Nursing Diagnosis of Constipation: A Comprehensive Guide for Nurses

Constipation, characterized by a decrease in the normal frequency of bowel movements, is a widespread health concern. It’s often accompanied by difficulty or incomplete stool passage, resulting in stools that are frequently hard and dry. As a prevalent gastrointestinal complaint, constipation can affect individuals of all ages, but certain populations are more susceptible. These include:

• Older Adults: This demographic often experiences reduced physical activity, slower metabolic rates, and diminished muscle strength throughout the digestive system, all contributing to constipation.
• Women (especially during pregnancy or postpartum): Hormonal fluctuations can disrupt bowel regularity in women. During pregnancy, the growing fetus can exert pressure on the intestines, slowing down stool transit.
• Individuals with Neurological Conditions: Certain neurological diseases can impact bowel function, leading to constipation.

Important Note: It is crucial to recognize that the nursing diagnosis “Constipation” has been updated to “Chronic Functional Constipation” by NANDA International. This revision by the Diagnosis Development Committee (DDC) reflects evolving language standards in healthcare. While the updated term is more precise, “Constipation” remains widely understood and used in clinical practice. For clarity and broader accessibility, this article will primarily use “Constipation” while acknowledging the official NANDA-I terminology.

In this guide, we will explore the Nursing Diagnosis Of Constipation in detail, covering its causes, signs and symptoms, assessment strategies, nursing interventions, and care plan examples.

Causes (Related Factors)

Identifying the underlying causes of constipation is essential for effective nursing diagnosis and intervention. Several factors can contribute to this condition:

• Dietary Factors:

  • Low Fiber Intake: A diet lacking in fiber-rich foods reduces stool bulk and slows down intestinal transit.
  • High Consumption of Dairy Products: Increased intake of milk, cheese, and other dairy items can contribute to constipation in some individuals.
  • Processed Foods: Diets heavy in highly processed foods are often low in fiber and can lead to constipation.
  • Dehydration: Insufficient fluid intake or dehydration can harden stools, making them difficult to pass. Nurses should also consider the risk of Fluid Volume Deficit as a related diagnosis.

• Activity Levels:

  • Sedentary Lifestyle: Low levels of physical activity and exercise can slow down bowel function.
  • Changes in Routine: Alterations in daily routines, such as travel or hospitalization, can disrupt regular bowel habits.
  • Limited Mobility: Bed rest and poor mobility significantly reduce physical activity and contribute to constipation.
  • Chronic Disability: Individuals with chronic disabilities may experience reduced mobility and altered bowel function.

• Psychological Factors:

  • Stress: Psychological stress can have a significant impact on gastrointestinal motility and contribute to constipation.

• Behavioral Factors:

  • Ignoring the Urge to Defecate: Regularly suppressing the urge to have a bowel movement can lead to constipation over time as the rectum becomes less sensitive to distension.

• Physical Health Factors:

  • Oral/Dental Issues: Dental problems can impact dietary choices, potentially leading to lower fiber intake.
  • Pregnancy and Postpartum: Hormonal changes and physical pressure during pregnancy and after childbirth can contribute to constipation.
  • Chronic Pain: Chronic pain may lead to reduced physical activity and medication use, both of which can increase the risk of constipation.

• Medications: A wide range of medications can have constipation as a side effect. These include:

  • Pain Medications:
    • Narcotics (Opioids): Opioid analgesics are notorious for causing constipation by slowing down bowel motility.
    • NSAIDs (Nonsteroidal Anti-inflammatory Drugs): While less likely than opioids, NSAIDs can still contribute to constipation in some individuals.
  • Antidepressants: Certain antidepressant medications can have anticholinergic effects, leading to constipation.
  • Antacids Containing Calcium or Aluminum: These types of antacids can cause constipation as a side effect.
  • Iron Supplements: Iron supplements are a common cause of constipation due to their effect on stool consistency.
  • Allergy Medications (Antihistamines): Some antihistamines possess anticholinergic properties, which can lead to constipation.
  • Certain Blood Pressure Medications: Some medications for hypertension can have constipation as a side effect.
  • Psychiatric Medications: Various psychiatric medications can contribute to constipation.
  • Antiemetics: Paradoxically, some antiemetics can cause constipation.
  • Anticonvulsants: Certain anticonvulsant medications may also lead to constipation.

