materials: 17 women between 19 and 35 years of age within the early puerperium period having constipation. The women reporting any chronic history of constipation and laxatives induced after the delivery were not included in the study. They were administered with the Modified Constipation Assessment Scale (MCAS), which rated them into mild, moderate, and severe constipation, and the Visual Analog Scale (VAS), to rate the abdominal discomfort due to constipation. The binder was prescribed for 2 days. Both pre-.and post-intervention data were collected and were statistically analyzed to know the effect.
Statistical analysis used: Parametric Paired sample t-test was used to compare the results.
Results: According to Paired sample t-test, the difference between the values of pre- and post-treatment with a P <5% significance level (i.e. 0.002 < 0.05) on MCAS can be observed. Similarly, on VAS, the significant and reliable statistical differences on the pre-.and post-treatment values with P <5% significance level (i.e., 0.001 < 0.05) can be observed. Therefore, this study justifies the improvements in health outcome post-intervention.
Conclusion: The study concluded that the abdominal binder has an effect on constipation within the early puerperium period. The binder also helps to relieve the abdominal discomfort as a result of constipation.

Keywords: Abdominal binder, Constipation, Early puerperium, Puerperium period, Straining

How to cite this article:
Bulbuli A, Dawadi M. Effect of abdominal binder on constipation in the early puerperium period: A pilot study. Indian J Phys Ther Res 2022;4:150-4

How to cite this URL:
Bulbuli A, Dawadi M. Effect of abdominal binder on constipation in the early puerperium period: A pilot study. Indian J Phys Ther Res [serial online] 2022 [cited 2023 Sep 27];4:150-4. Available from: https://www.ijptr.org/text.asp?2022/4/2/150/368058

Introduction

Constipation being one of the most common and exasperating postpartum problems in the female population. It is defined as a large bowel problem leading to pain while defecating, hard and lumpy stools resulting in strain, and a sense of incomplete evacuating <3 bowels per week.^[1] It affects the quality of life of every individual.

Constipation can result due to the lack of mobility, high intake of calcium and iron, changing hormones, and low-fiber diet during the pregnancy. However, after delivery due to episiotomy pain and hemorrhoids developed due to the 2^nd stage labor pressure can cause defecation problems.^[1] It affects one out of four women after the delivery and is the major source of concern since it negatively impacts the mother's as well as newborn baby's health during the puerperium period.

Puerperium is the 6-week period after childbirth where the woman's body returns to its prepregnancy state.^[2] During this period, the physiological changes that occur during pregnancy return to their nonpregnant state which is also known as the fourth trimester. There are three types of puerperium – Immediate puerperium which is the period of the first 24h after delivery, early puerperium is 2–7 days, i.e. 1^st week postpartum, and remote puerperium is the 6 weeks of postpartum where the genital organs revert to its normal position, i.e., involution.

An abdominal binder also known as Post Maternity Corset helps in faster healing and provides additional support and helps to speed up the process of regaining the mother's predelivery shape.^[3] An abdominal binder is used to facilitate postpartum recovery.^[3] It plays a major role in involution too. It is a wide belt that encircles the abdomen and supports the surgical site and is also used to relieve pain and improve mobility after major abdominal surgeries.^[3],[4]

Postpartum constipation is a common complication yet understudied domain of puerperal complication. Previous studies examined that the prevalence of postpartum constipation is 52% which is very high.^[5] It is one of the major sources of concern which affects the health of new mothers and also leaves a negative impact on the recovery process.^[5]

There are numerous studies that have reported various risk factors associated with postpartum constipation which includes hemorrhoids and fistula, pelvic organ prolapses on straining, that can lead to decreased quality of life. A randomized controlled trial conducted in 2015 has clearly mentioned the need for behavioral interventions and positions to enhance defecation for postpartum constipation. However, early mobilization, although helps to clear the bowel, which is generally avoided by postpartum women due to fatigue and postlabor exhaustion. Some studies also mentioned that abdominal massage along with breathing exercises helps to ease constipation. Various pharmacological interventions such as pain-relieving drugs and laxatives have also been studied to treat postpartum constipation but have their own complications such as drug dependency, poor digestion, and chronic bowel irritability.^[6]

Postpartum constipation is highly neglected and always treated with laxatives which could be the reason why nonpharmacological intervention is not an aid of assistance in clearing the bowels. The abdominal binder is hypothesized to increase mobility and decrease the feeling of distress but to reveal its use in gastrointestinal function. This study may explore a possible effect of a nonpharmacological intervention, i.e. an abdominal binder; hence, the current study focuses on establishing the role of abdominal binder on constipation in the postpartum period.

