Constipation diarrhea
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Understanding Constipation and Diarrhea: Causes, Treatments, and Implications
Epidemiology of Constipation and Diarrhea in Critically Ill Patients
Constipation and diarrhea are common complications in critically ill patients, with constipation affecting between 20% and 83% of patients and diarrhea affecting between 3.3% and 78%1. Prophylactic laxative bowel regimens, often used to prevent constipation, have been shown to increase the risk of diarrhea without significantly reducing constipation1. This highlights the complexity of managing bowel disorders in critically ill patients and the need for more effective treatment strategies.
Functional Bowel Disorders: Constipation and Diarrhea
Functional bowel disorders, including constipation and diarrhea, are characterized by symptoms such as abdominal pain, bloating, and abnormal bowel habits without any obvious anatomical abnormalities2. These symptoms are often due to gastrointestinal sensorimotor dysfunctions. Treatments for constipation include osmotic and stimulant laxatives, secretagogues, and serotonin 5-HT4 receptor agonists, while diarrhea is managed with loperamide, anticholinergic agents, rifaximin, bile-acid binding agents, eluxadoline, and clonidine2. Emerging therapies are also being developed to address these conditions more effectively.
Constipation and Diarrhea in Primary Care
In primary care, constipation and diarrhea are frequently encountered, with most cases being benign and self-limited3. Chronic constipation often requires dietary modifications and fiber supplementation, while chronic diarrhea is commonly associated with conditions like irritable bowel syndrome (IBS), inflammatory bowel disease, and lactose intolerance3. Effective management relies on a strong physician-patient relationship and periodic pharmacologic interventions.
Constipation and Diarrhea During Pregnancy
Pregnancy often exacerbates constipation, diarrhea, and symptomatic hemorrhoids, which are typically managed with home remedies or nonprescription preparations4. Severe or refractory cases may require additional diagnostic studies and specialized care4.
Enteral Nutrition and Bowel Disorders
Patients receiving enteral nutrition (EN) are more likely to experience constipation than diarrhea, with 70% of patients in one study experiencing constipation compared to 13% experiencing diarrhea8. The presence of fiber in the enteral formula and the use of prokinetic drugs can help manage these conditions8.
Irritable Bowel Syndrome: Diarrhea and Constipation Subtypes
Irritable bowel syndrome (IBS) can present with either diarrhea-predominant or constipation-predominant symptoms. Diarrhea-predominant IBS is associated with more frequent fast colonic contractions, while constipation-predominant IBS does not show this pattern7. Psychological factors such as anxiety, depression, and hostility are elevated in IBS patients, but do not differ significantly between the diarrhea and constipation subtypes7.
Chemotherapy-Induced Constipation and Diarrhea
Chemotherapy-induced constipation (CIC) and diarrhea (CID) are significant challenges in cancer treatment, affecting up to 16% and 80% of patients, respectively10. These conditions result from complex mechanisms including inflammation, GI dysmotility, and alterations in GI innervation. Current treatments focus on symptom management, but emerging therapies targeting the enteric nervous system show promise for better outcomes10.
Conclusion
Constipation and diarrhea are prevalent and often interrelated conditions that can significantly impact patient quality of life. Effective management requires a comprehensive understanding of the underlying causes, appropriate use of pharmacologic and non-pharmacologic treatments, and ongoing research into new therapeutic options. Whether in critically ill patients, those with functional bowel disorders, or individuals undergoing chemotherapy, tailored treatment strategies are essential for optimal care.
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Most relevant research papers on this topic
Constipation, diarrhea, and prophylactic laxative bowel regimens in the critically ill: A systematic review and meta-analysis.
Prophylactic laxative bowel regimens in critically ill patients may increase diarrhea risk but do not reduce constipation risk, and their use is not supported by limited data.
Meta-AnalysisExisting and emerging therapies for managing constipation and diarrhea.
Existing therapies for managing constipation and diarrhea include osmotic and stimulant laxatives, secretagogues, and serotonin 5-HT4 receptor agonists, with new compounds under development.
Constipation, diarrhea, and irritable bowel syndrome.
Chronic constipation can be managed successfully with dietary modification and fiber supplementation, while chronic diarrhea is often caused by irritable bowel syndrome, inflammatory bowel disease, and lactose intolerance.
Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy.
Constipation, diarrhea, and symptomatic hemorrhoids are disorders common in the general population, particularly in women. These conditions, if mild, often are self-treated with various home remedies or nonprescription preparations. Few of these patients, moreover, are referred to gastroenterologists, as primary care providers generally are confident managing these conditions, unless they are severe, refractory to conventional management, or require additional diagnostic studies.
Highly CitedDiarrhea/Constipation
Medical nutrition therapy can effectively manage functional bowel disorders by assessing causes and educating patients on dietary manipulations to reduce symptoms.
Case ReportConstipation and diarrhoea
Palliative care patients often experience constipation due to opioid-based pain management, and managing both symptoms requires a balance between pharmacological and non-pharmacological interventions.
Irritable bowel syndrome: physiological and psychological differences between diarrhea-predominant and constipation-predominant patients.
IBS patients show elevated levels of anxiety, interpersonal sensitivity, depression, hostility, and somatization of affect, but no significant differences between diarrhea and constipation-predominant patients.
Observational StudyHighly CitedConstipation is more frequent than diarrhea in patients fed exclusively by enteral nutrition: results of an observational study.
Enteral nutrition with fiber may protect against medication-associated intestinal motility disorders, and adding prokinetic drugs may help prevent constipation in hospitalized patients.
Observational StudyEpisodic Nature of Symptoms in Irritable Bowel Syndrome
IBS symptoms, such as diarrhea and constipation, tend to occur in episodes rather than randomly, with bloating and pain coexisting on 59.1% of days.
Observational Study
Rigorous JournalChemotherapy-Induced Constipation and Diarrhea: Pathophysiology, Current and Emerging Treatments
Chemotherapy-induced constipation and diarrhea affect approximately 16% of cancer patients, and emerging treatments targeting the enteric nervous system show promising avenues for alleviating these side effects.
Highly Cited