• Underlying Medical Conditions:

  • Hypothyroidism: An underactive thyroid gland can slow down metabolism and contribute to constipation.
  • Irritable Bowel Syndrome (IBS): While IBS can also cause diarrhea, constipation is a common symptom in some subtypes.
  • Neurological Disorders: Conditions like Parkinson’s disease and multiple sclerosis can affect bowel function.
  • Colorectal Cancer: Although less common, constipation can be a symptom of colorectal cancer and should be investigated, especially in older adults or when accompanied by other concerning symptoms.

Signs and Symptoms (Defining Characteristics)

Recognizing the signs and symptoms of constipation is crucial for accurate nursing diagnosis. These can be categorized as subjective (patient-reported) and objective (nurse-assessed) data:

Subjective Data (Patient Reports)

• Infrequent Bowel Movements: Fewer than three bowel movements per week is a key indicator of constipation.
• Hard, Dry Stools: Patients may describe their stools as hard, dry, and difficult to pass.
• Lumpy Stools: Stool consistency may be described as lumpy or pebble-like.
• Straining During Defecation: Significant straining and effort are often required to pass stools, sometimes accompanied by pain.
• Pain and Discomfort: Patients may report stomach pain, aches, or cramps associated with constipation.
• Bloating and Nausea: Sensations of bloating, fullness, and nausea can accompany constipation.
• Incomplete Evacuation: A persistent feeling that the bowels are not fully emptied after a bowel movement is a common complaint.

Objective Data (Nurse Assessment)

• Medical History Review: Assess the patient’s medical history for factors that could contribute to constipation, such as:
  • History of constipation
  • Activity level
  • Medications, including routine use of laxatives or stool softeners
• Abdominal Pain Assessment: If abdominal pain is present, conduct a thorough assessment using an age-appropriate pain scale. Document:
  • Location: Where is the pain located in the abdomen?
  • Severity: How intense is the pain (using a pain scale)?
  • Duration: How long has the pain been present?
  • Description: What does the pain feel like (e.g., sharp, cramping, dull)?
  • Aggravating/Relieving Factors: What makes the pain worse or better?
  • Consider abdominal pain nursing diagnosis if pain is a primary concern.
• Comprehensive Abdominal Assessment: Perform a systematic abdominal assessment in the following order to avoid altering bowel sounds:
  • Inspection: Observe the abdomen for distention, scars, or visible peristalsis.
  • Auscultation: Listen to bowel sounds in all four quadrants, noting their frequency and character (normal, hyperactive, hypoactive, absent).
  • Percussion: Percuss the abdomen to assess for tympany (air) or dullness (fluid or masses).
  • Palpation: Gently palpate the abdomen to assess for tenderness, masses, or organomegaly.
• Stool Characteristics Assessment: Evaluate stool characteristics based on patient reports and, when possible, direct observation. Note:
  • Color: Abnormal stool colors (e.g., black, red, pale) may indicate underlying issues.
  • Consistency: Use the Bristol Stool Chart to objectively categorize stool consistency.
  • Amount: Estimate the volume of stool passed.
  • Utilize the Bristol Stool Chart as a standardized tool for assessing stool form and consistency.

Image alt text: Bristol Stool Chart illustrating seven types of stool consistency, ranging from type 1 (separate hard lumps) to type 7 (watery, no solid pieces). Used for assessing bowel function and constipation.

Expected Outcomes (Goals)

Setting realistic and patient-centered goals is essential for effective nursing care planning for constipation. Common expected outcomes include:

• Normal Bowel Function: Patient will report passing soft, formed stools with bowel movements, indicating improved stool consistency.
• Regular Bowel Movements: Patient will establish a bowel movement frequency within the range of three times per week to three times per day, reflecting a return to a more regular pattern.
• Pain-Free Defecation: Patient will verbalize being free of pain and straining during bowel movements, signifying improved comfort.
• Understanding of Prevention: Patient will be able to identify actions and lifestyle modifications to prevent constipation recurrence in the future, demonstrating knowledge and self-management skills.
• Lifestyle Modifications: Patient will be able to enumerate specific behavior or lifestyle changes they can implement to prevent constipation, indicating a commitment to long-term health.

