New-Onset Constipation After Stroke
NEW-ONSET constipation after stroke was common and independently linked to poorer discharge outcomes in acute rehabilitation.
Constipation may be an underrecognized complication in acute stroke care, with new data showing high rates of poststroke constipation and a measurable association with rehabilitation outcomes. In a cross sectional study of 600 patients with acute stroke, investigators examined the incidence, contributing factors, and discharge impact of constipation developing after stroke in patients with no previous history of the condition.
Among all participants, 126 patients, or 21%, had a history of constipation. Poststroke constipation was identified in 278 patients, representing 46.3% of the cohort. New-onset constipation after stroke occurred in 184 patients, accounting for 38.8% of those without prior constipation.
Risk Factors for New-Onset Constipation
Several clinical and functional factors were associated with new-onset constipation after stroke. Hemorrhagic stroke, posterior circulation stroke, diabetes, use of osmotic diuretics, antacids, bedpan use, difficulty falling asleep, depression, and higher admission NIHSS scores were all identified as significant risk factors.
The findings suggest that bowel dysfunction after stroke may reflect more than immobility or routine medication exposure. Sleep disruption and depression appeared to contribute to constipation risk, pointing to the need for broader assessment during the acute stage of stroke rehabilitation.
Impact on Stroke Rehabilitation
New-onset constipation was independently associated with poor discharge outcome after adjustment for confounders, with the strongest signal seen among patients with moderate stroke severity. This association reinforces the importance of early recognition, particularly in patients whose rehabilitation trajectory may be vulnerable to preventable complications.
For clinicians, the results support routine screening for constipation risk in patients with stroke, including review of medication exposure, toileting method, neurologic severity, sleep quality, mood symptoms, and metabolic comorbidities. Identifying patients at risk may help optimize rehabilitation protocols and reduce barriers to recovery during the acute phase.
While the study design does not establish causality, the high incidence of new-onset constipation after stroke and its association with discharge outcome highlight a clinically relevant target for early supportive care.
Reference
Lv Z et al. New-onset constipation at acute stage after stroke: incidence, risk factors, and impact on stroke rehabilitation. Frontiers in Neurology. 2026;17:1721157.
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