Management of Constipation in Eating Disorders-A Scoping Review.

BACKGROUND

Constipation is a common nutrition impact symptom experienced by the eating disorder population.

OBJECTIVE

The aim of this scoping review was to identify current recommendations and evidence for managing constipation within the eating disorders population, specifically anorexia nervosa (AN) and bulimia nervosa (BN).

METHOD

Using a scoping review framework, a search of relevant databases (MEDLINE (Ovid), Cinahl, Web of Science and Embase) was undertaken using MESH terms. Keywords included: feeding and eating disorders', constipation', gastrointestinal disease'. Reference lists and grey literature were searched. Studies were included if they included a discussion on constipation management in eating disorders and published in English. Data was extracted from the papers; management options were categorized based on common themes.

RESULTS

Twenty-eight studies met inclusion criteria. Suggested management strategies from articles were categorized into five themes: weight restoration (including regular eating), fibre, fluid, medication (including laxative withdrawal) and education. The strongest recommendations are that normalization of weight positively reduces rates of constipation within four to twelve weeks. There is some consistency in recommendations for increased fibre intake, increased fluid intake, medication use and patient education, but conflicting recommendations on laxative withdrawal.

DISCUSSION

There is strong evidence to support for the role of weight restoration in the management of constipation in AN and BN. This is an area that needs more specialized research and practical recommendations particularly in regard to fibre, fluid, medication use, cessation of laxatives and patient and clinician education.