Management of Constipation in Hospitalized Patients
Abstract
1. Introduction
1.1. Impact of Constipation in Inpatient Settings
1.2. Inpatient Constipation Is Underdiagnosed and Undertreated
2. Etiology and Presentation
2.1. Primary Constipation
2.2. Secondary Constipation
Opioid-Induced Constipation
3. Evaluation and Differential Diagnosis
3.1. Initial Evaluation
3.2. Imaging
4. Differential Diagnosis of Constipation in Hospitalized Patients
4.1. Primary Constipation
4.2. Secondary Constipation
4.2.1. Opioid-Induced Constipation
4.2.2. Ileus
4.2.3. Intestinal Pseudo-Obstruction
5. Management and Treatment
5.1. Laxatives and Stool Softeners
5.2. Enemas
5.3. Intestinal Secretagogues and Prokinetics
5.4. Peripherally Acting µ-Opioid Receptor Antagonists
5.5. Surgical Interventions
6. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Noiesen, E.; Trosborg, I.; Bager, L.; Herning, M.; Lyngby, C.; Konradsen, H. Constipation–prevalence and incidence among medical patients acutely admitted to hospital with a medical condition. J. Clin. Nurs. 2014, 23, 2295–2302. [Google Scholar] [CrossRef]
- Osei-Boamah, E.; Chui, S.-H.J.; Diaz, C.; Gambert, S.R. Constipation in the hospitalized older patient: Part 2. Clin. Geriatr. 2012, 20, 20–26. [Google Scholar]
- Mounsey, A.; Raleigh, M.; Wilson, A. Management of constipation in older adults. Am. Fam. Physician 2015, 92, 500–504. [Google Scholar] [PubMed]
- Arco, S.; Saldaña, E.; Serra-Prat, M.; Palomera, E.; Ribas, Y.; Font, S.; Clavé, P.; Mundet, L. Functional constipation in older adults: Prevalence, clinical symptoms and subtypes, association with frailty, and impact on quality of life. Gerontology 2022, 68, 397–406. [Google Scholar] [CrossRef] [PubMed]
- Jackson, R.; Cheng, P.; Moreman, S.; Davey, N.; Owen, L. “The constipation conundrum”: Improving recognition of constipation on a gastroenterology ward. BMJ Qual. Improv. Rep. 2016, 5, u212167-w3007. [Google Scholar] [CrossRef][Green Version]
- Schwenk, E.S.; Grant, A.E.; Torjman, M.C.; McNulty, S.E.; Baratta, J.L.; Viscusi, E.R. The efficacy of peripheral opioid antagonists in opioid-induced constipation and postoperative ileus: A systematic review of the literature. Reg. Anesth. Pain Med. 2017, 42, 767–777. [Google Scholar] [CrossRef]
- Vincent, J.-L.; Preiser, J.-C. Getting critical about constipation. Pract. Gastroenterol. 2015, 114, 14–25. [Google Scholar]
- Lacy, B.E.; Mearin, F.; Chang, L.; Chey, W.D.; Lembo, A.J.; Simren, M.; Spiller, R. Bowel disorders. Gastroenterology 2016, 150, 1393–1407. [Google Scholar] [CrossRef]
- de Azevedo, R.P.; Machado, F.R. Constipation in critically ill patients: Much more than we imagine. Rev. Bras. Ter. Intensiv. 2013, 25, 73–74. [Google Scholar] [CrossRef] [PubMed]
- Candrilli, S.D.; Davis, K.L.; Iyer, S. Impact of constipation on opioid use patterns, health care resource utilization, and costs in cancer patients on opioid therapy. J. Pain Palliat. Care Pharmacother. 2009, 23, 231–241. [Google Scholar] [CrossRef]
- Bharucha, A.E.; Pemberton, J.H.; Locke, G.R., III. American Gastroenterological Association Technical Review on Constipation. Gastroenterology 2013, 144, 218–238. [Google Scholar] [CrossRef]
- Mostafa, S.M.; Bhandari, S.; Ritchie, G.; Gratton, N.; Wenstone, R. Constipation and its implications in the critically ill patient. Br. J. Anaesth. 2003, 91, 815–819. [Google Scholar] [CrossRef]
- Gacouin, A.; Camus, C.; Gros, A.; Isslame, S.; Marque, S.; Lavoue, S.; Chimot, L.; Donnio, P.Y.; Le Tulzo, Y. Constipation in long-term ventilated patients: Associated factors and impact on intensive care unit outcomes. Crit. Care Med. 2010, 38, 1933–1938. [Google Scholar] [CrossRef] [PubMed]
- Osei-Boamah, E.; Chui, S.-H.J.; Diaz, C.; Gambert, S.R. Constipation in the hospitalized older patient: Part 1. Clin. Geriatr. 2012, 20, 15–19. [Google Scholar]
- Tracey, J. Fecal impaction: Not always a benign condition. J. Clin. Gastroenterol. 2000, 30, 228–229. [Google Scholar] [CrossRef]
