UNIT IX: NURSING

MANAGEMENT OF PATIENTS
WITH GI DIAORDERS

TOPIC : CONSTIPATION

PRESENTED BY :
AYUSHI RAINA
CLINICAL INSTRUCTOR
 DEFINITION:
Constipation is an abnormal infrequency or irregularity of defecation,
abnormal hardening of stools that makes their passage difficult and
sometimes painful, a decrease in stool volume, or retention of stool in
the rectum for a prolonged period often with a sense of incomplete
evacuation after defecation.
 CAUSES
• Certain medications (ie, tranquilizers, anticholinergics,
antidepressants, antihypertensives, bile acid sequestrants, diuretics,
opioids, aluminumbased antacids, iron preparations, selected
antibiotics, and muscle relaxants)
• rectal or anal disorders (eg, hemorrhoids, fissures)
• obstruction (eg, bowel tumors);
• metabolic, neurologic, and neuromuscular conditions (eg,
Hirschsprung’s disease, Parkinson’s disease, multiple sclerosis)
• endocrine disorders (eg, hypothyroidism, pheochromocytoma)
• lead poisoning
• connective tissue disorders (eg, scleroderma, systemic lupus
erythematosus)
• Diseases of the colon commonly associated with constipation include
irritable bowel syndrome and diverticular disease
• any acute disease process in the abdomen (eg, appendicitis)
• Other causes: weakness, immobility, debility, fatigue, and an inability to
increase intraabdominal pressure to facilitate the passage of stools, as
may occur in patients with emphysema or spinal cord injury
• Ignore the urge to defecate
• result of dietary habits (ie, low consumption of fiber and inadequate fluid
intake)
• lack of regular exercise and a stress-filled life
 NORMAL PROCESS OF DEFECATION:

relaxation of the
stimulation of the relaxation of the external sphincter increased
inhibitory internal sphincter muscle &muscle intraabdominal
rectoanal reflex muscle in the pelvic pressure
region

Rectal
distension

Urge to defecate
 PATHOPHYSIOLOGY :
Interference with one of three major functions of the colon:

mucosal transport (i.e. myoelectric activity (i.e.

the processes of
mucosal secretions mixing of the rectal
defecation (eg. pelvic
facilitate the movement mass and propulsive
floor dysfunction)
of colon contents) actions)

CONSTIPATION
 CLINICAL MANIFESTATIONS
• fewer than three bowel movements per week
• abdominal distention; pain and pressure
• decreased appetite
• headache
• fatigue
• Indigestion
• a sensation of incomplete evacuation
• straining at stool
• the elimination of small-volume, lumpy, hard, dry stools.
 ASSESSMENT & DIAGNOSTIC
FINDINGS:
• Rome Criteria : If the previously mentioned manifestations must be
present for at least 12 weeks of the preceding 12 months
• patient’s history
• physical examination
• barium enema
• sigmoidoscopy
• stool testing for occult blood.
• Anorectal manometry (ie, pressure studies such as a balloon expulsion
test) may be performed to assess malfunction of the sphincter
• Defecography and colonic transit studies can also assist in the
diagnosis because they permit assessment of active anorectal
function
• pelvic floor magnetic resonance imaging (MRI)
 COMPLICATIONS
• hypertension
• fecal impaction
• hemorrhoids (dilated portions of anal veins)
• fissures (tissue folds)
• megacolon
 MEDICAL MANAGEMENT
• Routine exercise to strengthen abdominal muscles is encouraged.
• Daily dietary intake of 25 to 30 g/day of fiber (soluble and bulk-forming) is
recommended
• bulk-forming agents (Calcium polycarbophil (FiberCon) saline and osmotic agents
( Lactitol, magnesium citrate) ,lubricants, stimulants ( Ducodyl, Dulcolax) or fecal
softeners ( Docusate sodium)
• Enemas and rectal suppositories for the treatment of impaction. Treatment for
impaction removal can be embarrassing and painful because it usually also requires
digital dislodgement with enema administration.
• If long-term laxative use is necessary, a bulk-forming agent may be prescribed in
combination with an osmotic laxative.
Specific medications may be prescribed to enhance colonic transit by
increasing propulsive motor activity.
• Cholinergic agents (eg, bethanechol [Urecholine])
• cholinesterase inhibitors (eg, neostigmine [Prostigmin])
• prokinetic agents (eg, metoclopramide [Reglan])
• serotonin receptors such as tegaserod (Zelnorm) and prostones such
as lubiprostone (Amitiza).
 NURSING MANAGEMENT
• The nurse elicits information about the onset and duration of
constipation, current and past elimination patterns, the patient’s
expectation of normal bowel elimination, and lifestyle information
(eg, exercise and activity level, occupation, food and fluid intake, and
stress level) during the health history interview.
• Past medical and surgical history, current medications, and laxative
and enema use are important, as is information about the sensation
of rectal pressure or fullness, abdominal pain, excessive straining at
defecation, and flatulence.
Goals for the patient include:
• restoring or maintaining a regular pattern of elimination by
responding to the urge to defecate
• ensuring adequate intake of fluids and high-fiber foods,
• learning about methods to avoid constipation
• relieving anxiety about bowel elimination patterns
• avoiding complications
 Thank you and
have a nice day!
😊