Mealtime Partners, Inc.

Specializing in Assistive Dining and Drinking Equipment

June 2014 Independent Eating and Drinking Newsletter

Independent Eating...   is a Wonderful Thing

June Topics:

  • How Constipation Affects Appetite

  • Gastroparesis (Delayed Gastric Emptying)


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How Constipation Affects Appetite

People who are unable to eat and drink independently and are dependent upon others for food and drink are rarely heavy. In some cases this is because of the amount of energy it takes for them to execute controlled movement which burns calories rapidly. Others have difficulty consuming enough calories without becoming tired; others take so long to eat a small meal that it is difficult for their caregivers to provide enough time for them to consume a normal sized meal. Anything that reduces the desire to eat, for these individuals, is significant to their well-being and health.

For many people who are permanently limited in their ability to move, like those with spinal cord injuries, quadriplegia, amyotrophic lateral sclerosis (ALS), or other causes, constipation can be an ongoing problem. Constipation and delayed gastric emptying (which is discussed in the following article), are responsible for reducing the area that is available in the gastrointestinal tract to accommodate food. This is because food that was eaten at an earlier time is still in the body and occupying the space that should be available for the next meal. This causes a reduction in appetite and feelings of bloating or fullness.

The clinical definition of constipation is that a bowel movement only occurs three times a week or less. Constipation can be acute or chronic. Some people are impacted by it constantly; for other people, it is an occasional occurrence. When someone is constipated stools are hard and dry, and despite them being small relative to a normal stool, are hard to pass.

The gastrointestinal system is made up of a series of organs starting at the mouth, continuing through the esophagus, stomach, small intestine, large intestine (which includes the appendix, cecum, colon, and rectum), and the anus. The small intestines are responsible for absorbing the majority of the nutrients and liquid from food that has been digested in the stomach. When the remaining waste material passes into the large intestine it is solidified into a stool. The stool passes down the large intestine into the colon and into the rectum where it is stored prior to being excreted during a bowl movement. Constipation occurs when the stool remains in the rectum too long. Liquid is extracted from the stool and it becomes hard and dry. This consistency of stool is hard for the muscles of the rectum to push out through the anus.

There are many causes of constipation and it can affect people of all ages. Approximately 42 million, or around 15% of the U.S. population suffers from constipation. Common causes include a diet that is low in fiber (whole grains, vegetables, and fruits), lack of exercise, taking certain medications, neurological and metabolic disorders (spinal cord injury, Parkinson’s disease, diabetes, and thyroid disorders), and problems of the gastrointestinal tract (diverticulitis, colon polyps, tumors, and celiac disease). All of these can cause the processing of food by the body to slow down, and the result of this slowing is constipation.

Many people have what is known as functional constipation where they actually manage to have a bowel movement quite regularly but have to strain to expel the bowel movement, which is lumpy and hard, and they may not feel as if they have completely expelled everything in their rectum. However, this does not meet the definition of constipation despite the sufferer feeling as if they have problems.

Many cases of constipation can be mitigated by a change of diet. Most Americans do not eat enough fiber in their diet on a daily basis. Listed below are examples of how much fiber is contained in various foods:

Food Group Serving Size Fiber (g/serving)
Fruit 0.5 Cup 1.1
Dark-green Vegetables 0.5 Cup 6.4
Orange Vegetables 0.5 Cup 2.1
Cooked Dry Beans (legumes) 0.5 Cup 8.0
Starchy Vegetables 0.5 Cup 1.7
Other Vegetables 0.5 Cup 1.1
Whole Grains (bread, cereal, etc.) 28 g (1 oz.) 2.4
Meat 28 g (1 oz.) 0.1

The Academy of Nutrition and Dietetics recommends consuming 20 to 35 grams of fiber a day for adults. However, it is estimated that most people only eat an average of 15 grams per day. By increasing the amount of fiber eaten regularly, many people can gain relief from the difficulties of emptying their bowel. This can be achieved by eating a breakfast of bran cereal and/or eating whole wheat bread, and by adding fruit, legumes and vegetables to the diet. Fruit should be eaten with its skin on to obtain the highest intake of fiber.

Exercise can also facilitate a reduction in the occurrence of constipation. Many people become constipated when they are unable to move around due to illness, surgery, pregnancy complications, etc., that limit the amount of movement that can be undertaken. As mentioned earlier, many people who are permanently limited in their ability to move, like those with spinal cord injuries, quadriplegia relating to cerebral palsy, etc., constipation can be an ongoing problem. It has been shown in recent studies that for those who sit in a wheelchair all day long, standing on a regular schedule can improve bowel regularity and reduce constipation (even if using the “stand” function of a power wheelchair, or a standing frame).

