Constipation in intensive care unit: Incidence and risk factors Antonio Paulo Nassar Jr. MD a, ⁎ , Fernanda Maria Queiroz da Silva MD a , Roberto de Cleva PhD b a Department of Medicine, Discipline of Medical Emergencies, University of São Paulo, São Paulo-SP CEP 02402-400, Brazil b Department of Gastroenterology, University of São Paulo, São Paulo-SP CEP 02402-400, Brazil Keywords: Constipation; Gastrointestinal motility; Critical care; Critically ill; Enteral nutrition Abstract Purpose: Although gastrointestinal motility disorders are common in critically ill patients, constipation and its implications have received very little attention. We aimed to determine the incidence of constipation to find risk factors and its implications in critically ill patients Materials and Methods: During a 6-month period, we enrolled all patients admitted to an intensive care unit from an universitary hospital who stayed 3 or more days. Patients submitted to bowel surgery were excluded. Results: Constipation occurred in 69.9% of the patients. There was no difference between constipated and not constipated in terms of sex, age, Acute Physiology and Chronic Health Evaluation II, type of admission (surgical, clinical, or trauma), opiate use, antibiotic therapy, and mechanical ventilation. Early (b24 hours) enteral nutrition was associated with less constipation, a finding that persisted at multivariable analysis (P b .01). Constipation was not associated with greater intensive care unit or mortality, length of stay, or days free from mechanical ventilation. Conclusions: Constipation is very common among critically ill patients. Early enteral nutrition is associated with earlier return of bowel function. © 2009 Elsevier Inc. All rights reserved. 1. Introduction Gastrointestinal motility disturbances are common in critically ill patients [1,2]. Abnormalities in gastric emptying [3] and diarrhea [4] are well studied and have a considerable impact in critically ill patients' prognoses. However, constipation has received much less attention in clinical studies. Outside the intensive care unit (ICU) setting, constipation is a common symptom, affecting 2% to 27% of the population [5]. It seems that constipation has great implications in quality of life outside the ICU [6], but it was not a symptom reported in ICU patients' surveys [7,8]. There is not a homogeneous definition of constipation across studies. It has been defined as absence of bowel movements within 3 [9],6 [11], or 9 [10] days without bowel movements and either as need for treatment with laxatives or enemas according to the attending physician [12]. Conse- quently, the incidence of constipation in ICU setting is ⁎ Corresponding author. E-mail address: paulo_nassar@yahoo.com.br (A.P. Nassar). 0883-9441/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.jcrc.2009.03.007 Journal of Critical Care (2009) 24, 630.e9–630.e12