Clinical Conditions: Constipation and Diarrhea

In enteral nutrition, diarrhea is one of the most common complications; however, before interrupting NT, it is necessary to rule out other causes of this complication, such as the use of some drugs (antibiotics, magnesium-based antacids and prokinetic agents) hypoalbuminemia, pseudomembranous colitis, malabsorption and intestinal atrophy (1).

A Brazilian study analyzed the frequency of intestinal motility disorders and risk factors associated with diarrhea and constipation among hospitalized patients receiving exclusive ENT.

The study included 110 hospitalized adult patients who were followed up daily for 21 consecutive days. They were classified into three (3) groups according to the presented intestinal transit disorders: D group (diarrhea: defined as three (3) or more watery stools in 24 hours); C group (constipation: defined as those with less than one (1) bowel movement in 3 days); and N group (absence of diarrhea and constipation).

Patients were also classified according to the presence of fiber in enteral formula: fiber group (those who received EN with soluble and insoluble fiber at the dose of 1.5 g/100 ml for at least 5 consecutive days) and the fiber-free group (who received fiber-free EN without fiber for two (2) consecutive days).

Those belonging to C group accounted for 70% of the studied patients. The D group appeared in 13% of the total sample and the N group accounted for 17%.
The fiber-free enteral diet was associated with constipation (p <0.001) and most of these subjects were receiving mechanical ventilation (p <0.001) (2).

According to this study, constipation was the most common intestinal motility disorder in patients with ENT. \"Constipation in patients receiving EN seems to be barely discussed in relation to diarrhea, perhaps because it requires less attention from the multidisciplinary team involved in the treatment of patients.
On the other hand, constipation is a disorder that can often be associated with gastroparesis, ileoparesia and consequently to insufficient supply of EN, influencing the prognosis of patients,\" the authors write (2).

The enteral diet with fiber seems to protect from intestinal motility disorders and, in this study, it was associated with prevention of constipation in patients receiving ENT.


1. Romito R. Early Administration of Enteral Nutrients in Critically Ill Patients. AACN Clinical Issues 6(2): 242-256, 1995.

2. Bittencourt et al. Constipation is more frequent than diarrhea in patients fed exclusively by enteral nutrition: results of an observational study. Nutr Clin Pract. 2012;27(4):533-9.


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