!"#$%&'() %(++(,- .$ ./-(. 01/$'&0 0$'+.&2(.

&$'3
4$/ 2-$2)- 5&.1 )-(/'&', ('# 216+&0() #&+("&)&.&-+
7(/-' 8$$/-9 &:;<=;>>?"$@/'-%$@.1A(0A@B
C$@/'-%$@.1 D'&E-/+&.6 F G01$$) $4 H-().1 ('# G$0&() I(/-3 J16+&$.1-/(26
!0B'$5)-#,-%-'.+3
K$@)# )&B- .$ .1('B 8(/&(' L%)69 !)&+$' M&'#)-6 ('# N(0B&- J)('. 4$/ +1(/&', &'4$/%(.&$' ("$@. .1-&/ (E(&)(")- ("#$%&'() %(++(,- +-/E&0-+9 /-+-(/01 ('# ./(&'&', 2/$,/(%%-+A
M&'#( O&-#-/ 4$/ 1-/ 2/$4-++&$'() +@22$/. .1/$@,1$@. .1&+ 2/$P-0.
Case Scenarlo
Lxample:
SpasLlc
Cuadrlplegla
26 yrs old
ulsLorLed
body shape
AnLl-
ConvulsanL
for Lpllepsy
Chronlc
consLlpaLlon-
long Lerm laxaLlve
use
24 care
sLaff.
uependanL
for all
moblllLy

non verbal
CommunlcaLlon

8ackground Lo consLlpaLlon:
Cne of Lhe mosL common gasLrolnLesLlnal dlsorders worldwlde (kyle 2010).
Causes deblllLaLlng sympLoms = 8educed quallLy of llfe (Lamas eL al. 2009).

SympLoms of consLlpaLlon:
Abdomlnal paln
Abdomlnal dlsLenslon
lncompleLe and lnfrequenL defecaLlon
ulfflculLy when passlng sLools
Anal flssures
Paemorrholds
llaLulence
8ehavlour changes (Lamas eL al. 2009).

70 of paLlenLs wlLh learnlng dlsablllLles have chronlc consLlpaLlon.
WlLh an average colonlc LranslL Llme of 180 hrs = 7.3 days !
PealLhy populaLlon colonlc LranslL Llme ls approxlmaLely 33 hrs.
1he are approxlmaLely 1,191,000 people ln u.k. wlLh learnlng dlsablllLles.
(Coggrave eL al. 2014, Lmerson eL al. 2011, Lmly aL al. 1998, Lamas aL al. 2009).
resenL conservaLlve LreaLmenL for consLlpaLlon:
AlLeraLlon of dleL - lncrease flbre lnLake. lncrease fluld lnLake.
lncrease exerclse More effecLlve LolleLlng rouLlnes.
LaxaLlves SupposlLorles
Lnema (kyle 2011, Slnclalr 2010).
!! SluL LllLC1S Cl LCnC 1L8M LAxA1lvL uSL !!

ulsLenslon of abdomen Abdomlnal aln
llaLulence MedlcaLlon lnLeracLlon
osslble dependency Cramplng
osslble damage Lo smooLh muscles and Lhe enLerlc nerve sysLem.
(Lmly and 8ochesLer 2006, lord and 1alley 2012, Slnclalr 2010).

roposed lnLervenLlon ls
Def|ned as: Technique using effleurage, kneading and vibration applied to the abdominal wall following
Lhe presumed course of Lhe large lnLesLlne Lo relnforce Lhe gasLro-colic reflex. (Emly et al. 2001).

ShorLens colonlc LranslL Llme.
More frequenL defecaLlon.
8educes abdomlnal paln.
8educes abdomlnal dlsLenslon.
8elaxes Lhe mlnd & body.
SLlmulaLes parasympaLheLlc nervous sysLem whlch alds dlgesLlon.
(Lamas eL al 2009, naLlonal Cllnlcal Culdellne CenLre (nCCC) 2012, Slnclalr 2010).
at|ent
centred care
(NCGC 2012)
hysloLherapy role ln abdomlnal massage:

8eferences:

Coggrave,M.,norLon,C.,Cody,!.u.,2014. ManagemenL of faecal lnconLlnence and
consLlpaLlon ln adulLs wlLh cenLral neurologlcal dlseases. !"#$%&'( *&+&,&-( ". /0-+(1&+2#
3(42(5-. unlLed SLaLes of Amerlca: !ohn Wlley & Sons. lssue 1. ArL no.:Cu0023113.
uCl:10.1002/14631838.Cu002113.pub3.

