***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background ' Sitting month ' is the Chinese tradition for postpartum customs . Available studies indicate that some of the traditional postpartum practice s are potentially harmful for women 's health . However , no intervention study aim ing at postpartum practice s has been performed . In this paper we evaluated the effect of a health and nutrition education intervention , which focused on improving postpartum dietary quality and optimal health behaviors . Methods The study design was a r and omized controlled trial conducted in both urban and rural area of Hubei between August 2003 and June 2004 . A total of 302 women who attended the antenatal clinic during the third trimester with an uncomplicated pregnancy were recruited . Women r and omized to the education intervention group in both urban and rural area received two two-hour prenatal education sessions and four postpartum counseling visits . Control group women received usual health care during pregnancy and postpartum period . Women were followed up until 42 days postpartum . Outcome measures were nutrition and health knowledge , dietary behavior , health behavior and health problems during the postpartum period . Results Women in the intervention groups exhibited significantly greater improvement in overall dietary behaviors such as consumption of fruits , vegetables , soybean and soybean products as well as nutrition and health knowledge than those in the control groups . Significantly more women in the intervention groups give up the traditional behavior taboos . The incidence of constipation , leg cramp or joint pain and prolonged lochia rubra was significantly lower in the intervention groups as compared with the control groups . Conclusion The study shows that health and nutrition education intervention enable the women take away some of the unhealthy traditional postpartum practice s and decrease the prevalence of postpartum health problems . The intervention has potential for adaptation and development to large-scale implementation . Trial registration A prospect i ve cohort study was undertaken to evaluate the impact of pregnancy and the first delivery on the defecatory symptoms and to identify associated factors . Included were 487 nulliparous pregnant women who completed four question naires .  Flatus and fecal incontinence , constipation , and painful defecation are already present in early pregnancy and are significantly predictive for reporting symptoms after delivery , except for fecal incontinence . A third or fourth degree sphincter tear was significantly associated with fecal incontinence 12 months postpartum and with de novo fecal incontinence , while other factors associated with de novo onset of symptoms were of borderline significance . Defecation symptoms already present in early pregnancy are highly predictive for reported symptoms at 12 months postpartum except for fecal incontinence that is mainly related to anal sphincter lesion . Therefore , investigating the effects of childbirth in general on the anorectal function is not justified without knowledge of this function during pregnancy PURPOSE : Third-degree tears are generally managed by primary anal sphincter repair . Postoperatively , some physicians recommend laxative use , whereas others favor bowel confinement after anorectal reconstructive surgery . This r and omized trial was design ed to compare a laxative regimen with a constipating regimen in early postoperative management after primary obstetric anal sphincter repair . METHODS : A total of 105 females were r and omized after primary repair of a third-degree tear to receive lactulose ( laxative group ) or codeine phosphate ( constipated group ) for three days postoperatively . Patients were review ed at three days and at three months postpartum . Recorded outcome measures were symptomatic and functional outcome and early postoperative morbidity . RESULTS : Forty-nine patients were r and omly assigned to the constipated group and 56 patients to the laxative group . The first postoperative bowel motion occurred at a median of four ( mean , 4.5 ( range , 1–9 ) ) days in the constipated group and at two ( mean , 2.5 ( range , 1–7 ) ) days in the laxative group ( P < 0.001 ) . Patients in the constipated group had a significantly more painful first evacuation compared with the laxative group ( P < 0.001 ) . The mean duration of hospital stay was 3.7 ( range , 2–6 ) days in the constipated group and 3.05 days in the laxative group ( range , 2–5 ; P = 0.001 ) . Nine patients in the constipated group complained of troublesome postoperative constipation compared with three in the laxative group ( P = 0.033 ) . Continence scores , anal manometry , and endoanal ultrasound findings were similar in the two groups at three months postpartum . CONCLUSIONS : Patients in the laxative group had a significantly earlier and less painful bowel motion and earlier postnatal discharge . There was no difference in the symptomatic or functional outcome of repair between the two regimens Pregnancy is a time when women are susceptible to bowel habit perturbations . The purpose of this study was to provide new baseline data for a range of bowel habit parameters . Prospect i ve 7-day bowel habit diaries were completed during each of the three trimesters of pregnancy and after birth . Sensations of incomplete evacuation and time spent defecating were significantly increased during all three trimesters of pregnancy compared with after birth ( P < 0.05 ) . Symptoms of urgency were higher in nonlactating mothers ( 41 % of occasions ) compared with lactating women ( 17 % pf occasions ) ( P=0.07 ) . This study has confirmed the importance of investigating a range of bowel habit parameters during and after pregnancy — investigation of constipation per se may obscure changes in individual bowel habit parameters OBJECTIVE : To prospect ively estimate constipation prevalence and risk factors in pregnancy . METHODS : We enrolled healthy pregnant women in this longitudinal study during the first trimester . At each trimester and 3 months postpartum , participants completed a self-administered bowel symptom question naire , physical activity and dietary fiber intake measures , and a prospect i ve 7-day stool diary .  