http://doi.org/10.33698/NRF0053 Suresh Kumar Sharma, Prabhjot Kaur, Neha Sharma
Abstract: Constipation is a common complaint among critically ill patients. A prospective study was conducted to find out the incidence of constipation among 50 critically-ill patients admitted in I.C.U.’s of D.M.C & H, Ludhiana, Punjab. Follow up of the subjects ranged between 7-21 days with the mean follow up of 13.54±4.31 days. Each patient was followed daily from admission till discharge or three weeks and total 720 observations were made. It was found that 60% of critically-ill patients were constipated. Out of 720 observations, in 59.17% observations patients reported presence of bowel movements with soft (36.25%), hard (13.05%) and watery (9.86%) consistency, whereas bowel movements were absent in 40.83% observations. However, bowel sounds were present in 93.88% of the observations. The incidence of constipation was found higher in age group of 15-35 years (84.61%) which was found to be statistically significant (p<0.05). Males (62.50%), unmarried (83.33%) and urban dwellers (60.71%) have also reported higher incidence of constipation but that was not found statistically significant (p>0.05).
Key words: Incidence, Constipation, Critically-ill patients.
Introduction
Constipation is a common complaint in clinical practice. Poor dietary habits, postponed passage of stool and impaired mobility leads to decreased muscle tone and decreased peristalsis, thus, contributing to development of constipation’. Critically-ill patients usually remain confined to bed because of underlying disease process as well as prescribed mechanical ventilation & pharmacological agents due to which there is decreased muscle tone and peristalsis. Hospitalised critically-ill patients receiving opiates, sedatives, anticonvulsants and many others drugs are more likely to develop lower gastrointestinal motility disorders. Walsh studied 688 hospice patients receiving morphine and found that 48% of them were suffering from constipation, thus concluded that constipation is a common side effect of morphine. However, a study conducted by Zeilman & Grota (1995), revealed that motility disorder is common problem among persons receiving sedatives4. However, the occurrence of constipation and its implication in critically-ill patients is generally overlooked by the care providers in intensive care units. They generally monitor gastrointestinal functions and record features such as volume of gastric aspirate and occurrence of bowel opening rather than its absence (constipation). Unfortunately, this potentially serious problem is often overlooked and under-managed?. Although it seems to be a minor complication when compared to a life-threatening disease in critically-ill patients yet it can become detriment to quality of life if it is not well monitored and managed.
Objectives
To find out the incidence of constipation among critically-ill patients admitted in I.C.U.S.
Material and Methods
This prospective study was conducted in I.C.U.s of D.M.C & H Ludhiana, Punjab during the month of February March 2006. D.M.C.& H is an eminent tertiary care providing health care in Northern India which is well known for its trauma, emergency and 1.C.U.s facilities. All critically-ill patients above 12 years of age admitted in selected I.C.U.s of D.M.C & H, Ludhiana were selected as target population. Out of them 50 consecutively purposively selected patients were included but patients with history of recent bowel surgery, past history of constipation and history of current opioid addiction were excluded from study sample. An identification data sheet and observation proforma was prepared. Validity was established by seeking the opinion of five experts who were from the field of gastroenterology, medicine, neurosurgery, clinical nursing and nursing education. Each patient was followed daily from admission till discharge or three weeks and total 720 observations were made. The patients who have not passed stool for three consecutive days or having decreased frequency of bowel movements less than three per week were considered constipated. The data were analyzed and presented by using descriptive and inferential statistics.
Results
Findings revealed that 50 critically-ill patients age ranged between 14-85 years with mean age of 49.4±18.5 years. Majority of them were male (64%), married (88%) and belonged to urban area (56%). Statistically significant (p<0.05) higher incidence of constipation was found in age group of 15-35 years (84.61%) whereas males (62.50%), unmarried (83.3%) and urban dwellers (60.71%) have also reported higher incidence of constipation but that was not found to be statistically significant (p>0.05).
