Constipation in critically ill adults

Constipation is a common yet underrecognized gastrointestinal complication among critically ill adults, significantly impacting morbidity, length of stay, and overall prognosis. This narrative review explores the current understanding of constipation in the critical care setting, emphasizing the challenges in its definition and identification due to variability in clinical presentation and lack of standardized diagnostic criteria. We examine contributing factors such as immobility, opioid use, altered fluid and electrolyte balance, and the effects of critical illness itself on gastrointestinal motility. Furthermore, we discuss available and emerging management strategies in critically ill adults, including pharmacologic and non-pharmacologic interventions, and highlight the importance of early identification and targeted therapy in improving patient outcomes. Finally, we address the prognostic implications of constipation in critically ill adults and the need for prospective studies to better define its impact and inform evidence-based guidelines. This review aims to raise awareness and stimulate further research into this often-overlooked aspect of gastrointestinal pathophysiology in the intensive care unit.