From the Guidelines
Obstipation is a severe and potentially life-threatening form of constipation characterized by the inability to pass stool or gas, often requiring immediate medical intervention to prevent serious complications.
Definition and Causes
Obstipation involves a more complete blockage of the intestinal tract compared to regular constipation, and it can result from various causes including mechanical obstructions like tumors, strictures, or severe impaction, as well as neurological disorders affecting bowel motility or medications that severely slow gut movement 1.
Symptoms and Diagnosis
Symptoms of obstipation include abdominal distension, pain, nausea, vomiting, and a complete absence of bowel movements for extended periods, which can be similar to those of constipation but are typically more severe 1.
Treatment and Management
Treatment of obstipation depends on the underlying cause but may include manual disimpaction, enemas, prokinetic medications, or surgery for mechanical obstructions, with the goal of relieving the blockage and restoring normal bowel function 1.
Importance of Prompt Intervention
Obstipation is considered a medical emergency if accompanied by severe pain, vomiting, or signs of bowel perforation, as it can lead to serious complications including bowel necrosis or perforation if left untreated, highlighting the need for prompt and effective intervention to improve patient outcomes in terms of morbidity, mortality, and quality of life 1. Some key points to consider in the management of obstipation include:
- Assessing the cause and severity of the condition to guide treatment decisions
- Ruling out treatable causes such as impaction, obstruction, and metabolic disorders
- Using medications like bisacodyl, polyethylene glycol, or methylnaltrexone to manage constipation and relieve symptoms
- Considering manual disimpaction, enemas, or surgery as needed to address mechanical obstructions or other underlying causes
- Monitoring patients closely for signs of complications and adjusting treatment as needed to optimize outcomes.
From the Research
Definition of Obstipation
- Obstipation is not directly defined in the provided studies, however, constipation is broadly defined as an unsatisfactory defecation characterized by infrequent stools, difficult stool passage or both 2.
- The normal process of colonic transit and defecation is discussed in the context of constipation, and the etiology of constipation is reviewed 2.
- Constipation can be primary (idiopathic or functional) or associated with a number of disorders or medications 3.
Relationship between Obstipation and Constipation
- While the term "obstipation" is not explicitly mentioned in the studies, it can be inferred that obstipation may be related to constipation, as both conditions involve difficulties with bowel movements.
- The studies discuss various treatments for constipation, including stimulant and osmotic laxatives, intestinal secretagogues, and peripherally restricted μ-opiate antagonists 3.
- The effectiveness of different treatments for constipation is evaluated in the studies, including the use of docusate sodium 4, 5.
Treatment of Constipation
- The studies suggest that osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, are effective and safe therapies for both long and short term treatment of pediatric functional constipation 6.
- Stimulant laxatives, like Senna and Bisacodyl, probiotics, fiber preparations, enemas, and suppositories are also considered as adjunct therapies in specific clinical scenarios 6.
- The use of docusate sodium in constipation treatment is debated, with some studies concluding that it provides no benefit 4, 5.