Table 1: Incidence of constipation as per socio-demographic profile
N=50
| Socio-demographic variables 1(%) constipated(%) chi-square value |
| Age in years
15-35 years 13(26) 11(84.61) 5.13 36-55 years 15(30) 09(60.00) df=2 >55 years 22(44) 10(45.46) Gender Male 32(64) 20(62.50) 0.22 Female 18(36) 10(55.55) df=1 Marital status Married 44(88) 25(56.81) 1.53 Unmarried 06(12) 05(83.33) df=1 Habitat Urban 28(56) 17(60.71) 0.012 Rural 22(44) 13(59.09) df=1 |
- = Significant (p<0.05)
NS= Non significant (p>0.05).
Figure 1: Incidence of constipation among subjects
Table 2 depicts daily bowel movement pattern of subjects. 50 patients were observed every day and total 720 observations were made. Out of 720 observations, in 426 (59.17%) observations reported presence of bowel movements whereas, 294 (40.83%) observations showed absence of stool passed by the patients. Most of the patients reported passage of stool with soft consistency (36.25%), followed by hard stool (13.05%). Small number of observations i.e. 9.86% was made regarding watery stool. However, majority of the observations (93.88%) showed presence of bowel sounds.
| Variables f(%) |
| Consistency of stool
Not passed 294 (40.83) Passed 426 (59.17) Soft 261 (36.25) Hard 91 (13.05) Watery 71 (09.86) Bowel sounds Present 676 (93.88) Absent 44 (06.12) |
Discussion
This study was conducted on 50 critically-ill patients admitted in I.C.U.s of D.M.C. & H, Ludhiana. Results revealed 60% incidence of constipation among critically-ill patients. However, incidence was higher (83%) in a study conducted by Mostafa et al2 on 48 critically-ill patients for 3 months. Another study reported only 16% incidence of constipation, which was significantly lower than present study findings. The incidence of constipation was higher (84.61%) in age group of 15-35 years followed by 60% and 45.46% in age group of 36-55 years and >55 years, respectively and that was found to be statistically significant (p<0.05). Males had higher (62.50%) incidence than females (55.55%). These findings were supported by Mostafa’s study where number of constipated males (43.75%) were more than females (39.58%). Unmarried had higher (83.33%) incidence of constipation than married (58.14%). There was slight variation in incidence among urban (60.71%) and rural dwellers (59.09%) but these findings were not found statistically significant (p>0.05). Results of the study revealed that 59.17% observations were of stool passage and rest 40.83% showed absence of stool passage. However, bowel sounds were present in 93.88% observations. There was non-availability of literature to discuss these findings
Conclusion
The incidence of constipation was found to be 60% in critically-ill patients. However, with different socio-demographic characteristics, statistically significant (p<0.05) higher incidence was found higher in age group 15-35 years, whereas males (62.50%), unmarried (83.33%) and urban dwellers (60.71%) have also reported higher incidence of constipation but that was not found to be statistically significant (p>0.05). Bowel sounds were present in 93.88% of observed patients, but in 40.83% observations, patients reported absence of bowel movement. It is recommended that there is a need to develop standardize protocol and it should be empirically proved by carrying out larger experimental or quasi-experimental trial among critically-ill patients. This study should be replicated with large samples and for longer time period.
References
- Priscilla, Ebersole, Patricia H. Managing Basic Physiologic Needs Towards Healthy Ageing. Fifth Edition. Philadelphia: Mosby’s Publishers, 1998: 179-82
- Mostafa SM, Bhandari S, Ritchie G, Wenstone. Constipation and its implications in critically-ill patient. http://bja.oxfdjournals.org.
- Susan C. Mc Millan. Assessing and Managing Narcotic induced Constipation in Adults with Cancer. http://www.moffitt.usf.edu.
- Zeilman S, Grote R. The Effects of Long Term Sedation on Intestinal Function. Anaesthesist 1995 Dec; 44 (Suppl. 3): $549-58.