Lmerson, L., 8alnes, S., AllerLon, L. and Welch, v., 2011. PealLh lnequallLles and people wlLh
learnlng dlsablllLles ln Lhe uk. 617%"42'8 $(&9+$ &': 924(-; <(&%'2'8 :2-&,292+2(- ",-(%4&+"%y.
Avallable from:
hLLp://www.arcuk.org.uk/membersarea/wp-conLenL/uploads/2012/03/lPAL-WLu-
Lngland-2011.pdf [Accessed 20 Aprll 2014].

Lmly, M., Cooper, S. and vall, A., 1998. Colonlc MoLlllLy ln rofoundly ulsabled eople.
hysloLherapy, 84 (4),
178 183.

Lmly, M., Wllson, L. and uarby,!., 2001. Abdomlnal massage Lo adulLs wlLh leanrlng
dlsablllLles. nurslng 1lmes lus, 97 (30 ) , 61 -62.

Lmly, M. and 8ochesLer, ., 2006. A new look aL consLlpaLlon managemenL ln Lhe
communlLy. =%2+2-$ >"?%'&9 ". !"11?'2+0 @?%-2'8A 11 (8), 326 332.

Lmly,M.,8ell,S. and Poward,!., 2008. 1ralnlng module on abdomlnal massage : ro[ecL 6.
Leeds C1.

lord, A.C. and 1alley, n.!., 2012. LaxaLlves for chronlc consLlpaLlon ln adulLs. =%2+2-$ B(:2#&9
>"?%'&9, 343, 44-47.

Parrls,u. and llneberg,l.C., 2011. Multidisciplinary palliative care teams understanding of
mental Capacity Act 2005 best interest determinations. 6'+(%'&+2"'&9 >"?%'&9 ". C&992&+24(
@?%-2'8A17 (1), 20 -23.

kyle, C., 2011. Managlng consLlpaLlon ln adulL paLlenLs. @?%-( C%(-#%2,2'8A 9 (10), 481 -490.

Lamas, k., Llndholm, L., SLenlund, P., LngsLrom, 8.aAnd !acobsson, C., 2009. LffecLs of
abdomlnal massage ln managemenL of consLlpaLlon a randomlzed conLrolled Lrlal.
6'+(%'&+2"'&9 >"?%'&9 ". @?%-2'8 /+?:2(- A 46,
739 -767.

Lamas, k., Cranehelm, u.P. and !acobsson,C., 2010. Lxperlences of abdomlnal massage for
consLlpaLlon. >"?%'&9 ". !92'2#&9 @?%-2'8, 21, 737-763

Lewls, S.!. and PeaLon, k.W., 1997. SLool formscale as a useful gulde Lo lnLesLlnal LranslL
Llme. /#&':2'&42&' >"?%'&9 ". D&-+%"('+(%"9"80, 32, 920-924.

MenLal CapaclLy AcL, 2003

naLlonal Cllnlcal Culdellne CenLre (nCCC), 2012. aLlenL experlence ln adulL nPS servlces:
lmprovlng Lhe experlence of care for people uslng adulL nPS servlces. unlLed klngdom:
naLlonal lnsLlLuLe for PealLh and Cllnlcal Lxcellence (nlCL). Culdellne number: CC138.

lgram,!., Slmpson,8., Popklns,S., 8rown,!., Caulfleld,P., SmlLh,C., Payward Clles,S.,
nancarrow, S., 2006. /?7(%42-2"'A &##"?'+&,292+0 &': :(9(8&+2"' ". &#+242+2(- +" -?77"%+
5"%E(%-. London: 1he CharLered SocleLy of physloLherapy. Avallable from:
flle:///C:/users/karen/uocumenLs/A8S18AC120-
20CS1L8/supporLlng_supporL_workers_0.pdf [Accessed 13 May 2014].

Slnclalr,M.,2010. 1he use of abdomlnal massage Lo LreaL chronlc consLlpaLlon. >"?%'&9 ".
=":05"%E F B"4(1('+ G$(%&72(-A 13, 436-443H

Wllllams,v., 8oyle,C., !epson,M., SwlfL,., Wllllamson,1. and Peslop,., 2014. 8esL lnLeresLs
declslons: professlonal pracLlces ln healLh and soclal care. I(&9+$ &': /"#2&9 !&%( 2' +$(
!"11?'2+0A 22 (1), 78-86.
LLhlcal ConslderaLlons for CllenLs wlLh Learnlng ulsablllLles
1. Consent:
lf lnformed consenL cannoL be obLalned for abdomlnal massage LreaLmenL Lhen an
assessmenL of MenLal CapaclLy has Lo be carrled ouL by Mu1 quallfled professlonals.