Medications are available to treat constipation. They include laxatives that help reduce constipation by forming bulk within the food that has been eaten which retains liquids and makes stools softer, bulkier, and easier to expel through the anus; and other laxatives that simply help the regular stool retain fluids and thus remain softer.

Complications can develop that are associated with straining to have a bowel movement due to constipation. Hemorrhoids occur when the veins around the anus and in the rectum become inflamed. They can bleed if they become very irritated. This will show as bright red blood on toilet tissue or in the toilet (internal bleeding from other parts of the body will be seen as black blood in the stool). There are over-the-counter treatments for hemorrhoids which include ointments or suppositories. However, if they do not respond to this treatment, medical help should be sought. Additionally, small tears can occur around the anus due to pushing to evacuate hard stools. They can be itchy and may also bleed. They can also be treated with over-the-counter medications but, if they persist, a physician should be consulted.

Chronic constipation is common among people who have severe disabilities whether their disabilities are congenital or acquired. It is important that when someone is aware of their need to have a bowel movement that they do not wait to relieve themselves. Waiting can increase the likelihood of constipation. For those who are not aware of when they need to have a bowel movement it is important that they maintain a regular bowel emptying schedule. Constipation can reduce appetite and significantly reduce mealtime enjoyment because food isn’t appealing when you are not hungry. Therefore, it is important that bowel function occurs regularly and without strain. For advice about regulating bowel function, talk to your physician.

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Pass the Peas Please
Peas aren't the easiest things to pick up, but the Mealtime Partner can reliably serve bite after bite of them if that’s what you want. If not, just move on to the next bowl and sample the pasta salad.

The Mealtime Partner empowers its user to eat what they want, when they want it.

To see a video of the Mealtime Partner Dining System, click here. To discuss how it might meet your specific needs, call us at 800-996-8607 or email us by clicking here. (Be sure to include your telephone number so we can give you a call.)
The Mealtime Partner Dining System
The Mealtime Partner Dining System is quick and easy to learn and has no complicated programming requirements. Each Dining System comes with a complete training video on DVD so new users and caregivers can learn to use it in just a few minutes. To view a list of the instructional videos that may be selected by title, click here.

The Mealtime Partner is by far the best assistive dining equipment ever developed. Before the engineering design team ever started, the design requirements for it were developed by a team of medical experts working with potential users. They examined the shortcomings in prior designs, the needs and desires of users, and the special requirements for providing safe and reliable operation in the various, often harsh, environmental settings where it must function. This resulted in the design of a dining system with quiet operation, that is easy to setup and use, easy to clean, has high durability (will last many years), serves food reliably, and is very safe to use. There are no other devices currently on the market that can even come close to matching its performance. For more information about the Mealtime Partner, click here.

The Mealtime Partner meets the Medicare and Medicaid definitions of Durable Medical Equipment (DME). The United States Food and Drug Administration (FDA) considers the Mealtime Partner to be a Class I type medical device. The Mealtime Partners has successfully completed all governmental electrical safety and electro-magnetic compatibility (EMC) compliance testing. For more information about safety testing, click here.


Gastroparesis (Delayed Gastric Emptying)

Gastroparesis is a disorder that causes food to move very slowly from the stomach into the small intestines or even stop moving completely. Gastroparesis literally means stomach paralysis (gastric = stomach; paresis = paralysis). The stomach is not truly paralyzed but the vagus nerve that controls the muscle activity of the stomach, does not function properly when gastroparesis is present. Gastroparesis is a diagnosis that is made when the possibility of an obstruction in the gastric system has been ruled out. The body’s gastric system is a structure made up of tubes that begin at the mouth and end at the anus. The stomach is a sack that is positioned within the gastric “tube” under the left lower rib cage. When empty, it is quite small (about the size of about one half cup, using cooking measurements).

When we eat, food fills the stomach and the muscles of the stomach relax allowing it to expand to accommodate as much as 3 pints of liquids and solids. There is a valve at the entrance to the stomach, which opens and closes to allow foods and liquids to enter the stomach. Once they have passed through the valve, it closes to stop the contents of the stomach from passing back up into the esophagus. At the lower end of the stomach is another valve that permits digested food to pass into the small intestines. Both valves should remain closed while food is being dissolved in the stomach by strong digestive juices. The muscles of the stomach contract and relax to allow the digestive juices to liquefy the solids that have been eaten. When fully liquefied, the texture of the stomach contents will resemble cream of potato soup. Once this process is complete, the pyloric valve at the bottom of the stomach will open and close allowing a small amount of digested food to pass into the small intestines where liquid nutrients are absorbed into the body. This is a fully automatic body function which takes care of digesting food and emptying the stomach.

