From the Guidelines
Obstipation is a severe and life-threatening form of constipation that requires immediate medical attention to prevent serious complications, including bowel perforation or ischemia. According to the most recent and highest quality study, 1, obstipation is characterized by complete blockage of the intestines, making it extremely difficult or impossible to pass stool or gas. This condition typically results from conditions that physically block the intestines, such as tumors, strictures, or severe impaction, or from disorders affecting intestinal motility like neurological conditions or certain medications. Some key points to consider in the management of obstipation include:
- Assessment for cause and severity of constipation, as outlined in the NCCN clinical practice guidelines in oncology: palliative care 1
- Rule out impaction, especially if diarrhea accompanies constipation (overflow around impaction) 1
- Treatment may include manual disimpaction, enemas, prokinetic medications, or surgery in severe cases 1
- The use of laxatives, such as bisacodyl, polyethelene glycol, lactulose, sorbitol, magnesium hydroxide, or magnesium citrate, may also be considered 1
- In cases of opioid-induced constipation, peripherally acting mu-opioid receptor antagonists (PAMORAs) may be effective in managing symptoms 1 Symptoms of obstipation include abdominal distension, pain, nausea, vomiting, and complete absence of bowel movements. Prompt medical attention is essential to prevent serious complications and improve patient outcomes. In terms of specific treatments, the American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation recommends the use of PAMORAs, such as methylnaltrexone, in patients with opioid-induced constipation 1. Overall, the management of obstipation requires a comprehensive approach that takes into account the underlying cause of the condition, as well as the patient's overall health status and medical history.
From the Research
Definition of Obstipation
- Obstipation is not directly defined in the provided studies, but it can be inferred to be related to constipation, which is a common symptom that may be primary (idiopathic or functional) or associated with a number of disorders or medications 2.
- Constipation is characterized by a reduction in the frequency of bowel movements and/or difficulty with passage of stools, which may be intermittent or occasional 3.
Relationship to Constipation
- Functional constipation is a common pediatric GI disorder that is responsible for a significant portion of pediatric office visits each year, and it presents a significant stressor for patients, their families, and providers alike 4.
- Constipation can be treated with various over-the-counter agents, including osmotic laxatives, stimulant laxatives, probiotics, fiber preparations, enemas, and suppositories, which have demonstrated efficacy in pediatric functional constipation 4.
- In adults, constipation can be treated with polyethylene glycol 3350 (PEG3350) and docusate sodium, although the effectiveness of docusate sodium is widely debated 5, 6.
Treatment Options
- Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, remain the most effective and safe therapy for both long and short term treatment of pediatric functional constipation 4.
- Stimulant laxatives, like Senna and Bisacodyl, probiotics, fiber preparations, enemas, and suppositories make excellent choices for adjunct therapies in specific clinical scenarios 4.
- The use of docusate sodium in constipation prophylaxis and opioid-induced constipation is not supported by strong evidence, and it may supply minimal benefit 6.