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Constipation Pathophysiology
Many factors can contribute to constipation. The problem could have an external cause or come from the colon or the rectum.
Usually, the problem is delayed intestinal motility, which appears after years of excessive laxative use. However, a few patients may have an outlet obstruction as the underlying cause, such as rectal prolapse or a rectocele.
External factors contributing to constipation include poor eating habits, a lack of fluid intake, the abuse of certain medicines, endocrine conditions including hypothyroidism, and psychological disorders.
Causes
- Irregular eating patterns
- Insufficient fluids
- Diet low in fiber and/or high in fats and sugars
- Increased intake of caffeine and alcohol
- Delaying the urge to have a bowel movement
- Life changes (pregnancy, travel, aging)
- Inactivity
- Medications (including pain killers, antidepressants, and blood pressure drugs)
- Supplements (iron & calcium)
- Irritable bowel syndrome (IBS)
- Intestinal blockage
Symptoms
- Hard stools that are difficult to pass
- Pain with bowel movements
- Abdominal bloating
- Low back pain
- Hemorrhoids and/or fissures
- Less than three bowel movements a week
- Rectal bleeding with bowel movements
Subjective (Patient May Report)
- Complaints of straining at stooling, incomplete evacuation, abdominal bloating, or pain
- Abdominal pain
- Loss of appetite
- Avoidance of bowel movements (withholding, especially in public)
- A feeling of being blocked (or not having fully emptied the bowel)
- Repeat bladder infections (female)
Objective
- Large, dry stools that are difficult to pass
- Less than three bowel movements per week
- Bright red blood on surface of stool
Risk Factors
- Dehydration
- Eating a diet that’s low in fiber
- Getting little or no physical activity
- Taking certain medications (sedatives, opioid pain medications, some antidepressants, blood pressure drugs)
- Having a mental health condition (such as depression or an eating disorder)
Constipation Nursing Intervention
Assessment
Focus on the patient’s regularity and frequency of bowel movements, along with symptoms of nausea and vomiting. Ask the patient whether stools are difficult to pass or whether bowel movements are occurring at all.
Examine medical history in relation to suspected constipation (constipation history, level of activity, drugs frequently used for constipation).
Cardiac Function
- Increased blood pressure (from strain)
Respiratory function
- Shortness of breath
Neurologic and Sensory Functions
- Possible neurogenic bowel dysfunction
Visual Appearance & Labs
- Blood tests
- MRI defecography
- Evaluation of how well food moves through the colon
Constipation Nursing Diagnosis
Assessment
Further assessment should focus on changes in regularity and frequency of bowel movements, as well as medication side effects.
Rationale
Dietary adjustments help the colon process feces and make it easier for feces to travel through the body. Despite being convenient, processed foods and sugar lead to constipation. Peristalsis and stoma transit are supported by activity and exercise.
Care Plan/Planning
- A Nursing Care Plan (NCP) for Constipation starts at patient admission.
- The goal of an NCP is to create a treatment plan that’s specific to the patient. Plans should be anchored in evidence-based practices, accurately record existing data, and identify potential needs or risks.
Nursing Actions & Care Note for Constipation
Perform
- Abdominal assessment (percussion, palpation, and auscultation)
- Abdominal massage
Provide
- Adequate privacy
- Assistive equipment for mobility
Avoid
- Patient pain
- Caffeine and alcohol
- Intolerant foods (i.e. dairy, oils, etc.)
Administer
- Stool softeners and laxatives as ordered
- Suppositories
Monitor
- Patient hydration status
- Start a stool chart to keep track of the frequency and kind of bowel motions, establish a baseline, and spot irregularities
Encourage
- Client to watch defecation warning signs and develop a regular schedule by using a stimulus (such as a warm drink or prune juice).
- Avoidance of long-term use of laxatives and enemas and gradually withdrawing from their use (if used regularly).
- Decrease of opioids (if that’s the underlying concern)
Goals and Outcomes
- Experiencing a normal bowel pattern
- Experiencing relief from discomfort of constipation
- Identifying measures that prevent or treat constipation
Constipation Post Intervention Evaluation & Monitoring
Monitor
- Pattern of elimination
- Intake and output
Future goals
- Patient identifying measures that prevent or treat constipation such as activity, fluid intake, fiber, medication, etc.
- Patient adhering to a daily schedule to avoid constipation.
Prevention
- Patient maintaining a regular bowel schedule by eating a well-balanced diet high in fiber, drinking more water, and being active regularly.
Supplemental Material for Constipation
Client Case (Example)
Patient is a 39-year-old female who presents with complaints of constipation. The patient has been experiencing symptoms of constipation for the past week and has been to the hospital once before.
The patient reports that she does not have any pain or discomfort, but she wants to find out what is causing her constipation so that it can be treated properly. The plan of care for this client will include administering medication daily until all symptoms are gone.
This includes teaching the client how to eat healthy foods that help with digestion and bowel movements, encouraging her to exercise regularly, and encouraging her to drink plenty of water throughout the day.
Constipation NCLEX Questions
Correct answers are highlighted in green.
Which of the following are treatments for constipation?
- Ambulation
- High fiber diet
- Increased fluid intake
- Whole wheat foods
- High carbohydrate diet
Which of the following is a complication of constipation?
- Encopresis
- Impaction
- Hemorrhoids
- Rectal prolapse
- Colorectal cancer
Which of these clients are struggling with constipation?
- The client who eats a high-fiber diet, exercises, and has a bowel movement every 2 days.
- The client who eats a high-fat diet, is sedentary, and has a bowel movement every 5-7 days.
- The client who eats fruits and vegetables, drinks 8 glasses of water a day, and exercises daily.
- The client who uses the Valsalva maneuver for bowel movements, has hemorrhoids, and takes laxatives every other week.
- The client who has lumpy, hard stools every 2 days, drinks 8 oz. of water daily, drinks colas, and eats snacks throughout the day.
Find our other nursing care plans here
References
The Pathophysiology, Diagnosis, and Treatment of Constipation Dtsch Arztebl Int. 2009
Palliative Care for Constipation Pace University
