Nursing Care Plans For Constipation- Interventions and Examples

Introduction

Chronic constipation is infrequent bowel movements or difficult stools that persist for several weeks or longer. Constipation is generally described as having fewer than three bowel movements a week.

Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause people to strain excessively in order to have a bowel movement.

Treatment for chronic constipation depends in part on the underlying cause. However, in some cases, a cause is never found.

This blog post discusses what constipation is, its symptoms, nursing care plans and interventions with some examples .As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Symptoms of Constipation

Signs and symptoms of chronic constipation include:

• Passing fewer than three stools a week
• Having lumpy or hard stools
• Straining to have bowel movements
• Feeling as though there’s a blockage in your rectum that prevents bowel movements
• Feeling as though you can’t completely empty the stool from your rectum
• Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum

Constipation may be considered chronic if you’ve experienced two or more of these symptoms for the last three months.

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Causes of Constipation

Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract or cannot be eliminated effectively from the rectum, which may cause the stool to become hard and dry. Chronic constipation has many possible causes.

Blockages in the colon or rectum

Blockages in the colon or rectum may slow or stop stool movement. Causes include:

• Tiny tears in the skin around the anus (anal fissure)
• A blockage in the intestines (bowel obstruction)
• Colon cancer
• Narrowing of the colon (bowel stricture)
• Other abdominal cancer that presses on the colon
• Rectal cancer
• Rectum bulge through the back wall of the vagina (rectocele)

Problems with the nerves around the colon and rectum

Neurological problems can affect the nerves that cause the colon and rectum muscles to contract and move stool through the intestines. Causes include:

• Damage to the nerves that control bodily functions (autonomic neuropathy)
• Multiple sclerosis
• Parkinson’s disease
• Spinal cord injury
• Stroke

Difficulty with the muscles involved in the elimination

Problems with the pelvic muscles involved in having a bowel movement may cause chronic constipation. These problems may include:

• The inability to relax the pelvic muscles to allow for a bowel movement (anismus)
• Pelvic muscles that don’t coordinate relaxation and contraction correctly (dyssynergia)
• Weakened pelvic muscles

Conditions that affect hormones in the body

Hormones help balance fluids in your body. Diseases and conditions that upset the balance of hormones may lead to constipation, including:

• Diabetes
• Overactive parathyroid gland (hyperparathyroidism)
• Pregnancy
• Underactive thyroid (hypothyroidism)

Risk factors of Constipation

Factors that may increase your risk of chronic constipation include:

1. Age – more common in older adults
2. Sex – women are at high risk compared to men.
3. Being dehydrated
4. Low in fiber diet
5. Getting little or no physical activity
6. Taking certain medications, including sedatives, opioid pain medications, some antidepressants or medications to lower blood pressure
7. Having a mental health condition such as depression or an eating disorder

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Complications of Constipation

Complications of chronic constipation include:

Swollen veins in your anus (hemorrhoids). Straining to have a bowel movement may cause swelling in the veins in and around your anus.

Torn skin in your anus (anal fissure). A large or hard stool can cause tiny tears in the anus.

Stool that can’t be expelled (fecal impaction). Chronic constipation may cause an accumulation of hardened stool that gets stuck in your intestines.

Intestine that protrudes from the anus (rectal prolapse). Straining to have a bowel movement can cause a small amount of the rectum to stretch and protrude from the anus.

Treatment for constipation

Specific treatment for constipation will be determined by your doctor based on:

• Age, overall health, and medical history
• The extent of the condition
• Patient’s tolerance for specific medications, procedures, or therapies
• Expectations for the course of this condition

Most often, constipation can be treated through dietary and lifestyle changes, which relieve symptoms and help prevent the condition. Treatment may include:

Diet modifications. A diet with 20 to 35 grams of fiber daily helps in the formation of soft, bulky stool. While adding foods such as beans, whole grains, bran cereals, fresh fruits, and vegetables is helpful in adding fiber to the diet. Limiting foods such as ice cream, cheeses, meats, and processed foods, which contain little or no fiber, can also be helpful.

Laxatives. Laxatives may be prescribed after diet and lifestyle changes have failed to be effective.

Eliminating or changing medication

Biofeedback. Biofeedback is used to treat chronic constipation caused by anorectal dysfunction. This treatment retrains the muscles that control the release of bowel movements.

Lifestyle changes, such as increased water and juice intake, regular exercise, and allowing enough time for daily bowel movements, can be helpful.

Prevention of Constipation

The following can help you avoid developing chronic constipation.

