CONSTIPATION

Prepared byRaneem
Prepared by
 Raneem Al-Hejres
 Sdeem Fayez
 Sarab AlRuwaili
 Amani AlRuwaili
 Hind AlRuwaili
 Raghad Fazaa
  Definition

 Cause

 Symptomes
Outline
 Risk factors

 complication

 Nursing process

 Assessment

 Nursing diagnosis

 Planning

 Intervention
Introduction
 Constipation affects a substantial portion of
the Western population and is particularly
prevalent in women, children, and older
adults. Many persons with constipation do
not seek medical attention, but because
constipation affects between 3% and 31% of
the population, it results in over $6.9 billion
in medical costs annually and is 1 of the most
common reasons for an office visit to a
physician. For most affected persons,
constipation is intermittent andrequires no or
minimal intervention.
Definition
Constipation is a condition in which
a person has fewer than three
bowel movements a week or has
bowel movements with stools that
are hard, dry, and small, making
them painful or difficult to pass.
Cause of
Consrpation
:Common lifestyle causes of constipation include 
.o Low in fibre diet 
.o Dehydrationo Lack of exercise 
.o Sedentary lifestyle & travelling 
.o Eating large amounts of milk or cheese 
.o Stress 
.o Resisting the urge to have a bowel movement 
o Oldage 
Cause of
-:Medications: Ex • 
Consrpation
Nonsteroidal anti-inflammatory drugs, 
.Antidepressants, Antacids, Iron pills
-:Underlying diseases condition 
Endocrine problems, like underactive thyroid 
gland(hypothyroidism), diabetes, Uremia,
.Hypercalcemia
.o Colorectal cancer 
.o Irritable bowel syndrome (IBS) 
o Diverticular disease 
o TumorNeurogenic disorders 
Symptoms
Hard stools that are difficult to passPain with 
bowel movementsAbdominal bloatingLow
back painHemorrhoids and/or fissuresLess
than three bowel movements a weekRectal
bleeding with bowel movements
Risk Factors
Risk FactorsDehydrationEating a diet that’s 
low in fiberGetting little or no physical
activityTaking certain medications
(sedatives, opioid pain medications, some
antidepressants, blood pressure
drugs)Having a mental health condition (such
as depression or an eating disorder)
  The most common complications associated
complications with constipation are discomfort and
irritation that can lead to:
 Hemorrhoids Rectal bleeding Anal fissures
(tears in skin around the anus)Sometimes,
the difficulty passing a bowel movement can
cause more serious complications, such as:
Rectal prolapse (the large intestine detaches
inside the body and pushes out of the
rectum)Fecal impaction (hard, dry stool is
stuck in the body and unable to be expelled
naturally)
 Nursing process

Identify residents with symptoms that are

indicative of possible constipation.
• Conduct a bowel assessment.
• Undertake a physical examination of the
abdomen and, where indicated, a digital rectal
examination.
Each process includes the following:

Assessment methods, Diagnosis, Nursing

Intervention and Evaluation.
Nursing Assessment
Check on the usual pattern of elimination, 
including frequency and consistency of
stool.It is very crucial to carefully know what
is "normal" for each patient. The normal
frequency of stool passage ranges from twice
daily to once every third or fourth day. Dry
and hard feces are common characteristics of
.constipation
Assess usual dietary habits, eating habits, • 
eating schedule, and liquidintake. Irregular
mealtime, type of food, and interruption of
.usual schedule can lead to constipation
CONTINUED...
Assess the patient's activity level. Sedentary 
lifestyle such as sitting all day, lack of exercise,
prolonged bed rest and inactivity contribute to
constipation.Feel the need for privacy for
elimination.Defecating
Assess for fear of pain with defecation. Conditions • 
such as hemorrhoids, anal fissures, or other
anorectal disorders that are painful can cause the
patient to ignore the urge to defecate, which over
time results in a dilated rectum that no longer
.responds to the presence of stool
Nursing Diagnosis

Inappropriate toileting behaviors / elimination

urgency / abdominal distention / pain on defecation
/ straining / rectal bleeding / low back pain / fever /
rectal bleeding / abdominal pain / inability to pass
flatus
Lost neurological functioning
Changes in dietary and fluid intake
Inability to recognize the need for elimination
Changes in the level of activity
Nursing Diagnosis Investgation used to evaluate constipation include
• blood test
• lower GI series
• flexible sigmoidoscopy or colonoscopy
• colorectal transit studies
• anorectal function tests
• defecography
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
 Treat pain/discomfort as needed with  
appropriate non-pharmacological and
pharmacological methods as necessary
Nursing Perform abdominal massage 
 Interventions Administer appropriate stool 
softeners/laxatives as ordered
Increase patient’s activity level as patient is 
able to tolerate
Increase hydration 
Increase fiber rich foods in diet 
 • Administer drug as ordered & check for side effects.
Nursing
o Encourage the fluid intake of 2500 to 3000 mL/day
Intervention • Assist patient to take at least 20 g of dietary fiber.
• Advice the patient for some physical activity and
exercise.
o Monitor bowel pattern
Nursing
Evaluation • The client was able to monitoring of bowel actions
for frequency, character and episodes of
constipation/faecal incontinence using an appropriate
assessment tool such as the Bristol Stool Chart .
• The client was able to monitor for episodes of
constipation/faecal soiling and use of laxative
interventions (oral and rectal).
The client was able to monitoring of diet and fluid• 
intake, exercise patterns and functional ability
The client was able to Monitor the resident’s• 
satisfaction with bowel patterns
Summary Constipation very important conditions 
history - exclude secondary causes
Defecatory disorders to be kept in mind
Anorectal manometry, transit study very
useful Significant overlap - use more than
one test Biofeedback therapy - treatment of
choice in defecatory disorders
Reference
Greenbaum, D.S. (2013) The Lower GI Tract and its -1
Common Functional Disorders. Milwaukee, WI 53217-
8076, U.S.A: Internatioonal Foundation for Functional
.Gastrointestinal Disorders
Registered Nurses’ Association of Ontario. (2011). Gap -2
analysis worksheet for Prevention of Constipation in the
Older Adult Population. Retrieved from
http://ltctoolkit.rnao.ca/clinical-topics/continence-
constipation
.
Royal College of Nursing. (2012). Management of lower -3
bowel dysfunction, including DRE and DRF; RCN
.guidance for nurses