CONSTIPATION

(SEMBELIT)
Constipation: Decrease in normal frequency of defecation accompanied by difficult or
incomplete passage of stool and/or passage of excessively hard, dry stool.

Almost everyone has it at some point in life, and its usually not serious. Constipation is common
especially among older patients. The obvious culprits include a low fiber diet, repeatedly
ignoring the urge to go, not drinking enough water, or a lack of exercise. Also, the use of
medications, especially opioid analgesics, and overuse of enemas and laxatives, can cause
constipation. Certain psychological disorders like stress and depression can also cause such
condition. And because constipation is a case-to-case basis, some people believe they are
constipated if a day passes without a bowel movement; for others, every third or fourth day is
normal. Though common, constipation may also be a complex problem. Chronic constipation
can result in the development of hemorrhoids; diverticulosis; straining at stool, and perforation of
the colon. It is very important to be aware of the different possibilities because constipation can
become a lifelong, chronic problem. Tumors of the colon and rectum can result in obstipation
(complete lack of passage of stool). Thus, effective treatment for constipation includes fluids,
activity, and fiber.

Related Factors

Here are some factors that may be related to Constipation:

Limited fluid intake

Low-fiber diet

Lack of activity

Sedentary lifestyle

Medication use

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 Laxative overuse

Stress

Depression

Lack of privacy

Fear of pain with defecation

Ignoring urge to defecate

Tumor

Neurogenic disorders

Defining Characteristics

Constipation is characterized by the following signs and symptoms:

Passage of dry, hard stool

Passage of liquid fecal seepage

Infrequent passage of stool

Frequent but nonproductive desire to defecate

Straining at stools

Nausea and vomiting

Anorexia

Abdominal distention

Dull headache

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 Pain with defecation

Goals and Outcomes

The following are the common goals and expected outcomes for Constipation.

Patient maintains passage of soft, formed stool at a frequency perceived as normal

by the patient.

Patient states relief from discomfort of constipation.

Patient identifies measures that prevent or treat constipation.

Patient or caregiver verbalizes measures that will prevent recurrence of constipation.

Nursing Assessment

Assessment of the patient with Constipation includes a careful history and physical examination,
followed by appropriate laboratory and radiological investigations. The tests conducted are
directed by the clinical findings and should be used to strengthen the diagnosis as well assess the
depth of the problem.

Assessment Rationales

Check on the usual

It is very crucial to carefully know what is normal for each patient.
pattern of
The normal frequency of stool passage ranges from twice daily to
elimination, including
once every third or fourth day. Dry and hard feces are common
frequency and
characteristics of constipation.
consistency of stool.

Take account of a There is a big factor when patient becomes dependent on laxatives
possible laxative and and enemas. Abuse of laxatives and enemas causes the muscles

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 and nerves of the colon to function inadequately in producing an urge
enema use, type, and
to defecate. In the long run, the colon becomes atonic, distended, and
frequency.
does not respond normally to the presence of stool.

Check out usual

dietary habits, eating
Irregular mealtime, type of food, and interruption of usual schedule
habits, eating
can lead to constipation.
schedule, and liquid
intake.

Assess the patients Sedentary lifestyle such as sitting all day, lack of exercise, prolonged
activity level. bed rest and inactivity contribute to constipation.

Classify current A lot of drugs can slow down peristalsis. Opioids, antacids
medications usage with calcium or aluminum base, antidepressants, anticholinergics,
that may lead to antihypertensives, general anesthetics, hypnotics, and iron
constipation. and calcium supplements can cause constipation.

Feel the need for Defecating is a private thing. Most patients may have a hard time
privacy for having a bowel movement away from the sense of privacy in their
elimination. home.

Conditions such as hemorrhoids, anal fissures, or other anorectal

Evaluate for fear
disorders that are painful can cause the patient to ignore the urge to
of pain with
defecate, which over time results in a dilated rectum that no longer
defecation.
responds to the presence of stool.

Consider the degree Ignoring the urge to defecate eventually leads to chronic
to which the patient constipation because the rectum no longer senses or responds to the
responds to the urge presence of stool. The longer the stool stays in the rectum, the drier
to defecate. and harder it becomes. This will make the stool difficult to pass.

