外来受療患者の便秘ならびに過敏性腸症候群症状と排便自己管理の実態

The Current State of Constipation, Irritable Bowel Syndrome Symptoms, and Defecation Self-management Among Outpatients

要旨

　目的：効果的な患者指導を行うため、外来受療患者の排便に関する自己管理の実態、特に便秘症状および過敏性腸症候群（Irritable Bowel Syndrome：IBS）症状を有する患者が行っている自己管理を明らかにすることを目的とした。

　方法：2013年12月から2014年2月にＡ大学病院の外来受療患者800人を対象に自記式質問紙調査を実施した。

　結果：559名の有効回答から、排便に関する自己管理として、『食事管理』『運動習慣』『薬剤活用』『補完代替療法』の4因子が抽出された。『薬剤活用』は『食事管理』との相関が弱く（r＝.17，p＜.01）、『運動習慣』との相関がみられなかった。便秘、IBS傾向の患者の自己管理要因の関連性は、『薬剤活用』が便秘、IBS 傾向に属さない対照群に比べて高かった（OR＝10.9，5.64，p＜.05）。

　結論：薬剤使用が、食事・運動といった生活習慣とは関与なく行われている現状があると考えられた。便秘・IBS傾向の患者は、排便を適切に導くために薬剤を活用する傾向にある。患者指導の際には薬剤を活用し排便できているから良いと判断するのではなく、生活習慣を含めた自己管理状況に視点を広げる必要がある。

　Purpose: For patients to understand their self-management situation accurately, effective patient education is required, so that those with defecation issues can actively self-manage. Therefore, the present study purpose was to identify the realities of self-management among outpatients at university hospitals, particularly self-management by patients who have symptoms of constipation and irritable bowel syndrome (IBS).

　Method: A total of 800 self-administered questionnaires were distributed to outpatients at a university hospital from December 2013 to February 2014.

　Results: The four factors of “diet management,” “exercise habits,” “drug utilization,” and “alternative therapy” for facilitating defecation were extracted from 559 valid responses. “Drug utilization” had a low correlation (r = .17, p < .01) with “diet management,” and no correlation with “exercise habits.” The “drug utilization” group had a higher correlation compared with the controls regarding primary factors of selfmanagement for patients with constipation or IBS (OR = 10.9, 5.64; p < .05).

　Conclusion: It appears that drugs are currently administered without consideration of lifestyle factors, such as diet and exercise. Patients prone to constipation or IBS tend to use drugs to facilitate appropriate defecation. When undertaking patient education, it is necessary not to conclude that patients are fine when able to defecate using medication, but to broaden the perspective of self-management to include lifestyle habits.