Nursing Assessment for Constipation

A thorough nursing assessment is the foundation for developing an effective care plan for patients with constipation. This involves gathering both subjective and objective data.

1. Assess Changes in Bowel Habits: Inquire about any recent changes in bowel movement patterns and stool characteristics. Specifically note:

• Time of Day: When do bowel movements typically occur?
• Frequency: How often are bowel movements occurring now compared to usual?
• Experience: Are there any pain, straining, or difficulty during bowel movements?
• Previous Bowel Aids: Does the patient typically use stool softeners, laxatives, or other aids to facilitate bowel movements?

2. Observe Stool Characteristics: Monitoring stool characteristics provides a baseline for comparison and helps evaluate the effectiveness of interventions. Assess the following:

• Amount: How much stool is typically passed?
• Consistency: Use the Bristol Stool Chart to document consistency.
• Color: Note any unusual stool colors.
• Odor: While less specific, significant changes in odor might be relevant in some cases.

3. Assess Lifestyle Choices: Identify daily routine factors that may contribute to constipation. This information is crucial for developing individualized care plans and preventive strategies. Ask about:

• Activity Level: How physically active is the patient?
• Exercise Habits: Does the patient engage in regular exercise?
• Food Preferences: What types of foods does the patient typically eat?
• Dietary Habits: Describe the patient’s typical daily diet, focusing on fiber and fluid intake.

4. Review Medical History and Medications: Certain medical conditions and medications are known risk factors for constipation. Identifying these helps determine appropriate treatment strategies.

• Medical Conditions: Inquire about conditions like hypothyroidism, IBS, neurological disorders, etc.
• Medication List: Review all medications (prescription, over-the-counter, and supplements) for potential constipating side effects.

5. Check for Emotional Distress: Stress, anxiety, and depression can impact bowel function. Assessing for these factors is important for holistic patient care.

• Stress Levels: How stressed or anxious is the patient feeling?
• Mood: Are there any signs of depression or other mood disorders?

6. Utilize the Bristol Stool Scale: Employ the Bristol Stool Scale consistently to assess and document stool consistency objectively. This standardized tool ensures clear communication among healthcare team members.

7. Assess for Laxative Abuse or Misuse: Be vigilant for signs of laxative abuse, especially in older adults who may be at higher risk for chronic constipation and overuse of stimulant laxatives. Inquire about frequency and type of laxative use.

8. Identify Life Changes or Stressors: Major life changes and stressors can trigger or worsen constipation. Explore recent or ongoing stressors such as:

• Pregnancy
• Travel
• Trauma
• Changes in Relationships
• Occupational Factors
• Financial Worries
  These factors can disrupt routines and lead to neglecting bowel habits or experiencing gastrointestinal effects of stress.

9. Investigate Causes of Pain During Defecation: If the patient reports pain with bowel movements, explore potential underlying causes:

• Hemorrhoids
• Rectal Fissures or Prolapse
• Skin Breakdown in the Perianal Area
  These conditions can make defecation painful, leading to stool withholding and worsening constipation.

10. Perform Abdominal Assessment: Conduct a systematic abdominal assessment using the techniques of inspection, auscultation, percussion, and palpation in the correct sequence. This provides valuable objective data for diagnosis and treatment planning.

11. Perform Digital Rectal Examination (DRE): A DRE may be indicated to assess:

• Rectal Tone: Strength of the anal sphincter muscles.
• Pain or Bleeding: Presence of tenderness or blood in the rectum.
• Fecal Impaction: Presence of hard, impacted stool in the rectum.
  Note: DRE should be performed with sensitivity and patient comfort in mind, following institutional guidelines.

12. Consider Extensive Work-up if Treatment Fails: For persistent constipation unresponsive to initial medical management (over 3-6 months), consider referral for a more extensive outpatient work-up. Anorectal testing can help identify defecatory disorders. These tests may include:

• Anorectal Manometry: Measures pressure in the anal canal and rectum.
• Colonic Manometry: Assesses muscle activity in the colon.
• Colonic Transit Studies: Evaluates the rate at which stool moves through the colon.
• Surface Anal Electromyography (EMG): Measures electrical activity of anal sphincter muscles.
• Balloon Expulsion Testing: Assesses the ability to expel a balloon from the rectum.
• Imaging Studies: X-rays and ultrasound may be used to visualize the colon.
• Lower Gastrointestinal (GI) Endoscopy: Procedures like sigmoidoscopy or colonoscopy may be necessary to rule out structural abnormalities.

