Constipation Care Plan

By Fritz Mequiabas, RN,  BSN

Constipation care plan

Constipation is a symptom associated with various diseases.

It is prevalent among both young and elderly individuals. Usually, a lack of fiber, fluid and exercise are what disrupt normal bowel patterns.

However, there are other instances where taking narcotic analgesics or over using laxatives can result in constipation.

Even stress or depression can have its constipating effects. This is why medical doctors prescribe various treatment options to help individuals avoid the straining or pain from constipation that can come in the form of a constipation care plan.

Although constipation is not typically considered a serious condition, it is still helpful to be aware of available solutions. 

The following comprehensive care plan will help ensure that constipation is not ongoing. Chronic constipation may result in further complications, including hemorrhoids, diverticulitis and perforation of the colon. 

The following comprehensive care plan will expose related factors, define characteristics, reveal expected outcomes and give possible interventions that can help an individual avoid the risks associated with chronic constipation. 

Factors that may contribute to constipation

Constipation can be caused by the following factors

• A lack of fiber in the diet
  
  
• Eating foods high in hard to digest fats and proteins
  
  
• Dehydration
  
  
• Immobility or inactivity
  
  
• Pregnancy
  
  
• Laxative abuse
  
  
• The use of medications
  
  
• Pain during defecation
  
  
• A lack of privacy
  
  
• The fear of pain
  
  
• Neurogenic disorders
  
  
• Tumors or an obstructing mass

Defining characteristics of constipation

Before beginning our constipation care plan, let's note that constipation has been defined by the following characteristics:

• Dry, hard stool
  
  
• Infrequent bowel movements, less than 3 a week
  
  
• Straining during defecation
  
  
• Abdominal distension
  
  
• Liquid fecal seepage
  
  
• Frequent yet non-productive urges to defecate
  
  
• Nausea and vomiting
  
  
• Anorexia
  
  
• A dull headache, depression and restlessness
  
  
• A fear of pain during defecation

Recommended Care Plan for Constipation

Constipation can be quite complex. That is why it is important to properly assess the cause of constipation in order to know how to properly treat it.

A constipation care plan should include an ongoing assessment, therapeutic intervention and a continuity of care.

Ongoing Assessment

• Assess the previous frequency of bowel movements and compare it with the present pattern. A normal frequency of elimination may vary from twice daily to once every other day.
  
  What is important is consider what is the normal frequency for the individual. Frequency, quality, color and size of stools should be noted.
  
  
• For individuals who are using laxatives, the frequency and type should be assessed from time to time. Although laxatives can aid bowel movements, chronic use of laxatives can cause the muscles and nerves of the colon to become atonic and distended.
  
  
• Evaluate dependence on enemas. Long-term use of enemas for elimination can cause the colon to become unresponsive to the presence of stool.
  
  
• Assess usual dietary habits, eating schedule and fluid/liquid intake. Constipation can be caused by a change of the time of meals, types of food consumed, or anxiety.
  
  
• Know the person’s activity level. Inactivity, a lack of exercise or prolonged bed rest can contribute to constipation. 
  
  
• Assess medications currently used. There are some medications that can cause constipation, including narcotics, antidepressants, antihypertensives, anticholinergics, antacids with aluminum or calcium base, iron supplements and calcium supplements.
  
  
• Assess the accessibility to bathroom facilities. Some individuals who are hospitalized, bed ridden or immobile have difficulty in eliminating because of feeling anxious, frustrated or embarrassed to use a bedpan, or to have someone help them during elimination. 
  
  
• Assess if there is a fear of pain during defecation. Anorectal disorders, fissures and hemorrhoids are painful and some individuals ignore their urge to defecate to avoid this pain.
  
  
• Evaluate the patient’s degree of procrastination. Ignoring the urge to defecate can lead to chronic constipation, as the rectum will stop responding to or sensing the presence of stool. The longer the stool stays in the rectum, the harder and drier it gets.
  
  
• Assess for neurogenic diseases like multiple sclerosis. Neurogenic disorders can alter the ability of the colon to perform peristalsis, the wave-like contractions that move stool through the colon.

Therapeutic Interventions

• If the patient does not have a cardiovascular disease or any kind of condition that can limit his fluid intake, the patient should be encouraged to consume at least 64 to 96 ounces of fluid every day.
  
  
• Increase fiber intake to a minimum of 20 grams per day. Dietary fiber can be obtained from raw fruits, fresh vegetables or whole grains. Fiber helps stool to hold water, making stool moist, soft and slippery. It also adds bulk to stool, which is needed to stimulate peristalsis.
  
  
• Bran cereal, bean products, prunes and prune juices may be added to the diet. These are considered to be natural cathartics and rich in fiber.
  
  
• If the patient is capable of exercising, regular exercises or physical activity should be promoted. Abdominal exercises help to strengthen the abdominal muscles, which facilitate peristalsis.
  
  
• Encourage the patient to have a regular or specific time for elimination. There are a lot of individuals who defecate following their first meal of the day or their first cup of coffee, which prompts a gastro-colic reflex.
  
  As long as this occurs within the person’s regular elimination schedule, this reflex is beneficial.
  
  
• Remove fecal impaction with the finger if the patient is debilitated. Stools that stay in the rectum for a long period can become dry and hard, causing the patient to feel pain during defecation.
  
  
• Suggest a warm sitz bath or a hemorrhoidal preparation in order to minimize rectal discomfort.
  
  
• For patients who are hospitalized, it is important to orient them about the location of the bathroom and offer a warmed bedpan in case the patient needs assistance. Always provide privacy and an ample time to relax and empty the bowel. 

Continuity of Care

Continuing our constipation care plan...

• As much as possible, consult a dietician about an appropriate diet to help the patient overcome constipation. A dietician is the best person to approach for information about which foods can promote regular bowel elimination.
  
  Second, consult the attending doctor to make sure the patient’s diet doesn’t complicate the patient’s existing medical conditions.
  
  
• Reinforce the importance of a balanced diet, one that includes fiber rich foods, fresh fruits and vegetables, regular meal times, adequate fluid intake (64 to 96 ounces a day), regular bowel elimination, physical activity and privacy for defecation.
  
  
• Teach the patient how to read and interpret medication labels. Some medications result in constipation. Reading the labels on medications will let the patient know that constipation intervention should be taken while taking the medication. 
  
  
• If ordered by the physician, teach the patient how to use the laxatives ordered by the physician, including bulking agents, stool softeners, stimulant laxatives, suppositories and oil retention enemas. 
  
  
• Reinforce the patient’s knowledge of magnesium supplements if it is prescribed to promote regular bowel elimination.
  
  Taking a daily magnesium supplement is considered safe and effective for removing stool and maintaining regularity, without the need for straining or placing excess pressure on the rectal area.

Expected outcome of a constipation care plan

When a person is properly educated on a constipation care plan, it is expected that the patient will be able to pass a soft and formed stool with normal frequency.

Constipation becomes a serious health condition if it is not properly treated or the recommended interventions are not continued over time.

Thus, there should be a collaboration between the patient, his spouse and involved family members and healthcare providers in order to sustain and ensure normal bowel elimination.

(Return from Constipation Care Plan to Treatment for Chronic Constipation)