Nutritional management of constipation of critically ill patients


To compare the effectiveness of not unusualplace laxatives in producing a bowel motion in sufferers admitted to a medical intensive care unit. Ninety-five sufferers admitted to the MICU from July 1-October 31, 2004. Logistic regression analysis turned into used to compare sufferers who did and did now no longer have a bowel motion.

Of the 50 sufferers, 25 did now no longer have a bowel motion during the first 96 hours of MICU admission. Patients given a stimulant laxative and/or an osmotic laxative had been extra likely to have a bowel motion. Critically unwell sufferers have a high frequency of constipation, and opioid therapy is a significant hazard aspect. Routine management of stimulant or osmotic laxatives must be taken into consideration for this affected person population.

Clinical Impact

Constipation can motive stomach distension and discomfort, terrible tolerance of enteral feeding, confusion, and intestinal obstruction with vomiting and hazard of pulmonary aspiration. It can also be related to raised intra-stomach strain, that could effect on breathing function. Abdominal distension related to constipation can be related to bacterial overgrowth, thirteen gastrointestinal (GI) tract” be preferred.  They described this as “the lack of ability of the bowel to byskip stool because of impaired peristalsis” and cautioned that scientific symptoms and symptoms could consist of absence of stool for 3 or extra consecutive days with out mechanical obstruction irrespective of bowel sounds. four Indeed, some thing time period is employed, bowel sounds, that have been broadly used as a trademark of bowel activity, are unreliable and must now no longer shape a part of the diagnostic criteria.


There are few posted epidemiological facts specially associated with constipation in significantly unwell

A wide variety of things can make contributions to constipation in significantly unwell sufferers, a number of which can be extra apparent than others, for instance spinal twine injury. The consequences of morphine and different opioids on intestine motility are properly known,  however opioids produce other consequences that still boom the hazard of constipation, inclusive of decreasing intestinal secretions.  Sepsis may additionally boom the probability of constipation in significantly unwell sufferers. Indeed, current facts endorse that sepsis may also beautify the inhibitory consequences of opioids on colonic motility thru Toll-like receptor for a key signaling molecule in sepsis pathogenesis.

Interaction with enteral feeding

The courting among the kind and transport of enteral nutrition (EN) and constipation is interesting. On the only hand, not on time management of EN may also make contributions to constipation, 1 while, on the alternative hand, constipation withinside the significantly unwell may be related to an intolerance to EN.  Early EN is suggested in significantly unwell sufferers. Continuous EN is normally advocated to enhance the transport of vitamins. However, food and bolus transport of vitamins motive gastric and colonic distention, main to elevated antro-pyloric strain waves and motility.


Because of the capability headaches related to constipation indexed above, suitable remedy of constipation is vital. The maximum vital aspect in treating those sufferers is to make it a concern to reestablish, after which maintain, normal bowel movements.
Treating the Underlying Cause

Full bodily exam should consist of rectal exam and imaging while essential to exclude the presence of any mechanical obstruction that calls for surgical control. In acute colonic pseudo-obstruction (Ogilvie’s syndrome), a healing colonoscopic exam can be required to decompress the pseudo-obstruction.

Laxatives and Enemas

There are basically styles of remedy for constipation after efforts were made to eliminate the underlying motive: oral laxatives and suppositories or enemas. Lactulose is possibly the maximum broadly used,  with a advocated beginning dose of 10 ml two times an afternoon growing to a most of 20 ml 3 instances each day.  Senna (10 ml/day) is a generally used alternative.

Prophylaxis of Constipation

A couple of research have cautioned useful consequences of prophylactic laxative management in significantly unwell sufferers. forty two suggested that prophylactic use of lactulose 20 ml two times each day for three days in significantly unwell ventilated sufferers turned into related to elevated prevalence of bowel motion withinside the first seventy two hours in comparison to no intervention.

The first is the trouble of stomach distension that may set off discomfort, which ends up in elevated opioids for ache relief, inflicting extra constipation, and so the cycle begins off evolved again. Indeed, despite the fact that now no longer regularly taken into consideration as such, EN may be taken into consideration as, possibly the most appropriate shape of prophylaxis towards constipation! Other popular affected person control strategies, inclusive of making sure ok hydration and inspiring mobilization while possible, should now no longer be forgotten

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