13. Assist with Imaging Studies as Indicated: Imaging tests, such as abdominal X-rays or CT scans, may be ordered to:

• Rule out Underlying Causes of Colonic Ileus (Bowel Obstruction)
• Investigate Causes of Persistent Constipation

Nursing Interventions for Constipation

Nursing interventions are crucial for managing constipation and promoting bowel regularity.

1. Manual Disimpaction: For patients with fecal impaction, manual disimpaction may be necessary as an initial treatment. This involves digitally removing impacted stool from the rectum using a lubricated, gloved finger. Transrectal enemas may also be used in conjunction with or after disimpaction.

2. Administer Laxatives and Stool Softeners as Prescribed: Pharmacological interventions can be helpful in the short term to initiate bowel movements. Common types include:

• Bulk-Forming Agents (Fiber Supplements): Psyllium, methylcellulose, and wheat bran increase stool bulk and promote peristalsis.
• Emollient Stool Softeners: Docusate softens stool by increasing water and fat content.
• Rapidly Acting Lubricants: Mineral oil lubricates the stool and intestinal walls to ease passage. Use with caution, long-term use is generally discouraged.
• Prokinetics: Tegaserod (and other prokinetics if available) can stimulate bowel motility. Availability may vary and use is often limited.
• Stimulant Laxatives: Senna, bisacodyl stimulate intestinal contractions. Use should be short-term and avoided long-term due to potential dependence.
• Osmotic Laxatives: Polyethylene glycol (PEG), lactulose, magnesium citrate draw water into the bowel to soften stool. PEG is often preferred for chronic constipation due to its safety profile.
• Chloride Channel Activators: Lubiprostone and linaclotide increase intestinal fluid secretion and motility. Often used for chronic idiopathic constipation.

3. Apply Lubricant or Anesthetic Ointment: For patients with painful defecation due to hemorrhoids or fissures, topical lubricants and anesthetic ointments can provide relief and facilitate stool passage.

4. Emphasize Lifestyle Modifications: Patient education is paramount and should focus on long-term prevention of constipation through lifestyle changes rather than reliance on medications. Key teaching points include:

• Dietary Changes: Proper diet with adequate fiber and fluids.
• Hydration: Adequate fluid intake.
• Regular Physical Activity and Exercise.

5. Encourage a High-Fiber Diet: A balanced, fiber-rich diet is essential for preventing and managing constipation. Recommend incorporating:

• Whole Foods: Fruits, vegetables, and whole grains.
• Fiber Supplements: Wheat bran, psyllium, and other fiber supplements can be helpful if dietary intake is insufficient.
• Fiber-Rich Food Choices:
  • Fruits: Raspberries, strawberries, blueberries, pears, apples, bananas.
  • Vegetables: Peas, broccoli, Brussels sprouts, potatoes, sweet corn, cauliflower, carrots.
  • Grains: Barley, quinoa, bran, oatmeal, brown rice, whole wheat bread.
  • Legumes and Nuts: Split peas, lentils, baked beans, black beans, chia seeds, almonds, walnuts.
• Limit Low-Fiber and High-Fat Foods: Reduce intake of ice cream, cheese, meats, processed meals, and fast food, as these can contribute to constipation.

6. Promote Increased Fluid Intake: Adequate hydration is crucial for stool softening and ease of passage. Encourage intake of:

• Water: Plain water is the best choice.
• High-Fiber Fruits: Fruits with high water content can contribute to fluid intake.
• Vegetable Juices: Low-sodium vegetable juices.
• Fruit and Vegetable Smoothies: Healthy smoothies can increase both fluid and fiber intake.
• Popsicles: Can be a palatable way to increase fluid intake, especially for children or older adults.
• Warm Liquids: Tea, hot water with lemon, or decaffeinated coffee can stimulate bowel motility in some individuals.