When this process works properly we feel full when we have eaten; then gradually, as our stomach becomes empty, the feeling of fullness dissipates. If the process of emptying the stomach, by which the pyloric valve opens and closes releasing small amounts of stomach contents, does not work correctly, stomach emptying can be delayed or not happen at all. Under these circumstances the feeling of fullness remains as the stomach is still full. A feeling of bloating can occur, or, if foods remain in the stomach too long, nausea and vomiting can ensue.

The symptoms of gastroparesis include a feeling of fullness after meals, that does not dissipate over time, distention of the belly, nausea, burping, acid-reflux, and vomiting of food that is undigested a few hours after it has been eaten. This results in a lack of appetite due to the stomach still having food in it hours after the last meal. Also, the fear of vomiting can cause reduction in eating and result in weight loss. The most common identified cause of gastroparesis is insulin dependent diabetes. About 20% of individuals who have diabetes (particularly those who have neuropathy, or nerve damage, associated with their diabetes) show symptoms of gastroparesis. Other disorders that are known to be associated with the occurrence of delayed gastric emptying include Parkinson’s disease, kidney failure, and thyroid disorders. However, approximately 30% of cases of gastroparesis have no identifiable cause.

Before diagnosing gastroparesis, the possibility of an obstruction in the gastrointestinal tract (GI tract) must be ruled out. Obstructions can be caused by ulcer disease, scar tissue, or stomach cancer. Additionally, an obstruction called a bezoar, which is a ball of undigested vegetable material in the stomach, can be found. These conditions are identified by conducting an upper GI series of x-rays using barium to show the passage of food through the GI tract. Additionally, a Gastroscopy is conducted. A scope is passed through the mouth and into the stomach to look for problems and rule out possible issues. Lastly, a radioisotope gastric-emptying scan is conducted. The patient ingests a small quantity of radiation which is tracked as it passes through the body. The test usually takes 2 to 4 hours. Gastroparesis is diagnosed if more than half of the food eaten remains in the stomach after 2 hours.

Currently there is no cure for gastroparesis, the treatment to control it can be as simple as a change in diet and eating food that is easy to digest, eating small meals six times a day, avoiding fatty foods, and not eating high fiber foods that are slow to be digested.

If a change in diet does not control the symptoms, medications are available that can stimulate the stomach muscles, control nausea, and increase appetite. In rare cases that do not respond to treatment, surgical intervention may be considered. A jejunostomy feeding tube (J tube) may be placed directly through the abdominal wall, into the intestines to provide appropriate nutrition to the individual directly into their intestines avoiding the stomach that does not empty properly. For those who are fed using a J tube, specially designed formula is required that provides the appropriate nutrients. 

Gastroparesis can affect people of all ages. It is particularly difficult to identify when it occurs in infants and small children because they are unable to express how they feel or cooperate with the conduct of tests. It can occur in children who have health issues like neurologic disorders, and genetic/metabolic disorders, delays in development, premature birth, etc., or who have had a viral infection.

Delayed gastric emptying occurs more commonly in individuals who have other illnesses or disabilities and can be helped by eating a diet that is easy to digest and by consuming several small meals throughout the day rather than three big meals. For those who are unable to feed themselves, an assistive dining system can facilitate their being able to eat many small meals throughout the day, at a leisurely pace, without demanding a great deal of time from their care provider. Click here for information about the Mealtime Partner Assistive Dining System.

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Did You Know? Did you know that medical information found on Wikipedia may be inaccurate and therefore should not be used when seeking information about a medical condition? Wikipedia was started in 2001 and is a popular free encyclopedia that is available on the internet. The contents is written by volunteers from all over the world and is constantly edited and updated. A recently published journal article compared information about the top 10 most costly medical conditions in the United States found in peer-reviewed medical literature with corresponding articles published in Wikipedia. The study found that 9 out of 10 Wikipedia medical articles contained errors and concluded that caution should be used when using Wikipedia articles to answer questions about medical care. It is recommended that medical information be sought from a physician when an individual is sick or Internet sites that have medical advisory boards or are from public health authorities, like the U.S. Centers for Disease Control or the Department of Health and Human Services, that are reliable information sources when researching medical information.


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