Constipation is a common gastrointestinal issue that affects individuals of all ages. In nursing care, constipation is a significant concern because it can lead to discomfort, decreased appetite, abdominal pain, and more severe complications if not addressed early. This article provides a complete, mobile-friendly guide to the nursing diagnosis of constipation, including definition, related factors, assessment findings, interventions, examples, and references.
Definition
Constipation is defined as a condition in which an individual experiences or is at risk for decreased frequency of bowel movements, often resulting in hard, dry stools that are difficult to pass. It is commonly caused by slowed intestinal transit, impaired neuromuscular function, inadequate hydration, or lifestyle patterns that affect bowel elimination.
Related Factors
Constipation can occur due to physiological, neurological, situational, psychological, and pharmacological factors. Identifying the related factors helps formulate an accurate nursing care plan.
1. Pathophysiological Factors
- Innervation disorders such as spinal cord lesions or injury
- Dementia
- Cerebrovascular accident (stroke)
- Neurological diseases (e.g., Parkinson’s disease, multiple sclerosis)
- Reduced metabolic rate (obesity, diabetic neuropathy, hypothyroidism, uremia, hyperparathyroidism)
- Decreased peristalsis caused by hypoxia due to cardiac or pulmonary conditions
2. Medication-Related Factors
- Aluminum-containing antacids
- Iron supplements
- Calcium supplements
- Barium preparations
- Anticholinergics
- Diuretics
- Narcotic analgesics (opioids)
- Antiparkinson medications
- Phenothiazines
3. Situational and Behavioral Factors
- Physical inactivity or immobilization
- Pregnancy
- Stress and anxiety
- Lack of exercise
- Irregular bowel habits
- Fear of pain during defecation
- Inadequate fluid or fiber intake
Assessment Data
Nurses must assess subjective and objective data to validate the nursing diagnosis of constipation.
Major Defining Characteristics
- Decreased frequency of bowel movements
- Hard, dry, or lumpy stools
- Straining during defecation
- Abdominal distension or bloating
Minor Defining Characteristics
- Sensation of rectal pressure
- Headache
- Decreased appetite
- Abdominal discomfort or pain
- Feeling of incomplete evacuation
Nursing Goals and Expected Outcomes
- Patient achieves regular bowel movements without straining.
- Stool becomes soft and easy to pass.
- Patient increases fluid and dietary fiber intake.
- Abdominal discomfort decreases.
- Patient demonstrates understanding of healthy bowel habits.
Nursing Interventions and Rationales
1. Assess Bowel Patterns
Intervention: Monitor bowel movement frequency, stool characteristics, and associated symptoms.
Rationale: Provides baseline information and helps evaluate the effectiveness of interventions.
2. Encourage Adequate Fluid Intake
Intervention: Encourage the patient to drink 6–8 glasses of water per day, unless contraindicated.
Rationale: Fluids help soften stools and support regular bowel movements.
3. Promote High-Fiber Diet
Intervention: Encourage fruits, vegetables, beans, whole grains, and oats.
Rationale: Fiber increases stool bulk and stimulates peristalsis.
4. Encourage Physical Activity
Intervention: Promote walking, mobility exercises, or gentle movement.
Rationale: Activity enhances gastrointestinal motility and reduces constipation.
5. Educate About Healthy Bowel Habits
Intervention: Encourage regular toileting schedules and responding promptly to the urge to defecate.
Rationale: Prevents stool retention and promotes consistent bowel elimination.
6. Administer Medications When Prescribed
Intervention: Provide bulk-forming agents, stool softeners, or mild laxatives as ordered.
Rationale: Medications may be necessary to relieve constipation or restore bowel function.
7. Monitor for Complications
Intervention: Observe for signs of impaction, rectal bleeding, or severe abdominal pain.
Rationale: Early detection helps prevent complications such as obstruction or hemorrhoids.
Examples and Clinical Scenarios
Example Scenario 1
A 70-year-old male patient with a history of stroke has not had a bowel movement for five days. He reports abdominal discomfort and poor appetite. The nurse encourages fluid intake, assists with mobility, and introduces fiber-rich meals. After two days, the patient reports improved bowel movement frequency.
Example Scenario 2
A postoperative patient using opioid pain medication experiences constipation. The nurse educates the patient about increasing hydration, ambulation, and dietary fiber, and administers the prescribed stool softener.
Possible Complications
- Fecal impaction
- Hemorrhoids
- Rectal prolapse
- Anal fissures
- Bowel obstruction
Conclusion
Constipation is a common yet often underestimated nursing concern. Understanding the related factors, signs, and appropriate interventions helps nurses deliver effective, patient-centered care. Through proper assessment, education, lifestyle modification, and monitoring, nurses play a crucial role in restoring healthy bowel elimination and preventing complications.
References
- NANDA International. (2021). NANDA-I Nursing Diagnoses: Definitions & Classification.
- Potter & Perry. (2021). Fundamentals of Nursing.
- Ignatavicius, D., & Workman, M. (2020). Medical-Surgical Nursing.
- World Gastroenterology Organisation (WGO) – Constipation Guidelines.
