Last updated on January 27th, 2024 at 09:44 am
Constipation is a common digestive issue that can cause discomfort and pain for patients. Nursing diagnosis and care plans for constipation are essential to improve patient outcomes and provide effective care.
Nurses need to have a thorough understanding of the nursing diagnosis for constipation and develop appropriate interventions to manage the patient’s symptoms.
Overview of Constipation
Constipation is a common gastrointestinal disorder that affects people of all ages. It is a medical condition that is characterized by infrequent bowel movements, difficulty passing stools, or both. Constipation is diagnosed when a person has less than three bowel movements in a week.
Symptoms of constipation include bloating, abdominal discomfort, straining during bowel movements, and the sensation of incomplete evacuation. In some cases, constipation can lead to fecal impaction, which is a blockage of the intestine by hardened stool.
There are many factors that can contribute to constipation, including age, diet, lack of physical activity, certain medications, and underlying medical conditions. For example, older adults are more prone to constipation due to a decrease in muscle tone and mobility in the digestive tract.
Constipation can be a chronic condition, but it can also be a temporary problem that can be relieved with lifestyle changes, such as increasing fiber intake, drinking more water, and engaging in regular physical activity. However, in some cases, medical intervention may be necessary to manage constipation.
In conclusion, constipation is a common medical condition that can affect people of all ages. It is characterized by infrequent bowel movements, difficulty passing stools, or both. The symptoms of constipation can be uncomfortable and even painful. But, with proper diagnosis and management, constipation can be effectively treated and prevented.
Causes of Constipation
Constipation can be caused by various factors that affect bowel function. These factors may include a low-fiber diet, inadequate water intake, a sedentary lifestyle, certain medications, and medical conditions.
Diet and Physical Activity
A low-fiber diet is a common cause of constipation. Fiber adds bulk to the stool, making it easier to pass through the intestines. Inadequate water intake can also contribute to constipation because it can cause the stool to become hard and difficult to pass. A sedentary lifestyle can also slow down the digestive system, leading to constipation.
Medications
Certain medications can cause constipation as a side effect. Opioids and anticholinergics are examples of medications that can slow down the digestive system and cause constipation. Antidepressants can also cause constipation in some people.
Stress
Stress can affect the digestive system and cause constipation. When a person is stressed, the body releases hormones that can slow down the digestive system. This can lead to constipation.
Neurological Problems
Neurological problems such as multiple sclerosis can affect the nerves that control the digestive system. This can lead to constipation.
Medical Conditions
Medical conditions such as abdominal distention, diverticulitis, and anal fissures can cause constipation. Older adults are also more likely to experience constipation due to age-related changes in the digestive system. Ileus, a condition in which the intestines stop working, can also cause constipation.
In conclusion, constipation can be caused by various factors that affect bowel function. A low-fiber diet, inadequate water intake, a sedentary lifestyle, certain medications, and medical conditions are some of the common causes of constipation.
Signs and Symptoms
Constipation is a common gastrointestinal problem that affects individuals of all ages. The signs and symptoms of constipation may vary depending on the severity of the condition. Here are some of the common signs and symptoms of constipation:
- Less than three bowel movements per week
- Hard, dry, or lumpy stools
- Straining or difficulty in passing stools
- Feeling of incomplete evacuation after bowel movements
- Abdominal pain, cramps, or bloating
- Nausea or vomiting
- Loss of appetite
- Rectal bleeding or fissures due to straining during bowel movements
- Rectal pressure
Individuals experiencing these symptoms should seek medical attention immediately. In some cases, constipation may be a symptom of an underlying medical condition, such as bowel obstruction, colon cancer, or neurological disorders.
It is important to note that the frequency of bowel movements may vary from person to person. Some people may have bowel movements once or twice a day, while others may have them every other day or even less frequently. However, if an individual experiences a significant change in their bowel habits, such as a sudden decrease in frequency or difficulty in passing stools, they should consult a medical professional.
