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CONSTIPATION
BARBER, MARIE THERESE
BOBILES, FIONA
TURDIL, MAEROSE
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CONSTIPATION
is the infrequent or difficult evacuation of stool
and usually results from a decrease in activity or
dietary changes, such as inadequate intake of
fluids and dietary fiber (DynaMed, 2018).
Constipation that lasts longer than 3 months is
considered to be chronic.
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2 TYPES OF
CONSTIPATION:
1. Primary constipation is classified as a slow transit or outlet dysfunction.
3 Categories of Primary constipation
a. Functional constipation: Relates to irritable bowel syndrome
b. Slowed transit constipation: Delays in bowel movements
c. Outlet dysfunction: Results from anal sphincter dysfunction, pelvic floor
muscle weakness, or rectoceles
2. Secondary constipation is caused by dehydration, neurological
disorders, structural abnormalities, or medications.
- Secondary constipation relates to diet, lifestyle, and medications
(e.g., opiates, antidepressants, anticholinergics, and clozapine). It also
relates to a variety of conditions, such as neoplasia, diabetes multiple
sclerosis, Parkinson’s disease, Thyroid disease, and Pregnancy.
THE NURSING ASSESSMENT (WITH COMMON FINDINGS LISTED), DIAGNOSES,
INTERVENTIONS, EXPECTED OUTCOMES, AND EDUCATION FOR CONSTIPATION ARE LISTED
BELOW.
ASSESSMENT
Assesses for signs and symptoms such as:
- Infrequent bowel movements (less than three times
per week)
- Difficult to pass stool
- Hydration status (skin turgor, fluid intake)
- Painful or difficult bowel movements
- Dietary intake, especially for foods high in fiber
- Medications that cause constipation
- Less frequent stools or smaller volume of stool
- Abdominal tenderness or distension
NURSING DIAGNOSIS/RISK FOR
a. Ineffective Breathing Pattern or Impaired Gas Exchange
While less direct, severe abdominal distention from constipation/impaction can put
pressure on the diaphragm, potentially impairing breathing and oxygenation.
B. Deficient Fluid Volume or Risk for Deficient Fluid Volume
Constipation can contribute to or be caused by dehydration. Inadequate fluid intake often
results in hard stools as the colon reabsorbs more water.
Related to: Inadequate oral intake, excessive fluid loss (if applicable), etc.
C. Imbalanced Nutrition: Less Than Body Requirements
If poor nutrition is a contributing factor to the constipation (e.g., the patient is not eating
enough fiber or overall calories).
CONSTIPATION INTERVENTIONS
Monitor frequency and characteristics of the individual’s stool.
- Provide privacy for effective elimination.
- Emphasize the importance of responding to the urge to defecate.
- Encourage ambulation and physical activity.
- Provide bowel training.
- Manage fecal impaction (digitally).
- Promote a high fiber diet.
- Encourage adequate fluid intake (at least 2000 mL per day).
- Administer fiber and bulk-forming laxatives, as ordered.
- Monitor medication list for medications that can lead to constipation.
Management of constipation includes:
- Changing lifestyle, such as a high fiber diet
- Adding psyllium supplements
- Increasing fluid intake
- Including prunes in diet
- Reducing the amount of red meat, fried/fatty foods, and dairy products
PHARMACOLOGICAL MANAGEMENT
- Laxatives are frequently used to manage constipation and are often used in older people to
treat and prevent contipation (Point & Williams, 2019). There are many laxatives available,
including:
- Bulk-forming agents which increase the weight of stool, leading to bowel stimulation (e.g.,
psyllium (Metamucil®)
- Stool softeners or emollients which allows water into the stool to make it easier to pass (e.g.,
docusate sodium (Colace®)
- Osmotic agents which draw water to the bowel to soften the stool (e.g., lactulose
(Enulose® or Lactugal®)
- Stimulant laxatives which stimulate the muscles lining the gut to promote movement (e.g.,
senna (Senokot®).
- Prokinetic and secretory agents, which are used for severe constipation, to promote intestinal
motility (e.g., metoclopramide (Reglan®) or cisapride (Propulsid®)
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