7. Avoid Caffeine and Alcohol: Caffeine and alcohol can have dehydrating effects and may irritate the gastrointestinal tract in some individuals, potentially worsening constipation.

8. Advise Physical Activity: Encourage daily exercise and physical activity appropriate to the patient’s abilities. Exercise improves muscle tone, including abdominal muscles, and aids in digestion and bowel motility.

9. Encourage Elimination Diary: For patients with chronic constipation, an elimination diary can be a helpful tool to track bowel habits, diet, fluid intake, medications, and the effectiveness of interventions.

10. Establish Regular Bowel Movement Routine: Encourage patients not to ignore the urge to defecate and to establish a regular toileting schedule. Promote predictable timing, such as after meals, when the gastrocolic reflex is most active.

11. Promote Bowel Management Program: For patients with chronic bowel issues, a structured bowel management program can be beneficial. This includes:

• Privacy: Ensure privacy during toileting.
• Scheduled Time: Establish a regular time for attempting bowel movements.
• Preferred Toileting Method: Inquire about patient preferences for toilet, commode, or bedpan to maximize comfort and relaxation.

12. Promote Pain Relief During Defecation: For patients experiencing pain, suggest:

• Sitz Bath: A warm sitz bath before attempting defecation can relax the anal sphincter and reduce pain.

13. Gentle Abdominal Massage: Perform gentle abdominal massage, following the path of the colon (clockwise), to stimulate peristalsis and encourage stool movement.

14. Teach Abdominal Massage Techniques: Instruct the patient on how to perform abdominal massage independently at home.

15. Refer to Healthcare Provider for Medical Therapy: Advise patients to consult their healthcare provider before initiating or changing any medical therapies for constipation (laxatives, enemas, suppositories) to prevent misuse and ensure appropriate management.

16. Assist with Surgical Interventions (Rare): Surgery is rarely required for functional constipation but may be considered in a small percentage of patients with severe, refractory constipation. Surgical options include:

• Anal Procedures: For underlying anorectal issues.
• Antegrade Enemas (ACE Procedure): For severe cases unresponsive to other treatments.
• Colorectal Resection: In very rare cases of severe colonic inertia.
• Intestinal Diversion: Extremely rare and reserved for the most intractable situations.

17. Sacral Nerve Stimulation (Emerging Therapy): Sacral nerve stimulation is being investigated as a potential treatment for functional constipation, particularly in children. It involves stimulating the sacral nerves to improve bowel function. Further research is ongoing.

18. Provide Emotional Support: Offer ongoing emotional support and address any psychological distress related to bowel control issues. Chronic constipation can be frustrating and impact quality of life. Provide reassurance and connect patients with resources as needed.

Nursing Care Plans for Constipation

Nursing care plans provide a structured framework for organizing assessments and interventions to achieve patient-centered outcomes. Here are examples of nursing care plans for constipation:

Care Plan #1: Opioid-Induced Constipation

Diagnostic Statement:

Constipation related to opioid analgesics as evidenced by lack of bowel movement post-surgery.

Expected Outcomes:

• Patient will pass soft, formed stools every 1 to 3 days without straining, indicating resolution of opioid-induced constipation.
• Patient will implement measures to relieve opioid-induced constipation and prevent recurrence.

Assessment:

1. Review Medication History: Opioid-induced constipation is a common side effect. Determine if the patient is taking opioids and if so, the dosage and frequency. Verify if the medication is being taken as prescribed. Opioid-induced constipation affects a significant proportion of patients taking opioids for pain relief, even in non-cancer settings.

2. Assess Normal Defecation Pattern: Determine the patient’s usual bowel habits before opioid use. Normal bowel frequency varies, but hard, dry stools are characteristic of constipation. Utilize Rome Criteria IV, if appropriate, to assess for functional constipation. According to Rome IV criteria, constipation is present if at least two of the following criteria are met for the last three months:

• Hard stools in ≥25% of bowel movements
• Straining in ≥25% of bowel movements
• Sensation of incomplete evacuation in ≥25% of defecations
• Manual maneuvers to facilitate defecation in ≥25% of defecations

Interventions:

1. Administer Laxatives as Indicated: Prophylactic laxative use is generally recommended for all patients prescribed opioids, except for bulk-forming laxatives alone (they may not be sufficient for opioid-induced constipation). A combination approach is often most effective.