In addition, certain lifestyle factors may contribute to constipation, such as a low-fiber diet, inadequate fluid intake, lack of physical activity, and certain medications. Therefore, a thorough evaluation of an individual’s diet, exercise habits, and medication use is essential in identifying the underlying cause of constipation.
Treatment for Constipation
Constipation can be treated using a combination of lifestyle changes, medication, and other interventions. Treatment aims to relieve symptoms, improve bowel movements, and prevent constipation from recurring.
Lifestyle Changes
Lifestyle changes are often the first line of treatment for constipation. These may include:
- Increasing fiber intake: A high-fiber diet can help soften stools and make them easier to pass. Foods that are high in fiber include fruits, vegetables, whole grains, and legumes.
- Increasing fluid intake: Drinking plenty of water and other fluids can help prevent dehydration and make stools softer.
- Exercise: Regular physical activity can help stimulate bowel movements and improve overall health.
- Establishing regular bowel habits: Setting aside time each day for a bowel movement can help train the body to have regular bowel movements.
Medication
If lifestyle changes are not effective, medication may be prescribed. The following types of medication are commonly used to treat constipation:
- Laxatives: Laxatives help soften stools and stimulate bowel movements. There are several types of laxatives, including bulk-forming, osmotic, stimulant, and lubricant laxatives. Each type works in a different way to relieve constipation.
- Stool softeners: Stool softeners help make stools softer and easier to pass.
- Lubricants: Lubricants help lubricate the stool and intestinal walls, making it easier for stools to pass.
- Prokinetics: Prokinetics help stimulate contractions in the digestive system, which can help move stool through the intestines.
- Chloride channel activators: Chloride channel activators help increase the amount of fluid in the intestines, which can help soften stools and stimulate bowel movements.
Specific Medications
There are several specific medications used to treat constipation, including:
- Psyllium: Psyllium is a type of fiber that can help soften stools and make them easier to pass.
- Methylcellulose: Methylcellulose is another type of fiber that can help soften stools and make them easier to pass.
- Bisacodyl: Bisacodyl is a stimulant laxative that can help stimulate bowel movements.
- Mineral oil: Mineral oil is a lubricant that can help lubricate the stool and intestinal walls, making it easier for stools to pass.
- Calcium polycarbophil: Calcium polycarbophil is a bulk-forming laxative that can help soften stools and make them easier to pass.
- Sennosides: Sennosides are a type of stimulant laxative that can help stimulate bowel movements.
- Magnesium citrate: Magnesium citrate is an osmotic laxative that can help soften stools and stimulate bowel movements.
- Lactulose: Lactulose is an osmotic laxative that can help soften stools and stimulate bowel movements.
- Polyethylene glycol: Polyethylene glycol is an osmotic laxative that can help soften stools and stimulate bowel movements.
- Lubiprostone: Lubiprostone is a chloride channel activator that can help increase the amount of fluid in the intestines, which can help soften stools and stimulate bowel movements.
- Linaclotide: Linaclotide is a chloride channel activator that can help increase the amount of fluid in the intestines, which can help soften stools and stimulate bowel movements.
- Prucalopride: Prucalopride is a prokinetic that can help stimulate contractions in the digestive system, which can help move stool through the intestines.
It is important to note that medication should only be used under the guidance of a healthcare provider, as some medications can have side effects and interact with other medications.
Complications of Constipation
Constipation can lead to several complications, which can have a significant impact on a patient’s quality of life. Some of the complications of constipation are:
- Impaction: When stool remains in the colon for an extended period, it can become hard and difficult to pass. This condition is called impaction and can cause severe pain and discomfort. Impaction can also lead to fecal incontinence, which is the inability to control bowel movements.
- Hemorrhoids: Straining during bowel movements can cause hemorrhoids, which are swollen veins in the rectum or anus. Hemorrhoids can be painful and cause bleeding during bowel movements.
