Abstract
In hospitalized patients the prevalence of constipation is high, especially among elderly patients. Constipation impacts significantly the quality of life of patients and is associated with increased morbidity and length of hospital stay. This retrospective observational study intended to identify the prevalence of constipation in patients hospitalized in an internal medicine ward. In a sample of 80 patients, the median age was 79 years and 53% (n = 42) were women. We identified constipation in 68% (n = 56) of the patients during hospitalization. The medical team prescribed treatment only to 70% of those patients. Constipation was responsible for delirium in 11% of patients and 5% suffered urinary retention. This study shows constipation is prevalent among patients admitted in an internal medicine ward. Systematic assessment of this problem can improve the overall care of the patients, alleviate symptoms, and prevent complications.
Keywords: constipation, delirium, elderly, internal medicine, laxative
To the Editor
Constipation is a prevalent problem in the general population, ranging from 14.6% to 25.2%. 1 In hospitalized patients, especially among elderly patients, the prevalence of constipation is around 50%. 2 This is a multifactorial problem that can be caused by the acute disease, advanced age, decreased physical activity and oral intake, constipating drugs, reactive depression, and lack of privacy in the ward setting. 3 In elderly patients, constipation may manifest as delirium, can cause fecal impaction, and is a common cause of urinary retention. 4
Constipation impacts significantly the quality of life of patients and is associated with increased morbidity and prolonged hospitalization. Proper assessment for constipation can improve the overall patient care. 2
This is a retrospective observational study of all patients hospitalized in an internal medicine ward of a university hospital on a specific day, intended to identify the prevalence of constipation. The exclusion criteria were patients hospitalized for <5 days, on laxatives to treat hyperammonemia or preparing for colonoscopy, admitted with acute diarrhea or intestinal occlusion.
The presence of constipation was identified by collecting data from the medical and nursing registry and diagnosed if the patient had <3 defecations weekly or in the presence of fecalith. The data analyzed in the study were obtained by reviewing medical and nursing registry as well as prescription records.
From a total of 155 patients hospitalized on that day on the internal medicine ward, 75 patients were excluded.
In our sample of 80 patients, the median age was 79 years and 53% were women. Regarding the functional status, 46% were partially dependent on basic activities of daily living (ADLs) and 26% totally dependent on ADLs, using modified Barthel index. The reason for hospital admission was infection in 50%, 10% malignant disease progression or investigation, and 8% acute heart failure. The average length of hospital stay was 14.5 days. The most common comorbidities found were heart failure (59%), cognitive impairment (56%), diabetes mellitus (44%), chronic pulmonary disease (33%), had chronic constipation (12%).
We identified constipation in 68% of patients during hospitalization. The medical team prescribed treatment only to 70% of those patients, meaning 16 patients were untreated for constipation. The average duration of constipation was 4.9 days, with 9 days without defecation the longest time registered.
The laxatives prescribed were stimulant in 91% of cases, 28% osmotic, 17% poo‐softeners and 36% of patients were prescribed with at least two types of laxative therapy.
We found that constipated patients were on opioid therapy in 33% of cases, neuroleptic drugs in 30%, and 26% on diuretics; 5% of patients were on these three types of therapy.
Constipation caused delirium and urinary retention in 11% and 5% of patients, respectively.
We showed that constipation is prevalent among hospitalized patients. There were 30% of untreated patients and 16% of complications. Systematic assessment of this problem can alleviate symptoms and prevent complications. 3 Therefore, we consider important the elaboration of protocols to improve the diagnosis and proper treatment of constipated patients.
AUTHOR CONTRIBUTIONS
Rita Rego was responsible for data curation, formal analysis, draft preparation, and final revision. Daniela Barroso was responsible for data curation and draft preparation. Elga Freire was responsible for conceptualization and draft preparation.
CONFLICT OF INTEREST STATEMENT
None to declare.
REFERENCES
- 1. Schuste BG, Kosar L, Kamrul R. Constipation in older adults. Can Fam Physician. 2015;61(2):152‐158. [PMC free article] [PubMed] [Google Scholar]
- 2. Linton A. Improving management of constipation in an inpatient setting using a care bundle. BMJ Open Quality. 2014;3:1‐3. doi: 10.1136/bmjquality.u201903.w1002 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Junqueira JB, Norton C, Santos VLCG. Constipation in hospitalized patients ‐ a study of prevalence and associated factors. J Wound Ostomy Continence Nurs. 2021;48(1):53‐60. doi: 10.1097/WON.0000000000000720 [DOI] [PubMed] [Google Scholar]
- 4. Chiba T, Kikuchi S, Omori S, Seino K. Chronic constipation and acute urinary retention. Eur J Gastroenterol Hepatol. 2022;34(1):e1‐e2. doi: 10.1097/MEG.0000000000001970 [DOI] [PMC free article] [PubMed] [Google Scholar]