2. Encourage Early Physical Mobility: Promote early ambulation and physical activity post-surgery, as tolerated. Early mobility helps prevent constipation and reduces other postoperative complications, promotes faster recovery, and shortens hospital stays. [Reference: Tazreean, Nelson, & Twomey, 2022]

3. Educate Patient and Family about Opioid-Induced Constipation: Explain that constipation is a common and expected side effect of opioid analgesics. Reassure the patient that this is manageable with appropriate interventions, such as stimulant laxatives (senna/bisacodyl), stool softeners (docusate), or osmotic laxatives (polyethylene glycol), combined with physical activity.

4. Discourage Long-Term Laxative Use (Stimulant Laxatives): Advise against routine long-term use of stimulant laxatives, as this can lead to laxative dependence and impaired bowel function over time. Focus on lifestyle modifications and other strategies for long-term management.

Care Plan #2: Constipation Related to Immobility

Diagnostic Statement:

Constipation related to immobility as evidenced by bloating and abdominal discomfort.

Expected Outcomes:

• Patient will pass Bristol Stool Chart Type 3 (sausage-shaped with cracks) or Type 4 (sausage-shaped, smooth, and soft), indicating improved stool consistency.
• Patient will report relief from constipation-related discomfort, as evidenced by the absence or reduction of:
  • Bloating
  • Abdominal discomfort
  • Abdominal distension
  • Anorexia
  • Nausea
  • Vomiting
• Patient will demonstrate measures to relieve discomfort associated with immobility-related constipation.

Assessment:

1. Assess Usual Bowel Pattern: Thoroughly assess the patient’s typical bowel habits, including:

• Time of day for bowel movements
• Stool amount
• Frequency of bowel movements
• Stool consistency (baseline using Bristol Stool Chart)
• History of laxative use
• Dietary habits (fiber intake)
• Exercise patterns
• Fluid intake
  Each individual has a “normal” bowel pattern. A detailed baseline assessment is crucial for evaluating the effectiveness of nursing interventions.

2. Assess Mobility Level: Determine the patient’s current level of mobility and any limitations. Knowing the extent of mobility helps plan appropriate exercise and activity interventions.

Interventions:

1. Advise Increased Fiber Intake: Recommend a daily fiber intake of 18 to 25 grams. Suggest fiber-rich food sources such as prune juice, leafy green vegetables, wholemeal bread, and pasta. Fiber adds bulk to the stool, stimulating peristalsis and reducing bowel transit time.

2. Advise Increased Fluid Intake: Recommend a fluid intake of 1.5 to 2 liters per day (6 to 8 glasses of water), unless contraindicated by comorbidities like kidney or heart disease. Water softens the fecal mass, promotes lubrication, and prevents stool impaction.

3. Encourage Physical Activity: Promote physical activity within the patient’s mobility limitations.

• For immobile patients: Encourage turning and repositioning in bed regularly.
• For patients with reduced mobility: Suggest gentle exercises like knee-to-chest raises, waist twists, and arm stretches to stimulate peristalsis. Physical activity stimulates peristaltic waves in the colon, facilitating stool transit.

4. Demonstrate Abdominal Massage: Demonstrate gentle external abdominal massage using aromatherapy oils (if appropriate and not contraindicated), following the direction of colon flow (clockwise). Abdominal massage increases intra-abdominal pressure, encouraging rectal loading and potentially stimulating bowel sensation.

5. Perform Enemas or Disimpaction (If Necessary): Consider enemas if natural interventions are ineffective. Enemas can cleanse the bowel and stimulate emptying. Manual disimpaction may be needed for fecal impaction unresponsive to other measures.

Care Plan #3: Constipation Related to Poor Diet Habits

Diagnostic Statement:

Constipation related to poor diet habits as evidenced by straining to have bowel movements and fewer than three stools per week.

Expected Outcomes:

• Patient will maintain passage of soft, formed stool without straining, indicating improved bowel function.
• Patient will identify measures to prevent or treat constipation through dietary modifications and lifestyle changes.

Assessment:

1. Review Daily Dietary Regimen: Assess the patient’s daily diet, paying particular attention to fiber intake. Determine if the diet is deficient in fiber-rich foods (vegetables, fruits, whole grains) and high in processed foods, which contribute to poor intestinal function.