- Rectal prolapse: Chronic constipation can cause the rectum to protrude through the anus, a condition called rectal prolapse. Rectal prolapse can cause fecal incontinence and difficulty with bowel movements.
- Colorectal cancer: There is evidence to suggest that chronic constipation may increase the risk of colorectal cancer. However, more research is needed to confirm this link.
- Diarrhea: In some cases, constipation can lead to diarrhea. This occurs when liquid stool leaks around the impacted stool and passes through the rectum.
- Vomiting: Severe constipation can lead to vomiting, which can be a sign of a bowel obstruction.
- Abdominal tenderness: Constipation can cause abdominal tenderness, which is pain or discomfort in the abdomen.
- Continence: Chronic constipation can lead to fecal incontinence, which is the inability to control bowel movements.
- Cramping: Constipation can cause cramping and abdominal pain, which can be severe in some cases.
- Impaired gas exchange: In rare cases, constipation can lead to impaired gas exchange, which is a condition where the body cannot exchange oxygen and carbon dioxide effectively.
It is essential to monitor patients with constipation for any signs of complications and take appropriate measures to prevent them. Healthcare providers should educate patients on the importance of maintaining regular bowel movements and adopting healthy lifestyle habits to prevent constipation and its complications.
Prevention of Constipation
Preventing constipation is essential to ensure a healthy bowel movement. Nurses can play a crucial role in educating patients on how to prevent constipation. Here are some ways to prevent constipation:
Diet
A healthy diet that is rich in fiber can prevent constipation. Patients should consume a diet that is high in fruits, vegetables, whole grains, and legumes. These foods are rich in fiber and can promote bowel movements. Patients should also avoid foods that can cause constipation, such as processed foods, cheese, and red meat.
Water
Drinking plenty of water can help prevent constipation. Patients should aim to drink at least eight glasses of water per day. Dehydration can cause constipation, so it is essential to stay hydrated.
Physical Activity
Regular physical activity can promote bowel movements. Patients should aim to exercise for at least 30 minutes per day. Exercise can help stimulate the muscles in the intestines, which can promote bowel movements.
Stool Chart
Using a stool chart can help patients monitor their bowel movements. The stool chart helps patients identify the type of stool they are producing and can help them identify any changes in their bowel movements. Patients should aim to produce stool that is type 3 or type 4 on the stool chart.
Medications
Certain medications can cause constipation. Patients should talk to their healthcare provider about any medications that may be causing constipation. Healthcare providers can recommend alternative medications or prescribe medications to help promote bowel movements.
Preventing constipation is essential to ensure a healthy bowel movement. Nurses can play a crucial role in educating patients on how to prevent constipation. Patients should consume a diet that is high in fiber, drink plenty of water, exercise regularly, use a stool chart to monitor their bowel movements, and talk to their healthcare provider about any medications that may be causing constipation.
Nursing Assessment for Constipation
When a patient presents with symptoms of constipation, a thorough nursing assessment is crucial to identify the underlying cause and develop an appropriate care plan. The assessment should include a detailed medical history, physical exam, and digital rectal exam (DRE) to evaluate the patient’s bowel function and identify any structural abnormalities.
During the nursing assessment, the nurse should ask the patient about their bowel habits, including frequency, amount, and consistency of stool. The nurse should also ask about any medications the patient is taking that may contribute to constipation. Certain medications, such as opioids, anticholinergics, and calcium channel blockers, are known to cause constipation.
The physical exam should include an abdominal assessment to evaluate for distention, tenderness, and palpable masses. The nurse should also assess for incomplete evacuation, which is a common symptom of constipation. Incomplete evacuation can be identified by the presence of hard stool in the rectum or by the patient’s report of a feeling of incomplete bowel movement.