Know if there is a
history of neurogenic
diseases, such
Neurogenic disorders may decrease peristaltic activity.
as multiple
sclerosis or
Parkinsons disease.

Nursing Interventions

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The following are the therapeutic nursing interventions for Constipation:

Interventions Rationales

Sufficient fluid is needed to keep the fecal mass

Encourage the patient to take in fluid
soft. But take note of some patients or older
2000 to 3000 mL/day, if not
patients having cardiovascular limitations
contraindicated medically.
requiring less fluid intake.

Assist patient to take at least 20 g of Fiber adds bulk to the stool and makes defecation
dietary fiber (e.g., raw fruits, fresh easier because it passes through
vegetable, whole grains) per day. the intestine essentially unchanged.

Urge patient for some physical activity Movement promotes peristalsis. Abdominal
and exercise. Consider isometric exercises strengthen abdominal muscles that
abdominal and gluteal exercises. facilitate defecation.

Encourage a regular period for Most people defecate following the first daily meal
elimination. or coffee, as a result of the gastrocolic reflex.

Stool that remains in the rectum for long periods

becomes dry and hard; debilitated patients,
Digitally eliminate the fecal impaction.
especially older patients, may not be able to pass
these stools without manual assistance.

Consider the following examples to minimize rectal discomfort:

The warmth of the water relaxes muscles before

Warm sitz bath defecation attempts.

These over-the-counter preparations shrink

Hemorrhoidal preparations swollen hemorrhoidal tissue.

For hospitalized patients, the following should be employed:

A sitting position with knees flexed straightens
Unless contraindicated, the rectum, enhances the use of abdominal

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 encourage the patient to use
the bathroom. For bedridden
patients; assist the patient in
assuming a high-Fowlers
position with knees flexed.
Close the bathroom door or
pull curtains around the bed.
For patients with neurological problems:
Abdominal massage
Using the heel of the hand or a tennis
ball, apply and release pressure firmly
but gently around the abdomen in a
clockwise direction.
Digital anorectal stimulation
A gloved lubricated finger is lightly
inserted into the rectum and moderately
rotated in a circular motion. This is
performed for about 15 to 20 seconds
until flatus/stool is passed.
Discuss with a dietitian about dietary
sources of fiber.
Explain to the patient and caregiver
the importance of the following:
A balanced diet that
muscles, and facilitates defecation.
This position best uses gravity and allows for
effective Valsalva maneuver.
Privacy is very important because it helps the
patient feel comfortable for defecation.
Abdominal massage has been known to be helpful
in neurogenic bowel disorder but not for
constipation in older adults.
Digital stimulation increases muscular activity in
rectum by raising rectal pressure to aid in
expelling fecal matter.
A person with enough knowledge about the matter
will recommend sources of fiber consistent with
the patients usual eating habits. A patient
unaccustomed to a high-fiber diet may experience
abdominal discomfort and flatulence; a
progressive increase in fiber intake is
recommended.
These steps lead to establishing regular bowel
habits.
Twenty grams of fiber per day is suggested.
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 comprises adequate fiber,
fresh fruits, vegetables, and
grains

Sufficient fluid intake (eight

glasses per day or 2000 to Increased hydration promotes a softer fecal mass.
3000 mL/day)

A regular period for Successful bowel training relies on routine.

elimination and an adequate Facilitating regular time prevents the bowel from
emptying sporadically.
time for defection

Exercise strengthen abdominal muscles and

Regular exercise and activity stimulate peristalsis.

Privacy allows the patient to relax, which can help

Privacy for defecation promote defecation.

Explain the use of pharmacological The use of laxatives or enemas is indicated for
agent as ordered. short-term management of constipation.

Bulk fiber (Metamucil and These laxatives increase fluid, gaseous, and solid
similar fiber products) bulk of intestinal contents.

These laxatives soften stool and lubricate intestinal

Stool softeners (e.g., Colace) mucosa.

Chemical irritants (e.g., castor These laxatives irritate the bowel mucosa and
oil, cascara, Milk of cause rapid propulsion of contents of
small intestine.
Magnesia)

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 These laxatives aid in softening stools and
stimulate rectal mucosa; best results occur when
Suppositories given 30 minutes before usual defecation time or
after breakfast.

Oil retention enema This intervention softens stool.