Constipation was defined using the Rome II criteria ( presence of at least two of the following symptoms for at least one quarter of defecations : straining , lumpy or hard stools , sensation of incomplete evacuation , sensation of anorectal obstruction , manual maneuvers to facilitate defecation , and fewer than three defecations per week ) . Generalized linear logistic models explored factors associated with constipation during pregnancy . RESULTS : One hundred three women were enrolled with mean ( ±st and ard deviation ) age of 28 ( ±5 ) years ; 54 % were nulliparous and 92 % white . Constipation prevalence rates were 24 % ( 95 % confidence interval [ CI ] 16–33 % ) , 26 % ( 95 % CI 17–38 % ) , 16 % ( 95 % CI 8–26 % ) , and 24 % ( 95 % CI 13–36 % ) in the first , second , and third trimesters and 3 months postpartum , respectively . Additionally , irritable bowel syndrome ( by Rome II criteria ) prevalence rates were 19 % ( 95 % CI 12–28 % ) , 13 % ( 95 % CI 6–23 % ) , 13 % ( 95 % CI 6–23 % ) and 5 % ( 95 % CI 1–13 % ) in the first , second , and third trimesters and 3 months postpartum , respectively . In multivariable longitudinal analysis , iron supplements ( OR 3.5 , 95 % CI 1.04–12.10 ) and past constipation treatment ( OR 3.58 , 95 % CI 1.50–8.57 ) were associated with constipation during pregnancy . CONCLUSION : Constipation measured using the Rome II criteria affects up to one fourth of women throughout pregnancy and at 3 months postpartum . LEVEL OF EVIDENCE : An increase in the prevalence of  constipation during pregnancy has been suggested to occur . We design ed a prospect i ve study to evaluate the prevalence of  constipation during pregnancy and puerperium , to investigate possible associations with eating habits and lifestyle , and to evaluate the frequency of laxative use . A structured question naire was developed addressing demographics , obstetric characteristics , lifestyle , eating habits , variables required for the diagnosis of constipation , and laxative use to evaluate the prevalence of constipation during pregnancy and puerperium . The question naire was administered in the obstetric clinic in the first trimester of pregnancy , and by telephone in the second and third trimesters , and in the puerperal period . The prevalence of self-reported constipation in these time periods was 45.4 , 37.1 , 39.4 , and 41.8 % , respectively . Prevalence defined by the Rome II criteria for the same time periods was 29.6 , 19 , 21.8 , and 24.7 % . These values were similar to the data previously reported for the female population . Agreement between the self-reported and Rome II results was moderate . The self-reported criterion showed high sensitivity in all time periods , using the Rome II criterion as gold-st and ard . No factor was associated with variations in the prevalence of constipation during pregnancy , though an increase was recorded in the consumption of fruit , vegetables , fiber , and water . The prevalence of constipation during pregnancy and puerperium is similar to that recorded among the female population from the same geographic area BACKGROUND Stool form scales are a simple method of assessing intestinal transit rate but are not widely used in clinical practice or research , possibly because of the lack of evidence that they are responsive to changes in transit time . We set out to assess the responsiveness of the Bristol stool form scale  to change in transit time . METHODS Sixty-six volunteers had their whole-gut transit time  ( WGTT ) measured with radiopaque marker pellets and their stools weighed , and they kept a diary of their stool form on a 7-point scale and of their defecatory frequency . WGTT was then altered with senna and loperamide , and the measurements were repeated . RESULTS The base-line WGTT measurements correlated with defecatory frequency ( r = 0.35 , P = 0.005 ) and with stool output ( r = -0.41 , P = 0.001 ) but best with stool form ( r = -0.54 , P < 0.001 ) . When the volunteers took senna ( n = 44 ) , the WGTT decreased , whereas defecatory frequency , stool form score , and stool output increased ( all , P < 0.001 ) . With loperamide ( n = 43 ) all measurements changed in the opposite direction . Change in WGTT from base line correlated with change in defecatory frequency ( r = 0.41 , P < 0.001 ) and with change in stool output ( n = -0.54 , P < 0.001 ) but best with change in stool form ( r = -0.65 , P < 0.001 ) . CONCLUSIONS This study has shown that a stool form scale can be used to monitor change in intestinal function . Such scales have utility in both clinical practice and research We evaluated the efficiency of polyethylene glycol at low dosage as a treatment for  constipation in the puerperium . A prospect i ve , open label and control study was performed in 225 puerpery patients . We observed a 94.7 % of study group patients and a 10.7 % of a control group patients had a  evacuation  in the first 48 hours , ( p < 0.01 ) . Decreased consistency of the stools was seen in the PEG group ( 74.3 % ) . According to our findings , low doses of PEG were useful and safe as a treatment for  constipation in the puerperium , without side effects BACKGROUND AND AIM Functional constipation is a common functional bowel disorder for which there is no reliable medical treatment . This study was design ed to determine the therapeutic efficacy and safety of the Yun-chang capsule , a Chinese herbal formula , in the treatment of patients with functional constipation . METHODS In our multi-center , prospect i ve , double-blind , r and omized , placebo-controlled , dose-escalation trial , patients with functional constipation received 70 mg of Yun-chang capsule plus 35 mg placebo ( group A ) , 105 mg of Yun-chang capsule ( group B ) , or 105 mg placebo ( group C ) , three times daily for 2 weeks . The primary end-points were the changes in main symptom score and cumulative symptom score 2 weeks after the treatment . The secondary end-points were adverse events . RESULTS A total of 140 patients were recruited and 132 met the inclusion criteria ; 44 patients constituted each of the three treatment groups . Compared with patients in group C , patients in groups A and B had significant improvement in the main symptom score , cumulative symptom score , the change from baseline of the main symptom score , and the change from baseline of the cumulative symptom score at week 1 and week 2 . The scores showed slight superiority of group B over group A at week 1 and week 2 , although these differences were not statistically significant . There were no differences in adverse events . CONCLUSIONS The Yun-chang capsule is efficacious and safe for the treatment of patients with functional constipation . Larger and longer-term trials are required to fully assess the benefits and safety of this treatment for functional constipation 
    Output:
    
Results were pooled in a meta- analysis only where there was no substantial statistical heterogeneity .
Future trials should report on the following important outcomes : pain or straining on defecation ; incidence of postpartum constipation , quality of life , time to first bowel movement after delivery , and adverse effects caused by the intervention such as : nausea or vomiting , pain and flatus