A DRE may be performed to assess for rectal prolapse, hemorrhoids, or other structural abnormalities that may contribute to constipation. The nurse should also assess for signs and symptoms of irritable bowel syndrome (IBS), which is a common cause of chronic constipation.
Additional diagnostic tests may be ordered based on the patient’s symptoms and medical history. Criteria for the diagnosis of constipation include fewer than three bowel movements per week, straining during bowel movements, hard or lumpy stool, and a feeling of incomplete evacuation.
Defecography and MRI defecography may be used to evaluate for structural abnormalities or pelvic floor dysfunction that may contribute to constipation. The nursing assessment should be comprehensive and person-centered to identify the underlying cause of constipation and develop an appropriate care plan.
Nursing Diagnosis for Constipation
Nursing diagnosis is a critical aspect of constipation management. It involves an assessment of the patient’s condition, identification of the problem, and formulation of a nursing care plan. The nursing diagnosis for constipation includes several factors that contribute to the condition.
Factors Considered in Nursing Diagnosis for Constipation
- Stool consistency and frequency: Patients with constipation may have hard stools or infrequent bowel movements, which can cause discomfort and incomplete evacuation.
- Abdominal pain and bloating: Constipation can cause abdominal pain and bloating due to the accumulation of fecal matter in the intestines.
- Medication use: Certain medications, such as opioids, can contribute to constipation.
- Diet and fluid intake: Low fiber diets and inadequate fluid intake can also lead to constipation.
Nursing Diagnosis for Constipation
Based on the factors mentioned above, you can develop a nursing care plan for constipation. Some nursing diagnoses for constipation may include:
- Impaired bowel elimination: This nursing diagnosis is appropriate for patients who experience difficulty passing stools or have infrequent bowel movements.
- Acute pain related to abdominal distention: This diagnosis is appropriate for patients who experience abdominal pain and bloating due to constipation.
- Risk for constipation related to medication use: This diagnosis is appropriate for patients who are taking medications that can cause constipation.
- Hip Fracture: Constipation related to immobility secondary to hip fracture surgery as evidenced by difficulty to pass stool and no bowel movement for 4 days post-surgery.
- Parkinson’s Disease: Constipation related to reduced muscle control secondary to Parkinson’s Disease, as evidenced by reduced bowel movement, hard and lumpy stool, verbalization of having to strain when on the toilet, restlessness.
- Dementia: Constipation related to ignoring the urge to defecate secondary to dementia as evidenced by straining and passage of hard stools, restlessness, and refusal to go to the toilet.
- Diverticulitis: Constipation related to inflammatory process of diverticulitis as evidenced by type 1-2 stools on Bristol stool chart, inability to open bowels in the last 3 days, irritability.
- Chemotherapy: Constipation related to side effect of systemic anti-cancer therapy (SACT) as evidenced by type 1-2 stools on Bristol stool chart 2 days post-chemotherapy session, feeling of difficulty in emptying stools, irritability.
Nursing Interventions for Constipation
Nursing interventions for constipation may include:
- Encouraging fluid intake: Nurses may encourage patients to drink more water or other fluids to help soften stools and promote bowel movements.
- Increasing fiber intake: Nurses may recommend a high-fiber diet or fiber supplements to help promote bowel movements.
- Administering laxatives: Nurses may administer laxatives to help soften stools and promote bowel movements.
- Assisting with toileting: Nurses may assist patients with toileting and provide education on proper toileting techniques.
- Assessing and monitoring bowel movements: Nurses may assess and monitor a patient’s bowel movements to evaluate the effectiveness of interventions and adjust the nursing care plan accordingly.
- Commence stool chart. To monitor the pattern of elimination including amount and type of stool passed.
- Start a fluid balance chart. To monitor the patient’s hydration status and identify dehydration as possible cause of constipation.
- Assess mobility and level of physical activity. Reduced physical activity can affect peristalsis and promote constipation. Mobility may be difficult in the first few days after surgery.