- Jani, B.; Marsicano, E. Constipation: Evaluation and management. Mo. Med. 2018, 115, 236–240. [Google Scholar]
- Zhang, S.; Wang, R.; Danyan, L.; Zhao, L.; Zhu, L. Role of gut microbiota in functional constipation. Gastroenterol. Rep. 2021, 9, 392–401. [Google Scholar] [CrossRef] [PubMed]
- Maselli, D.B.; Camilleri, M. Pharmacology, clinical effects, and therapeutic potential of cannabinoids for gastrointestinal and liver diseases. Clin. Gastro Hepatol. 2021, 19, 1748–1758. [Google Scholar] [CrossRef]
- Kurz, A.; Sessler, D.I. Opioid-induced bowel dysfunction: Pathophysiology and potential new therapies. Drugs 2003, 63, 649–671. [Google Scholar] [CrossRef] [PubMed]
- Peng, J.; Sarkar, S.; Chang, S.L. Opioid receptor expression in human brain and peripheral tissues using absolute quantitative real-time RT-PCR. Drug Alcohol. Depend. 2012, 124, 223–228. [Google Scholar] [CrossRef]
- Kumar, L.; Barker, C.; Emmanuel, A. Opioid-induced constipation: Pathophysiology, clinical consequences, and management. Gastroenterol. Res. Pract. 2014, 2014, 141737. [Google Scholar] [CrossRef]
- Pappagallo, M. Incidence, prevalence, and management of opioid bowel dysfunction. Am. J. Surg. 2001, 182 (Suppl. S1), 11S–18S. [Google Scholar] [CrossRef] [PubMed]
- Argoff, C.E. Opioid-induced constipation: A review of health-related quality of life, patient burden, practical clinical considerations, and the impact of peripherally acting μ-opioid receptor antagonists. Clin. J. Pain 2020, 36, 716–722. [Google Scholar] [CrossRef]
- Panchal, S.J.; Muller-Schwefe, P.; Wurzelmann, J.I. Opioid-induced bowel dysfunction: Prevalence, pathophysiology and burden. Int. J. Clin. Pract. 2007, 61, 1181–1187. [Google Scholar] [CrossRef] [PubMed]
- Bell, T.J.; Panchal, S.J.; Miaskowski, C.; Bolge, S.C.; Milanova, T.; Williamson, R. The prevalence, severity, and impact of opioid-induced bowel dysfunction: Results of a US and European patient survey (PROBE 1). Pain Med. 2009, 10, 35–42. [Google Scholar] [CrossRef] [PubMed]
- Gupta, S.; Patel, H.; Scopel, J.; Mody, R.R. Impact of constipation on opioid therapy management among long-term opioid users, based on a patient survey. J. Opioid Manag. 2015, 11, 325–338. [Google Scholar] [CrossRef] [PubMed]
- Takaoka, M.; Igarashi, A.; Futami, A.; Yamamoto-Mitani, N. Management of constipation in long-term care hospitals and its ward manager and organization factors. BMC Nurs. 2020, 19, 5. [Google Scholar] [CrossRef] [PubMed]
- Camilleri, M.; Drossman, D.A.; Becker, G.; Webster, L.R.; Davies, A.N.; Mawe, G.M. Emerging treatments in neurogastroenterology: A multidisciplinary working group consensus statement on opioid-induced constipation. Neurogastroenterol. Motil. 2014, 26, 1386–1395. [Google Scholar] [CrossRef]
- Jamshed, N.; Lee, Z.E.; Olden, K.W. Diagnostic approach to chronic constipation in adults. Am. Fam. Physician 2011, 84, 299–306. [Google Scholar] [PubMed]
- Rao, S.S.; Meduri, K. What is necessary to diagnose constipation? Best. Pract. Res. Clin. Gastroenterol. 2011, 25, 127–140. [Google Scholar] [CrossRef]
- Sayuk, G.S. The digital rectal examination: Appropriate techniques for the evaluation of constipation and fecal incontinence. Gastroenterol. Clin North Am. 2022, 51, 25–37. [Google Scholar] [CrossRef] [PubMed]
- Somwaru, A.S. Imaging of Constipation and Its Complications. In Constipation; Mózsik, G., Ed.; Intech Open: London, UK, 2018. [Google Scholar]
- Araghizadeh, F. Fecal impaction. Clin. Colon. Rectal Surg. 2005, 18, 116–119. [Google Scholar] [CrossRef]
- Crockett, S.D.; Greer, K.B.; Heidelbaugh, J.J.; Falck-Ytter, Y.; Hanson, B.J.; Sultan, S. American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation. Gastroenterology 2019, 156, 218–226. [Google Scholar] [CrossRef]
- Włodarczyk, J.; Waśniewska, A.; Fichna, J.; Dziki, A.; Dziki, Ł.; Włodarczyk, M. Current overview on clinical management of chronic constipation. J. Clin. Med. 2021, 10, 1738. [Google Scholar] [CrossRef]