2. Menta| Capac|ty Act 200S :
roLecLs vulnerable adulLs.
8alances :
AuLonomy and wlsdom.
roLecLlon and empowermenL. ( MenLal CapaclLy AcL 2003, Wllllams eL al. 2014)
3. 8est |nterest dec|s|on:
lf lL ls esLabllshed LhaL Lhe cllenL does noL have Lhe menLal capaclLy Lo make an lnformed
declslon, Lhen besL lnLeresL declslons can be made.
(Parrls and llneberg 2011, Wllllams eL al.2014)

4. 8est |nterest dec|s|ons |nvo|ve :
1he cllenL, mulLldlsclpllnary PealLhcare rofesslonal 1eam,
our clients General Practitioner (GP), and family members.

C Lo glve a full medlcal prlor Lo commenclng any abdomlnal massage programme
Lamas eL al : A sLudy of how a cllenL may experlence abdomlnal massage
1 and carer awareness of posslble emoLlons by cllenL. Cur cllenL cannoL verbally express
Lhese emoLlons or feellngs (2010). Aware of non-verbal communlcaLlon !
C Lo advlse on weanlng off laxaLlves as effecLlveness of abdomlnal massage lncreases.
In Summary: Abdomlnal massage Lo be uLlllsed alongslde convenLlonal LreaLmenL Lo enhance quallLy of llfe and reduce dlsLresslng sympLoms of chronlc consLlpaLlon. Lvldence
supporLs abdomlnal massage Lo be parL of a bowel managemenL programme speclflc Lo our lndlvldual cllenL . 1hls lncludes educaLlon and advlce on : uleL, fluld, LolleLlng hablLs,
moblllLy, full bowel assessmenLs and ongolng quallLy of llfe assessmenL by carer and 1 - Careful conslderaLlon of cllenL experlence and 8esL lnLeresL ls vlLal ! (Lmly and 8ochesLer 2006, kyle 2011)
LffecLlves of an abdomlnal massage programme ls evaluaLed by: assesslng bowel paLLerns, sLool assessmenLs, physlcal assessmenLs,
funcLlonal moblllLy, medlcaLlon, llfesLyle (dleL and fluld lnLake) records are malnLalned by care sLaff as parL Lhe massage programme.
1 should Lhen revlew aL each follow-up sesslon. (Lmly and 8ochesLer 2006, kyle 2011,Lewls and PeaLon 1997)

1. 1 core foundaLlonal skllls :
Able Lo assess Lhrough palpaLlon
Massage 1echnlques are a core sklll for
hysloLheraplsLs
(Lmly eL al. 2008).
2. 1ralnlng requlred by 1 :
Abdomlnal massage compeLency aL
unlverslLy level.
lf abdomlnal massage ls noL covered ln a
unlverslLy unlL Lhen Lo compleLe a
recognlsed quallLy uk based course.

(for example: Lhose offered by Marlan Lmly or
Allson Llndley refer Lo acknowledgemenLs:
permlsslon glven Lo share course lnformaLlon)




3. 1 ls able Lo Lhen :

-1raln Care sLaff for care agency or
1rusL.
-lndlvldual cllenL speclflc care sLaff
Lralnlng
-1each cllenL self- abdomlnal massage.
(Lmly eL al. 2008).
4. Cngolng assessmenL & monlLorlng:

1 and carer Lo follow a seL procedure of
Lralnlng, supervlsed pracLlce sesslons,
assessmenLs and sLrlcL record keeplng .
When carer ls safe and compeLenL ,Lhen 1 wlll
re- assess every 6 monLhs.
(Lxample: Lmly eL al.2008).


1 Lralnlng and monlLorlng of care sLaff
compeLence and safeLy wlll follow Lhe CharLered
SocleLy of hysloLherapy sLandards of delegaLlng
Lasks.
(lgram eL al. 2006).



Causes of
consLlpaLlon:

SLress
~
Low flbre
lnLake
~
Low fluld
lnLake
~
CerLaln medlcaLlons
~
olypharmacy
~
lnacLlvlLy
~
ulsLorLed body
shapes
~
Plgh Lone
(Slnclalr 2010)

LaxaLlve use cosLs Lhe
nPS approxlmaLely
60 Mllllon
er year!
ulagram showlng dlrecLlon of
abdomlnal massage along large
lnLesLlne:
ermlsslon granLed Lo used lmage from Lmly
eL al. (2008).