Assessment and Management
of Constipation
Emily Booth RN BScN MN PHC-NP
NURSE LED OUTREACH TEAM
Agenda
 Definition
 Types/Classification
 Causes
 Anatomy and Physiology
 Bowel Assessment
 Treatment
 Summary/Conclusion
What is Constipation?
One or more of…
Excessive straining with bowel movement
Sense of incomplete emptying with BM
Failed or lengthy attempts to defecate
Hard stools
Decreased stool frequency
Prevalence
 Most common digestive complaint
 4.53 million people per year
 2.5 million physician visits per year
 Twice as common in women than men
 2 fold increase in LTC residents
Types of Constipation
Types of Constipation
Primary Causes:
 Disorder of neuromuscular function and brain- gut
function
 Slow transit time (decreased propulsion of stool)
 Evacuation disorders (incoordination of contractions
or inadequate relaxation of pelvic floor muscles
during defecation)
 IBS (genetic, environmental, social, biological, psych
factors)
Types of Constipation
Secondary Causes: other conditions
 Dietary – inadequate fluid intake and dietary fibre
 Behavioural – decrease physical activity, failure to
respond to initial urge to defecate, chronic use of
stimulant laxatives
 Metabolic – hypercalcemia, hypothyroid
 Neurologic – parkinsons, spinal cord lesions, DM
 Disease of the colon – strictures, fissures, ca
Anatomy and Physiology
Anatomy and Physiology
Colon – divided into ascending colon ( from cecum
to edge of liver border), goes across the abdomen
under the stomach called the transverse colon and
then descends down the left side of the abdomen
(descending colon)and leads into the sigmoid colon
and rectum
 Ascending and transverse colon absorb H2O and
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electrolytes
Descending and sigmoid colon stores fecal matter until
eliminated
Smooth muscle of colon contracts and relaxes in
response to distension and mixing movements occur
Contents of colon enter the rectum usually q am
Spinal reflex to defecate occurs and the anal sphincter
relaxes or contracts with pelvic and abdominal muscle
movement
Risk Factors for Older Adults
Diet low in fibre
Poor or reduces oral fluid intake
Low level of physical activity or immobility
Advanced age
Overuse of laxatives
Endocrine/metabolic disease (diabetes, hypothyroid,
hypercalcemia, hypokalemia)
 Neurologic disease (stroke, MS, parkinsons)
 Disease of the colon (diverticulitis, IBS)
 Medications (anticholinergic drugs)
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Drug Induced Constipation
OPIOIDS Cause Constipation
Codeine, morphine, oxycodone, fentanyl patch
The Hand that Writes the Narcotic Writes
the Cathartic
Drug Induced Constipation
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Antinauseant
Antiparkinson meds
Alzheimers meds
Iron supplements
Incontinence meds
Antacids
Ulcer meds
Antidepressants
Antipsychotics
Antihypertensives
Lipid lowering drugs
Quality of Life
 Pain, discomfort, bloating
 Lack of appetite
 Nausea
 Fatigue
 Irritability
 Change in behaviour
 Haemorrhoids, prolapse
 Fecal impaction , diarrhea
Bowel Assessment
The most essential step is determining the etiology or
cause
Usual bowel pattern and measures currently used
Hx of problem
Ability to sense urge to defecate
Daily fluid and fibre intake
Relevant medical/surgical hx
Functional abilities
7 day bowel record
Physical assessment
Treatment
First line acute
 Treat underlying cause
 Diet and lifestyle measures
 Prunes and /or stool softener
 If impacted , enema/suppository/disimpaction and
stimulant laxative
Ongoing Constipation
First line
 Treat underlying cause
 Diet/lifestyle measures
 Bulk laxative (metamucil/psyllium) or prunes, and/or
stool softener
Second line
 Diet/lifestyle measures
 Osmotic laxative (lactulose, mg containing laxatives)
Third line
Diet/lifestyle measures
Osmotic laxative (lactulose, glycerin, PEG or mg
containing products – MOM, citromag fleet)
Stimulant laxative (senna, castor oil or dulcolax) if no
BM x 3 days
Laxatives
 Caution with bulk forming laxatives in elderly , may
cause obstruction
 Stool softeners are not to be used alone for
constipation. Little value for chronic constipation.
Help with pain and straining with defecating
Pharmacologic Considerations
 Meds do have a place in the treatment of
constipation
 Short term, time limited
 Choose laxatives based on resident symptoms and hx
 Use homes bowel protocol
Summary
 Focus is on prevention
 Resident specific interventions
 Staff communication ( 7 day bowel record and
ongoing monitoring)
 In house bowel protocol
 Pharmacological interventions
The End