What are the risks of constipation?

Risks of Constipation

Constipation is a major cause of patient distress and can lead to serious complications including bowel obstruction, urinary retention, rectal bleeding, intestinal perforation, and increased healthcare burden with higher hospitalization rates. 1

Direct Medical Complications

Gastrointestinal complications are the most immediate risks:

• Nausea and vomiting develop as constipation worsens 1
• Bowel obstruction can occur from severe fecal impaction 1
• Fecal impaction itself leads to overflow incontinence with watery stool leaking around hard stool masses 1
• Intestinal perforation is a life-threatening complication, particularly in patients with diverticular disease or those receiving enemas 1
• Stercoral ulcers and rectal bleeding result from pressure necrosis of the bowel wall 1

Anorectal complications include:

• Hemorrhoids from chronic straining 1
• Anal fissures from passage of hard stools 1
• Rectal prolapse from prolonged straining 1
• Rectal mucosal damage especially from enema use 1, 2

Systemic and Metabolic Risks

Urinary complications are frequently overlooked:

• Urinary retention occurs from mechanical compression 1
• Urinary tract obstruction can develop with severe fecal impaction 1

Metabolic disturbances include:

• Dehydration from prolonged constipation 1
• Electrolyte imbalance particularly with fecal impaction 1
• Renal insufficiency as a consequence of dehydration and obstruction 1

Healthcare System Burden

Increased healthcare utilization represents a significant risk:

• Higher hospitalization rates for patients with untreated constipation 1
• Increased nursing hours required for management 1
• Prevention and early intervention reduce both patient distress and care costs 1

High-Risk Populations

Elderly patients face amplified risks:

• Five times more prone to constipation than younger individuals 1, 3
• Prevalence ranges from 24% to 50% in older adults 1, 3
• Risk factors include polypharmacy, reduced mobility, reduced hydration, and diminished urge to defecate 1, 3

Cancer patients experience particularly high morbidity:

• Prevalence ranges from 40% to 90% in advanced cancer patients 1, 3
• Constipation is one of the most prevalent symptoms in palliative care (51-55%) 1
• Complications are magnified by cancer treatments and opioid use 1

Patients on opioids have specific risks:

• All opioids cause constipation with no tolerance development over time 1, 3
• Opioid-induced constipation affects gastrointestinal opioid receptors, causing persistent symptoms 1

Special Complications in Specific Conditions

Williams syndrome patients face unique risks:

• Chronic constipation is a common lifelong problem requiring aggressive treatment 1
• Complications include rectal prolapse, hemorrhoids, and intestinal perforation 1
• Diverticulitis occurs at a young age in adolescents and adults with this condition 1

Critical Warning Signs

Life-threatening complications require immediate recognition:

• Constipation lasting more than 7 days warrants medical evaluation 4
• Rectal bleeding may indicate serious underlying pathology 4
• Failure to have a bowel movement despite treatment suggests potential obstruction 4
• Undiagnosed abdominal pain with constipation contraindicates certain interventions like enemas 1