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Kim Y, See KC. Constipation in critically ill adults. World J Gastrointest Pathophysiol 2025; 16(4): 112019 [PMID: 41479858 DOI: 10.4291/wjgp.v16.i4.112019]
World J Gastrointest Pathophysiol. Dec 22, 2025; 16(4): 112019 Published online Dec 22, 2025. doi: 10.4291/wjgp.v16.i4.112019
Constipation in critically ill adults
Yuri Kim, Kay C See
Yuri Kim, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
Kay C See, Department of Medicine, National University Hospital, Singapore 119228, Singapore
Author contributions: Kim Y drafted the manuscript, designed the tables, and performed literature review and analysis; See KC provided overall supervision and critically reviewed and edited the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Yuri Kim, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore. yurikim6232@gmail.com
Received: July 16, 2025 Revised: August 25, 2025 Accepted: December 1, 2025 Published online: December 22, 2025 Processing time: 159 Days and 17.1 Hours
Abstract
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.
Core Tip: Constipation is a frequently overlooked complication in critically ill adults that adversely affects clinical outcomes. This review synthesizes current evidence on its complex pathophysiology, multifactorial etiology and diagnostic challenges within the intensive care unit. It underscores the importance of timely recognition and comprehensive management strategies combining both therapeutic and preventive strategies. By highlighting gaps in standardized diagnostic criteria and therapeutic protocols, this article advocates for further research to establish evidence-based guidelines aimed at improving patient prognosis and quality of care in the intensive care unit.
