Constipation is a common complaint seen in many different patient populations. It occurs most commonly in the elderly, but even young patients can be constipated, especially if they are on chronic opiod therapy. The pathophysiology of this condition may be due to many factors. One potential cause is dehydration, causing hard stools. Another is neurological defects in the colon. Side effects from medication are yet another possibility for the slowing of faeces in transit through the large intestine.
Laxatives and other preparations are among the most common over the counter remedies used by the public. However, the treatment of constipation is often more complex than simply using a laxative. In addition, the overuse of these pharmacological treatments can lead to a sluggish bowel that refuses to be stimulated to motility without outside help. As a nurse, you should try several different treatments for constipation before immediately resorting to medications. It is important to educate patients and caregivers alike on the many ways to treat this common condition.
Toileting behaviors and training are a big issue in treating constipation. Often, elderly patients have weak abdominal muscles, and this makes it difficult to expel faeces. In addition, most people are lying flat which does not make defecating any easier. You should encourage your patient to get into a position that is going to help them move their bowels. The best position for this is a squat, but it can be challenging to get your patient into this position.
If the patient is able to ambulate to the bathroom, do what you can to bend their knees and assist them in leaning forward with supervision. Although privacy is a large part of moving ones bowels, it would be unsafe to leave a patient in this position due to fall risks. Even if your patient is on a bedpan, you can still facilitate this position. Sit the head of the bed up, helping the patient to get comfortable on the pan with the change in angle. Encourage them to bend their knees toward their chest or help them to get into a squatting position by arranging their legs yourself. It may feel awkward, but this position will help the patient activate the muscles needed for defecation.
Diet and Exercise
Diet and exercise are going to vary widely depending on who your patient is. If you are talking to someone with occasional constipation that is not in a health facility, it helps to suggest a high fibre diet, particularly foods like bran, prune juice, and whole grain breads. You should also encourage them to drink more fluids, particularly water, to help with transit of the stool through the large intestine. Fortunately, there are many dietary products on the market that can help with constipation. There are high fibre bars that can easily provide patients their recommended daily intake (RDI) of fibre. In addition, soluble fibre is available in a solution that completely dissolves, helping make it more palatable for the average irregular user.
Patients and residents of health facilities still need to focus on diet and exercise to increase their ability to move stool. The meals they are fed should be high in fibre and whole grains. Again, it helps to make the fibre more palatable to encourage patients to get their RDI. One potential problem with nursing home residents in particular is poor hydration. It is very easy for a patient to become dehydrated unless they are offered liquids on a regular basis. Some patients may not realise they are thirsty, while others may not ask. Liquid is important for preventing constipation, and policies should be in place to encourage drinking.
Pharmacological intervention should only be used as a last resort if toilet training and diet does not work. The most common medication used for constipation in nursing homes is stool softener, which pulls water and fat into the stools for easier transit through the colon. This is not fast acting and usually helps when taken over a period of time. Bulk forming laxatives (soluble fibre supplements) were touched on briefly above. If the patient is not able to get fibre in their diet, then these can help to make up for the fibre missing in the diet.
Osmotic laxatives are commonly used medications; for instance low-dose polyethylene glycol or saline solutions. Like stool softeners, these laxatives help to pull water into the colon and are not absorbed while they are in the intestine. They tend to work more quickly than stool softeners, but not as quickly as stimulant laxatives. Stimulant laxatives are the type that most people think about when considering how to move their bowels. They irritate the bowel to promote the transit of stool, but they can be addictive.
- Lippincott Nursing Center; Preventing, assessing, and managing constipation in older adults; Francis Toner BSN, RN and Edith Claros PhD, MSN, RN; December 2012
- Rehabilitation Nursing Foundation; Practice Guidelines For The Management Of Constipation In Adults; Susan L. Folden, PHD ARNP CS, et. al.