1. Include plenty of high-fiber foods in your diet, including beans, vegetables, fruits, whole grain cereals, and bran.
2. Eat fewer foods with low amounts of fiber, such as processed foods and dairy and meat products.
3. Drink plenty of fluids.
4. Stay as active as possible and try to get regular exercise.
5. Try to manage stress.
6. Don’t ignore the urge to pass stool.
7. Try to create a regular schedule for bowel movements, especially after a meal.
8. Make sure children who begin to eat solid foods get plenty of fiber in their diets.

Diagnosis for Constipation

The tests performed by a doctor will depend on the duration and severity of constipation since most persons experience constipation at one time or another. The doctor will also take into account the patient’s age and whether there is blood in the stool, recent changes in bowel habits, or weight loss.

Diagnosing constipation may include:

Medical history. The doctor will ask for a description of constipation, including duration of symptoms, frequency of bowel movements, and other information to help determine the cause of constipation.

Physical examination. A physical examination may also include a digital rectal examination (DRE), in which the doctor inserts a gloved, lubricated finger into the rectum to evaluate the tone of the muscle that closes off the anus. This examination also helps detect tenderness, obstruction,  blood, amount and caliber of stool, and if the enlargement of the rectum is present.

Other diagnostic tests may include:

1. Abdominal X-ray
2. Lower GI (gastrointestinal) series (also called barium enema). A lower GI series is a procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky liquid used to coat the inside of organs so that they will show up on an X-ray) is given into the rectum as an enema. An X-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.
3. Colonoscopy. Colonoscopy is a procedure that allows the doctor to view the entire length of the large intestine and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, into the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.
4. Sigmoidoscopy. A sigmoidoscopy is a diagnostic procedure that allows the doctor to examine the inside of a portion of the large intestine and is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.
5. Colorectal transit study. This test shows how well food moves through the colon. The patient swallows capsules containing small markers, which are visible on X-ray. The patient follows a high-fiber diet during the course of the test, and the movement of the markers through the colon is monitored with abdominal X-rays taken several times three to seven days after the capsule is swallowed.
6. Anorectal function tests. These tests diagnose constipation caused by abnormal functioning of the anus or rectum.

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Nursing Care Plans for Constipation Based on Diagnosis

Nursing Care Plan 1: Post-Surgical Care: Nursing Diagnosis – Constipation related to immobility secondary to hip fracture surgery

It is evidenced by difficulty to pass stool and no bowel movement for 4 days post-surgery.

Desired outcome

The patient will manage to pass stool in 1-2 days.

Interventions	Rationales
Commence stool chart.	To monitor the pattern of elimination, including the amount and type of stool passed.
Start a fluid balance chart.	To monitor the patient’s hydration status and identify dehydration as a possible cause of constipation.
Commence food chart.	Diet post-surgery may be different from the patient’s normal eating pattern. Assessing the food intake of the patient may help improve elimination.
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 a 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 the 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. Patients need to be supported and be given adequate time to use the toilet as needed.
Refer the patient to physiotherapy.	Patients post-surgery may find it hard to mobilize due to the surgical wound and pain. Physiotherapists can help improve the patient’s mobility and provide tips on how to move around better with ease.
Administer laxatives as prescribed.	Laxatives are effective in promoting bowel movements.
Offer assistive mobility devices like zimmer frame, wheelchair, and/or use of commode.	Mobility may be difficult for patients post-surgery. Providing them with assistive equipment may ease their burden when mobilizing around, which may include trips to the toilet.
Administer pain killers as needed.	A patient may require additional pain management following surgery when planning to do activities like a trip to the toilet to open their bowels.

Nursing Care Plan 2: Neurological Disorders: Nursing Diagnosis – Constipation related to reduced muscle control secondary to Parkinson’s Disease

Evidenced by a reduced bowel movement, hard and lumpy stool, verbalization of having to strain when on the toilet, restlessness

Desired Outcome

Return of normal elimination pattern following managed PD symptoms.

Interventions	Rationales
Commence stool chart.	To monitor the pattern of elimination, including the amount and type of stool passed.
Commence fluid balance chart.	Patients with PD may find it difficult to hydrate themselves due to reduced muscle control.
Commence food chart.	Patients with PD may have reduced appetite due to reduced ability to feed themselves secondary to reduced muscle control.
Assess mobility and level of physical activity.	Reduced physical activity can affect peristalsis and promote constipation. Assessing the physical activities of patients with PD may help identify additional care needs, such as the need for an assistive device when going to the toilet.
Assess medications list.	Patients with PD may be on some medications that can cause constipation. Reviewing the medication list can help identify and plan for alternatives to these medications.
Encourage a high fiber diet and oral fluid intake.	PD can affect the patient’s ability to feed him/herself and reduce appetite. Ensuring that the patient has proper nutrition with adequate fiber in the diet can improve the bulk of stool for easier passage. Also, adequate hydration will help provide lubrication and prevent stool from becoming hard and dry.
Assess what helps the patient open his/her bowels easier.	Patients with PD may need additional support when completing activities of daily living. Assessing what helps the patient may improve his/her experience and make elimination more of an ease.
Provide time to use the toilet.	Due to changes in muscle control and mobility issues, patients with PD may need more time in the toilet than others.
Provide privacy.	PD patients may find it embarrassing to open their bowels in ward areas. Providing privacy can help them focus on opening their bowels.
Administer laxatives as prescribed.	Laxatives are effective in promoting bowel movement.
Administer PD drugs on time.	Administration of PD drugs on time will improve management of symptoms, reduce involuntary muscle movements, and improve muscle control.

