Getting Critical About Constipation

Gastrointestinal motility is a complex process, which is often altered during critical illness, an effect that can lead to constipation. There is no consensus definition for constipation and it is therefore difficult to accurately assess incidence across studies. More recently, the term “paralysis of the lower gastrointestinal tract” has been suggested. Constipation can cause abdominal distension and discomfort, and reduce tolerance to enteral feeding. It can impair respiratory function and has been associated with worse patient outcomes including prolonged ICU length of stay and prolonged mechanical ventilation. The etiology of constipation in ICU patients is multifactorial and includes immobility, fluid and electrolyte disturbances, adverse effects of medication, and sepsis. Management must focus on treating the underlying cause and re-establishing regular bowel movements.