- Encourage high fiber diet and oral fluid intake. Bowel movements may change post-surgery due to the medications given during procedures and immobility. Encouraging the patient to include fiber in diet when able and to drink plenty of fluids will help ease constipation.
- Provide time to use the toilet. Opening of the bowel may be painful in the first few days post-surgery. It is important for patients to be supported and be given adequate time to use the toilet as needed.
- Provide privacy. Patients may find it embarrassing to open their bowels in ward areas. Providing privacy can help them focus in opening their bowels.
- Encourage fiber intake of at least 25 grams per day for women and 38 grams per day for men, as recommended by the dietitian. To help the food move through the intestines. Examples of good dietary fiber include artichokes, carrots, and spinach.
In conclusion, nursing diagnosis is an essential aspect of constipation management. By identifying the contributing factors and implementing appropriate nursing interventions, nurses can help patients manage their constipation and improve their quality of life.
Expected Goals and Outcomes
When developing nursing care plans for constipation, setting goals and expected outcomes is crucial. Common goals include improving bowel function and relieving associated symptoms like abdominal pain and bloating. Within 4 hours of nursing intervention and treatment, the patient will identify measures that prevent or treat constipation.
Other expected outcomes may include:
- The patient will have a bowel movement within a specified time frame, such as 24-48 hours.
- The patient will report relief from abdominal pain and bloating.
- The patient will report feeling more comfortable and less anxious.
- The patient will understand the importance of maintaining regular bowel movements and will be able to identify measures to prevent constipation in the future.
- The patient will manage to pass stool in 1-2 days.
- The patient will be able to re-establish return of normal elimination pattern and being free from pain while passing stools.
To achieve these goals and outcomes, nursing interventions may include:
- Commence stool chart. To monitor the pattern of elimination including amount and type of stool passed.
- Start a fluid balance chart. To monitor the patient’s hydration status and identify dehydration as possible cause of constipation.
- Assess mobility and level of physical activity. Reduced physical activity can affect peristalsis and promote constipation. Mobility may be difficult in the first few days after surgery.
- Encourage high fiber diet and oral fluid intake. Bowel movements may change post-surgery due to the medications given during procedures and immobility. Encouraging the patient to include fiber in diet when able and to drink plenty of fluids will help ease constipation.
- Provide time to use the toilet. Opening of the bowel may be painful in the first few days post-surgery. It is important for patients to be supported and be given adequate time to use the toilet as needed.
- Provide privacy. Patients may find it embarrassing to open their bowels in ward areas. Providing privacy can help them focus in opening their bowels.
- Encourage fiber intake of at least 25 grams per day for women and 38 grams per day for men, as recommended by the dietitian. To help the food move through the intestines. Examples of good dietary fiber include artichokes, carrots, and spinach.
It is important to regularly reassess the patient’s condition and adjust the care plan as needed. By setting clear goals and expected outcomes and implementing appropriate nursing interventions, healthcare providers can effectively manage constipation and improve the patient’s quality of life.
More Nursing Interventions and Rationales for Constipation
Nursing interventions for constipation aim to improve bowel movement and prevent complications. These interventions can include lifestyle changes, medication administration, and enemas. Here are some common nursing interventions and their rationales:
Lifestyle Changes
- Increase fiber intake: Fiber helps soften stool and promote bowel movement. Nurses can advise patients to eat more fiber-rich foods such as fruits, vegetables, and whole grains.
- Increase fluid intake: Drinking enough fluids can help prevent dehydration and soften stool. Nurses can advise patients to drink at least 8 cups of water per day.
- Increase exercise: Exercise can help stimulate bowel movement. Nurses can advise patients to engage in regular physical activity such as walking or jogging.
- Use a stool chart: A stool chart can help patients track their bowel movements and identify any changes. Nurses can provide patients with a stool chart and teach them how to use it.