Subjects and Methods

This experimental pilot study was conducted in a tertiary care hospital in Belagavi city. A total of 17 postpartum women aged 19–35 at 1^st week after full-term normal vaginal delivery (FTNVD) or lower segment cesarean section (LSCS) during the early puerperium period having constipation were enrolled in the current study from March 31, 2022. All participants were screened to meet the inclusion criteria; females aged 19–35 years on early puerperium period having constipation and willing to participate. The exclusion criteria were any laxatives-induced patients, history of chronic constipation, and postcesarean abdominal suture infection. All participants were assessed for their demographic data which includes age, height and weight, and body mass index (BMI). Informed written consent was taken from all the participants after thorough explanation of the purpose and description of the study. This study was accepted by the Institutional Research Ethics Review Committee, (KAHER IPT ERC SI. No. 651). This study has also been registered in Indian Clinical Trial Registry (CTRI/2022/02/040492).

Procedure

All the participants were recruited on the 2^nd day of their delivery irrespective of the mode of delivery. They were asked to specify their abdominal discomfort on the Visual Analog Scale (VAS), a 10 cm segmented numeric horizontal straight line with the extremes labeled as “no abdominal discomfort” at 0 cm, and the other end labeled as “worst abdominal discomfort” at 10^th cm. The VAS is used to reveal the severity of the abdominal discomfort and classify into the groups of no discomfort (0), mild abdominal discomfort (1–3), moderate abdominal discomfort (4–7), and severe abdominal discomfort (8–10).^[7] The participants were then asked to fill the Modified Constipation Assessment Scale (MCAS) to indicate their constipation severity. The MCAS is a validated, subjective measure of 9 items to assess the presence and severity of constipation.^[8] Participants are asked to rate their answers on a three-point scale: “no problem, “problem,” and “serious problem.“

They were prescribed an abdominal binder (CLING, Maternity Corset) on the 2^nd day of their delivery as per their girth measurement taken in crook lying with complete expiration.^{[9],[10],[11]} A measurement was obtained by a measuring tape. A therapist measured the area where the maximum abdominal bulge was noted with measuring tape in centimeters. The corset was then asked to be worn around the abdomen, with the closures in the front. The participants were asked to make sure that the binder is snugly fitted but not too tight and they should be able to breathe comfortably. The binder was prescribed for 8h a day except during meals, till 2h and while sleeping. After 2 days, i.e., on the 4^th day of their delivery, abdominal discomfort due to constipation was reassessed by the VAS and the participants were asked to fill the MCAS questionnaire again.

Statistical methods

The sample size was calculated on Microsoft Excel 2013 version, sample size template with the following formula given by Cochran.

Data were collected and analysis was executed on IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp. Parametric test was done for data analysis purpose. Quantitative data such as age, height, weight, and BMI including the MCAS questionnaire and the VAS were expressed as mean ± standard deviation and the results were compared by Paired sample t-test for preintervention and postintervention within the group. Statistically differences within the group were tested with significance level of 5%.

Results

The average age of the participants was 27.17 ± 4.41 years, ranging from 21 to 34 years. The majority was younger than 28 years with average BMI of all the participants was 26.72 kg/m². Out of 17 sample sizes, 6 FTNVD and 11 LSCS-delivered women were having constipation [Figure 1].

Figure 1: Percentage of females who underwent FTNVD and LSCS

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Within the group, pre- and posttest using Paired sample t-test for the VAS and MCAS [Table 1], both the VAS and MCAS mean evaluate posttreatment changes, with posttreatment results recording low value. In addition, the standard deviation indicates a match with the posttreatment value that is lower than the pretreatment value for the VAS [Figure 2] and the MCAS [Figure 3]. The mean difference is positive indicating posttreatment score has decreased after the intervention which is the desired condition for the treatment outcome. The effect size or Cohen's d indicates 1.76 and 0.99 values for VAS and MCAS, respectively, which is assumed to be very high in effect size as per the standard parameters of reference. With reference to the results, P value seems to be up to the 5% significance level, i.e., 0.001 < 0.05 in VAS and 0.002 < 0.05 in MCAS. Therefore, the study justifies the improvements in health outcomes postintervention.