2. Note Oral/Dental Health Issues: Inquire about any oral or dental problems that may affect dietary intake. Dental issues can lead to a preference for soft, low-fiber foods.

3. Determine Fluid Intake: Assess daily fluid intake to identify potential deficits. Inadequate fluid intake is a significant contributor to constipation. Encourage the patient to track their water intake, using glasses or water bottles to monitor consumption.

Interventions:

1. Discuss Laxative and Enema Use (Appropriate Use and Limitations): Discuss the role of laxatives and enemas in relieving constipation but emphasize that these should not be substitutes for long-term lifestyle modifications. Explain that lifestyle changes are more effective and sustainable for managing chronic constipation.

2. Identify Bowel Activity Stimulating Factors: Help the patient identify factors that typically stimulate their bowel activity. These might include caffeine, walking, or previous laxative use. Also, identify factors that may precipitate constipation, such as opioid pain medications, limited mobility, or pelvic surgery. Utilize stimulating factors, where appropriate and safe, to help promote bowel movements.

3. Promote Lifestyle Changes (Comprehensive Education): Provide detailed education and encouragement regarding lifestyle modifications:

• Dietary Fiber: Instruct and encourage a diet balanced with fiber and bulk. Emphasize fruits, vegetables, and whole grains. Suggest fiber supplements (wheat bran, psyllium) if needed to meet daily fiber goals.
• Limit Low-Fiber and High-Fat Foods: Advise limiting foods with little or no fiber, as well as high-fat foods (ice cream, cheese, meats, fast foods, processed foods).
• Adequate Fluid Intake: Promote adequate fluid intake, including water, fruit and vegetable juices, and fruit/vegetable smoothies.
• Warm, Stimulating Fluids: Suggest drinking warm liquids like decaffeinated coffee, hot water, or tea, which can stimulate bowel motility in some individuals.
• Daily Activity and Exercise: Encourage daily activity and exercise within the patient’s abilities.
• Don’t Ignore Urge to Defecate: Advise against ignoring the urge to have a bowel movement.
• Establish Regular Toileting Schedule: Promote privacy and a routinely scheduled time for attempting bowel movements, preferably using a bathroom or commode rather than a bedpan if hospitalized.
  Dietary fiber increases stool bulk and softens consistency, promoting easier stool elimination and overall bowel health.

4. Encourage Sitz Baths: Recommend sitz baths, particularly for patients with painful defecation. Sitz baths relax the anal sphincter and provide cleansing and soothing effects to the rectal area.

References

1. Ackley, B.J., Ladwig, G.B., Flynn Makic, M.B., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook: An evidence-based guide to planning care (12th edition). Mosby.
2. Basson, M. D. (2021, October 17). Constipation treatment & management: Approach considerations, dietary measures, pharmacologic therapy. Diseases & Conditions – Medscape Reference. Retrieved July 2023, from https://emedicine.medscape.com/article/184704-treatment#showall
3. Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
4. Diaz, S., Bittar, K., & Mendez, M. D. (2023, January 31). Constipation – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. Retrieved July 2023, from https://www.ncbi.nlm.nih.gov/books/NBK513291/
5. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions and rationales (15th ed.). F. A. Davis Company.
6. Cleveland Clinic (2019). Constipation. https://my.clevelandclinic.org/health/diseases/4059-constipation
7. Gulanick, M. & Myers, J.L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
8. Herdman, T. H., Kamitsuru, S., & Lopes, C. (Eds.). (2024). NANDA-I International Nursing Diagnoses: Definitions and Classification, 2024-2026. Thieme. 10.1055/b-000000928
9. Mayo Clinic (2021). Constipation. https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253
10. Mayo Clinic (2021). Nutrition and healthy eating. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/high-fiber-foods/art-20050948
11. Sizar, O., Genova, R.,& Gupta, M. (2022). Opioid-induced constipation. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK493184/
12. Tazreean, R., Nelson, G., & Twomey, R. (2022). Early mobilization in enhanced recovery after surgery pathways: current evidence and recent advancements. Journal of comparative effectiveness research, 11(2), 121–129. https://doi.org/10.2217/cer-2021-0258