- Provide adequate privacy: Privacy can help patients feel more comfortable and relaxed during bowel movements. Nurses can ensure that patients have access to a private bathroom and that they are not interrupted during bowel movements.
Medication Administration
- Stool softeners: Stool softeners such as docusate sodium can help soften stool and make it easier to pass. Nurses can administer stool softeners as ordered by the physician.
- Laxatives: Laxatives such as bisacodyl, sennosides, and magnesium citrate can help stimulate bowel movement. Nurses can administer laxatives as ordered by the physician.
- Lubricants: Lubricants such as mineral oil can help lubricate the stool and make it easier to pass. Nurses can administer lubricants as ordered by the physician.
- Prokinetic agents: Prokinetic agents such as lubiprostone, linaclotide, and prucalopride can help stimulate bowel movement by increasing intestinal motility. Nurses can administer prokinetic agents as ordered by the physician.
- Enemas: Enemas can help stimulate bowel movement by introducing fluid into the rectum. Nurses can administer enemas as ordered by the physician.
Care Plans
- Develop a care plan: A care plan can help nurses identify the patient’s specific needs and develop a personalized plan of care. Nurses can work with the physician and other healthcare providers to develop a care plan for the patient.
- Monitor for complications: Constipation can lead to complications such as fecal impaction and bowel obstruction. Nurses should monitor the patient for signs of complications and report any concerns to the physician.
In conclusion, nursing interventions for constipation aim to improve bowel movement and prevent complications. These interventions can include lifestyle changes, medication administration, and enemas. Nurses should work with the physician and other healthcare providers to develop a personalized plan of care for the patient.
Best Nursing Books and Resources
These are the nursing books and resources that we recommend.
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The Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care
This is an excellent reference for nurses and nursing students. While it is a great resource for writing nursing care plans and nursing diagnoses, it also helps guide the nurse to match the nursing diagnosis to the patient assessment and diagnosis.
This handbook has been updated with NANDA-I approved Nursing Diagnoses that incorporates NOC and NIC taxonomies and evidenced based nursing interventions and much more.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
All introductory chapters in this updated version of a ground-breaking text have been completely rewritten to give nurses the knowledge they require to appreciate assessment, its relationship to diagnosis and clinical reasoning, and the goal and use of taxonomic organization at the bedside.
Nursing Care Plans: Nursing Diagnosis and Intervention
It contains more than 200 care plans that adhere to the newest evidence-based recommendations.
Additionally, it distinguishes between nursing and collaborative approaches and highlights QSEN competencies.
Nursing References & Sources
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
Bharucha AE, Lacy BE. Mechanisms, Evaluation, and Management of Chronic Constipation. Gastroenterology. 2020 Apr;158(5):1232-1249.e3. doi: 10.1053/j.gastro.2019.12.034. Epub 2020 Jan 13. PMID: 31945360; PMCID: PMC7573977.
Forootan, M., Bagheri, N., & Darvishi, M. (2018). Chronic constipation: A review of literature. Medicine, 97(20), e10631. https://doi.org/10.1097/MD.0000000000010631
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.
Larkin PJ,Cherny NI,La Carpia D,Guglielmo M,Ostgathe C,Scotté F,Ripamonti CI,ESMO Guidelines Committee., Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines. Annals of oncology : official journal of the European Society for Medical Oncology. 2018 Oct 1
Osuafor CN, Enduluri SL, Travers E, Bennett AM, Deveney E, Ali S, McCarthy F, Fan CW. Preventing and managing constipation in older inpatients. Int J Health Care Qual Assur. 2018 Jun 11;31(5):415-419. doi: 10.1108/IJHCQA-05-2017-0082. PMID: 29865964.
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
Włodarczyk J, Waśniewska A, Fichna J, Dziki A, Dziki Ł, Włodarczyk M. Current Overview on Clinical Management of Chronic Constipation. Journal of Clinical Medicine. 2021; 10(8):1738. https://doi.org/10.3390/jcm10081738
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