- Brenner, D.M.; Harris, L.A.; Chang, C.H.; Waldman, S.A.; Poppers, D.M.; Kassebaum-Ladewski, A.; Sayuk, G.S. Real-world treatment strategies to improve outcomes in patients with chronic idiopathic constipation and irritable bowel syndrome with constipation. Am. J. Gastroenterol. 2022, 117 (Suppl. S4), S21–S26. [Google Scholar] [CrossRef]
- Chamie, K.; Golla, V.; Lenis, A.T.; Lec, P.M.; Rahman, S.; Viscusi, E.R. Peripherally acting μ-opioid receptor antagonists in the management of postoperative ileus: A clinical review. J. Gastrointest. Surg. 2020, 25, 293–302. [Google Scholar] [CrossRef]
- Buchanan, L.; Tuma, F. Postoperative ileus. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2023. [Google Scholar]
- Ahmed, S.; Sharman, T. Intestinal Pseudo-Obstruction. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2022. [Google Scholar]
- Bull, J.; Wellman, C.V.; Israel, R.J.; Barrett, A.C.; Paterson, C.; Forbes, W.P. Fixed-dose subcutaneous methylnaltrexone in patients with advanced illness and opioid-induced constipation: Results of a randomized, placebo-controlled study and open-label extension. J. Palliat. Med. 2015, 18, 593–600. [Google Scholar] [CrossRef] [PubMed]
- Corsetti, M.; Brown, S.; Chiarioni, G.; Dimidi, E.; Dudding, T.; Emmanuel, A.; Fox, M.; Ford, A.C.; Giordano, P.; Grossi, U.; et al. Chronic constipation in adults: Contemporary perspectives and clinical challenges. 2: Conservative, behavioural, medical and surgical treatment. Neurogastroenterol. Motil. 2021, 33, e14070. [Google Scholar] [CrossRef]
- Pergolizzi, J.V., Jr.; Christo, P.J.; LeQuang, J.A.; Magnusson, P. The use of peripheral μ-opioid receptor antagonists (PAMORA) in the management of opioid-induced constipation: An update on their efficacy and safety. Drug Des. Devel Ther. 2020, 14, 1009–1025. [Google Scholar] [CrossRef]
- Movantik [Package Insert]; AstraZeneca Pharmaceuticals: Wilmington, DE, USA, 2020.
- Relistor [Package Insert]; Salix Pharmaceuticals: Bridgewater, NJ, USA, 2020.
- Symproic [Package Insert]; Shionogi & Co., Ltd.: Florham Park, NJ, USA, 2020.
- Bartz, L.; Klein, C.; Seifert, A.; Herget, I.; Ostgathe, C.; Stiel, S. Subcutaneous administration of drugs in palliative care: Results of a systematic observational study. J. Pain Symptom Manag. 2014, 48, 540–547. [Google Scholar] [CrossRef] [PubMed]
- Rauck, R.; Slatkin, N.E.; Stambler, N.; Harper, J.R.; Israel, R.J. Randomized, double-blind trial of oral methylnaltrexone for the treatment of opioid-induced constipation in patients with chronic noncancer pain. Pain Pract. 2017, 17, 820–828. [Google Scholar] [CrossRef] [PubMed]
- Vriesman, M.H.; Koppen, I.J.N.; Camilleri, M.; Di Lorenzo, C.; Benninga, M.A. Management of functional constipation in children and adults. Nat. Rev. Gastroenterol. Hepatol. 2020, 17, 21–39. [Google Scholar] [CrossRef] [PubMed]
- Knowles, C.H.; Grossi, U.; Chapman, M.; Mason, J. Surgery for constipation: Systematic review and practice recommendations: Results I: Colonic resection. Color. Dis. 2017, 19 (Suppl. S3), 17–36. [Google Scholar] [CrossRef] [PubMed]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Sayuk, G.S.; Yu, Q.T.; Shy, C. Management of Constipation in Hospitalized Patients. J. Clin. Med. 2023, 12, 6148. https://doi.org/10.3390/jcm12196148
Sayuk GS, Yu QT, Shy C. Management of Constipation in Hospitalized Patients. Journal of Clinical Medicine. 2023; 12(19):6148. https://doi.org/10.3390/jcm12196148
Chicago/Turabian StyleSayuk, Gregory S., Qi T. Yu, and Corey Shy. 2023. "Management of Constipation in Hospitalized Patients" Journal of Clinical Medicine 12, no. 19: 6148. https://doi.org/10.3390/jcm12196148
APA StyleSayuk, G. S., Yu, Q. T., & Shy, C. (2023). Management of Constipation in Hospitalized Patients. Journal of Clinical Medicine, 12(19), 6148. https://doi.org/10.3390/jcm12196148