Nursing Care Plan 3: Dementia: Nursing Diagnosis – Constipation related to ignoring the urge to defecate secondary to dementia

It is evidenced by straining and passage of hard stools, restlessness, and refusal to go to the toilet.

Desired outcome

The patient will be able to re-establish return of normal elimination pattern and be free from pain while passing stools.

Interventions	Rationales
Start stool chart.	To monitor the pattern of elimination, including the amount and type of stool passed.
Commence fluid balance and food chart.	Patients with dementia may have an altered eating and drinking pattern. Assessing how well they are hydrated and fed can help assess the need for supplementary hydration and nutrition provision.
Assess mobility and level of physical activity.	Dementia can have varying effects on a patient’s activity levels.
Assess medications list.	Some medications given to patients with dementia can cause constipation. A review of their medications list can help plan for alternatives.
Encourage a high fiber diet and oral fluid intake.	Patients with dementia may not be aware of what they eat and how much they drink. Encouraging them to eat the proper food and to drink plenty will help improve their eating routine and promote regular elimination.
Provide time to use the toilet.	Allowing them to have more time in the toilet will give them enough time to figure out how things work.
Encourage regular time for elimination.	Providing time to defecate will help the patient develop a routine and promote regular bowel movements.
Assess the patient’s ability to use the toilet facility.	Patients with dementia may need to be reoriented about the toilet facility.
Provide privacy.	Privacy will help the patient focus on opening their bowels and limit distractions to patients with dementia.
Make a clear path to the toilet.	Patients with dementia may easily lose their way. Making sure that the toilet is easily found and is free from clutter will help patients with dementia find their way to the toilet.
Administer laxatives as prescribed.	Laxatives are effective in promoting bowel movement as needed.

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Nursing Care Plan 4: Gastrointestinal Disorders: Nursing Diagnosis – Constipation related to the inflammatory process of diverticulitis

It is evidenced by type 1-2 stools on the Bristol stool chart and the inability to open bowels in the last 3 days.

Desired Outcome

The patient will be able to re-establish normal bowel elimination.

Interventions	Rationales
Commence a stool chart. Use a standardized stool assessment tool such as the Bristol stool chart.	To monitor the patient’s bowel pattern.
Administer laxatives as prescribed.	To help evacuate stools, the following laxatives can be used as prescribed: •Stimulant laxatives •Stool softeners, especially for the elderly patients •Bulk laxatives
Encourage to increase oral fluid intake as tolerated, ideally at least 2L per day. Check if the patient is in any fluid restriction before doing so.	To help soften the stool and make it easier to pass.
Encourage physical mobility and exercise as tolerated.	To increase bowel peristaltic movement.
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.

Nursing Care Plan 5: Cancer and Ongoing Chemotherapy Treatment: Nursing Diagnosis – Constipation related to a side effect of systemic anti-cancer therapy (SACT)

Evidenced by type 1-2 stools on Bristol stool chart 2 days post-chemotherapy session, feeling of difficulty in emptying stools, irritability

Desired Outcome

The patient will be able to re-establish normal bowel elimination.

Interventions	Rationales
Coordinate with the oncology pharmacist on reviewing the patient’s medications list.	Some medications given to patients with cancer patients can cause constipation. A review of their medications list can help plan for alternatives.
Consider changing the laxative regimen.	Laxatives are effective in promoting bowel movement. However, chemotherapeutic agents may cause the patient to be increasingly constipated, thus the need to regularly review bowel elimination status and try a different laxative regimen.
Encourage fiber intake of at least 25 grams per day for women and 38 grams per day for men, as recommended by the dietitian. Educate on increasing fluids like water and juices.	To help the food move through the intestines. Examples of good dietary fiber include artichokes, carrots, and spinach.
Refer the patient to the oncology dietitian.	Oncology dietitians are specialists in dealing with constipation and other bowel movement problems related to cancer and anti-cancer treatments.
Refer the patient to physiotherapy.	Physiotherapists can help improve the patient’s mobility and provide pelvic floor exercises for constipation.
Encourage exercises as tolerated.	Physical activity promotes peristalsis and elimination.

References

• ncbi.gov
• scholar.google.com