Table 1: Pre post scores of VAS and MCAS after intervention

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Figure 2: Within the group, pre- and postanalysis for VAS. VAS: Visual Analog Scale

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Figure 3: Within the group, pre- and postanalysis for MCAS. MCAS: Modified Constipation Assessment Scale

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Pre- and postanalysis of symptoms and their treatment efficacy in case of full-term normal delivery (FTND) versus LSCS was performed [Figure 4]. Increased intensity of abdominal discomfort and decreased frequency of spontaneous bowel movements were noted more in LSCS as compared to FTND. It is revealed that 64.7% of women who underwent LSCS have constipation and 35.3% of women who had FTNVD have constipation. Postintervention analysis showed a significant positive change from 2.0 ± 0.7 in both FTND and LSCS.

Figure 4: Changes in the VAS and MCAS scores in FTND and LSCS. *P < 0.05 Paired t-test. LSCS: Lower segment cesarean section, VAS: Visual Analog Scale, MCAS: Modified Constipation Assessment Scale, FTND: Full-term normal delivery

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Discussion

This study includes a group of women with complaints of constipation in their early puerperium period and is not associated with any history of chronic constipation with an aim to find the effect of an abdominal binder in acute constipation. As various studies have proven that the abdominal binder has some benefit in postoperative cases but there is no evidence that explains the abdominal binder or any other maternity corset that helps to relieve postpartum complication like constipation. Women suffering from constipation in such a sensitive period declines their quality of life, deteriorates their emotional, as well as socioeconomic aspects as well. In view of conservative management in such cases abdominal binder can be useful. Gustafson et al. also reported that the use of an abdominal binder was found to be more helpful than typical pain-relieving measures.^[9] Various studies already proved that the use of maternity corset in postoperative cases promotes faster healing acting as an artificial transverse abdominis muscle, reducing pain after surgery, and also helping to relieve distress in most of the cases.^[1],[3],[9] Abdominal muscles indirectly act on the pelvic floor muscles as well.^[12]

The major muscles that are responsible for defecation are external anal sphincter and internal anal sphincter along with the pelvic floor most commonly puborectalis muscle. The external anal sphincter along with puborectalis needs to relax, whereas the abdominal muscles should contract to defecate, i.e., to get feces out from the rectum. As abdominal muscles and pelvic floor muscles have correlation to each other; in fact, they act as a single muscle unit (superficial abdominal muscle, deep abdominal muscle, diaphragm, and pelvic floor muscle) helps in regular normal defecation and stimulating peristalsis movement.^[4] Prior studies also found out that on increasing an intra-abdominal pressure, it facilitates the colonic propulsive force which helps in maintaining intestinal motility.^[4] Hence, the binder provides pressure to the abdomen that increases the intra-abdominal pressure, thereby compressing the intestine and inducing colonic propulsive force during voluntary effect. Spontaneous isometric contraction of the upper abdomen while relaxing the lower abdomen by indirect synergistic activation of the pelvic floor and lower abdominal muscles improves the pelvic floor and external anal sphincter muscles. It relaxes and enables optimal defecation.^[4]

Our study has also found that the constipation being one of the most common postpartum complications is more in LSCS as compared to FTNVD. The possible causes observed in having constipation more in LSCS are the use of anesthesia during surgery (it can temporarily make muscles sluggish), pain medications, dehydration, weakened pelvic muscles, lack of mobility after the surgery, psychological fear of suture opening, and due to pain at the suture site.^[13] A support provided by abdominal binder may have improved the psychological satisfaction in patients having postoperative distress.^[13]

The current study also highlights that women having more BMI are more prone to be constipated in the early puerperium period. A study done by Isenring et al. also concluded that age, as well as BMI, is related to the rectosigmoid transit time in patients having constipation.^[14]

The abdominal discomfort in constipation is very obvious; in fact, it leads to abdominal pain as well. The abdominal pain and discomfort due to constipation are considered key symptoms of irritable bowel syndrome. A meta-analysis conducted to know the effect of abdominal binders in major abdominal surgeries also concluded that in terms of aiding mobilization, easing pain, and lowering postoperative discomfort, the abdominal binder was effective in promoting healing following abdominal procedures.^[15] It acts as a supporting splint in the incision area which helps to relieve abdominal discomfort. In LSCS, an incision such as horizontal or transverse incision is made on the lower part of the abdomen to deliver the baby. The increasing intra-abdominal pressure and Valsalva maneuver during defecation in constipated condition causes more pain at the incision area which can also be minimized by using the binder; hence, it provides support to the area.

In the present study, we have found out that along with aiding the surgical site and healing promotion, an abdominal binder helps in acute constipation as well. A strong point of our study is that there is a statistical difference noted in the MCAS in postintervention.

Conclusion

The study concluded that there is an effect of abdominal binder on constipation in the early puerperium period. It relieved abdominal discomfort and pain after surgery. With a larger sample size, the study is expected to further elucidate its clinical value.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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