Diarrhea and Constipation

  • Paul Ellis Marik


Diarrhea is a common problem in the ICU.1 Diarrhea is best defined as ≥3 loose stools per day.2,3 The incidence of diarrhea in the ICU varies widely according to the definition used.1 However, approximately 20–30% of ICU patients will develop clinically relevant diarrhea.4,5 In the ICU, diarrhea is best classified as infectious or non-infectious, based on the different therapeutic approaches. Multiple risk factors contribute to the causation of both infectious and non-infectious diarrhea.


Dietary Fiber Enteral Nutrition Clostridium Difficile Enteral Feeding Fecal Impaction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Wiesen P, Van GA, Preiser JC. Diarrhoea in the critically ill. Curr Opin Crit Care. 2006;12:149–154.PubMedCrossRefGoogle Scholar
  2. 2.
    Whelan K, Judd PA, Preedy VR, et al. Enteral feeding: the effect on faecal output, the faecal microflora and SCFA concentrations. Proc Nutr Soc. 2004;63:105–113.PubMedCrossRefGoogle Scholar
  3. 3.
    Manatsathit S, Dupont HL, Farthing M, et al. Guideline for the management of acute diarrhea in adults. J Gastroenterol Hepatol. 2002;17(Suppl):S54–S71.PubMedCrossRefGoogle Scholar
  4. 4.
    Marcon AP, Gamba MA, Vianna LA. Nosocomial diarrhea in the intensive care unit. Braz J Infect Dis. 2006;10:384–389.PubMedCrossRefGoogle Scholar
  5. 5.
    Barrett JS, Shepherd SJ, Gibson PR. Strategies to manage gastrointestinal symptoms complicating enteral feeding. JPEN. 2009;33:21–26.CrossRefGoogle Scholar
  6. 6.
    Shimoni Z, Averbuch Y, Shir E, et al. The addition of fiber and the use of continuous infusion decrease the incidence of diarrhea in elderly tube-fed patients in medical wards of a general regional hospital: a controlled clinical trial. J Clin Gastroenterol. 2007;41:901–905.PubMedCrossRefGoogle Scholar
  7. 7.
    Edes TE, Walk BE, Austin JL. Diarrhea in tube-fed patients: feeding formula not necessarily the cause. Am J Med. 1990;88:91–93.PubMedCrossRefGoogle Scholar
  8. 8.
    Smith CE, Marien L, Brogdon C, et al. Diarrhea associated with tube feeding in mechanically ventilated critically ill patients. Nurs Res. 1990;39:148–152.PubMedCrossRefGoogle Scholar
  9. 9.
    Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med. 2002;346:334–339.PubMedCrossRefGoogle Scholar
  10. 10.
    Wistrom J, Norrby SR, Myhre EB, et al. Frequency of antibiotic-associated diarrhoea in 2,462 antibiotic-treated hospitalized patients: a prospective study. J Antimicrob Chemother. 2001;47:43–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Schwaber MJ, Simhon A, Block C, et al. Factors associated with nosocomial diarrhea and Clostridium difficile-associated disease on the adult wards of an urban tertiary care hospital. Eur J Clin Microbiol Infect Dis. 2000;19:9–15.CrossRefGoogle Scholar
  12. 12.
    Krause R, Reisinger EC. Candida and antibiotic-associated diarrhoea. Clin Microbiol Infect. 2005;11:1–2.PubMedCrossRefGoogle Scholar
  13. 13.
    Gramlich L, Kichian K, Pinilla J, et al. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition. 2004;20:843–848.PubMedCrossRefGoogle Scholar
  14. 14.
    Nakamura T, Hasebe M, Yamakawa M, et al. Effect of dietary fiber on bowel mucosal integrity and bacterial translocation in burned rats. J Nutr Sci Vitaminol. 1997;43:445–454.PubMedCrossRefGoogle Scholar
  15. 15.
    Dobb GJ, Towler SC. Diarrhoea during enteral feeding in the critically ill: a comparison of feeds with and without fibre. Intensive Care Med. 1990;16:252–255.PubMedCrossRefGoogle Scholar
  16. 16.
    Yang G, Wu XT, Zhou Y, et al. Application of dietary fiber in clinical enteral nutrition: a meta-analysis of randomized controlled trials. World J Gastroenterol. 2005;11:3935–3938.PubMedGoogle Scholar
  17. 17.
    Rushdi TA, Pichard C, Khater YH. Control of diarrhea by fiber-enriched diet in ICU patients on enteral nutrition: a prospective randomized controlled trial. Clin Nutr. 2004;23:1344–1352.PubMedCrossRefGoogle Scholar
  18. 18.
    Schultz AA, Ashby-Hughes B, Taylor R, et al. Effects of pectin on diarrhea in critically ill tube-fed patients receiving antibiotics. Am J Crit Care. 2000;9:403–411.PubMedGoogle Scholar
  19. 19.
    Elia M, Engfer MB, Green CJ, et al. Systematic review and meta-analysis: the clinical and physiological effects of fibre-containing enteral formulae. Aliment Pharmacol Ther. 2008;27:120–145.PubMedCrossRefGoogle Scholar
  20. 20.
    Schneider SM, Girard-Pipau F, Anty R, et al. Effects of total enteral nutrition supplemented with a multi-fibre mix on faecal short-chain fatty acids and microbiota. Clin Nutr. 2006;25:82–90.PubMedCrossRefGoogle Scholar
  21. 21.
    Morrow LE, Kollef MH. Probiotics in the intensive care unit: why controversies and confusion abound. Crit Care. 2008;12:160.PubMedCrossRefGoogle Scholar
  22. 22.
    Sazawal S, Hiremath G, Dhingra U, et al. Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials. Lancet Infect Dis. 2006;6:374–382.PubMedCrossRefGoogle Scholar
  23. 23.
    McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol. 2006;101:812–822.PubMedCrossRefGoogle Scholar
  24. 24.
    Besselink MG, van Santvoort HC, Buskins E, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet. 2008;371:651–659.PubMedCrossRefGoogle Scholar
  25. 25.
    Koretz RL. Probiotics, critical illness, and methodologic bias. Nutr Clin Pract. 2009;24:45–49.PubMedCrossRefGoogle Scholar
  26. 26.
    Nikolaos L, Dimitrios V, Hellen M, et al. Saccharomyces boulardii fungaemia in an intensive care unit patient treated with caspofungin. Crit Care. 2008;12:414-(doi:10.1186/cc6843).CrossRefGoogle Scholar
  27. 27.
    Patanwala AE, Abarca J, Huckleberry Y, et al. Pharmacologic management of constipation in the critically ill patient. Pharmacotherapy. 2006;26:896902.CrossRefGoogle Scholar
  28. 28.
    Mostafa SM, Bhandari S, Ritchie G, et al. Constipation and its implications in the critically ill patient. Br J Anaesth. 2003;91:815–819.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care MedicineEastern Virginia Medical SchoolNorfolkUSA

Personalised recommendations