Constipation Clinical Management
Key Points
- Constipation is typically identified by infrequent or difficult stool passage, commonly fewer than three bowel movements weekly.
- Slow transit increases water reabsorption, producing hard stool, straining, and painful defecation.
- Early nursing priorities are cause identification, bowel-pattern assessment, and nonpharmacologic prevention.
- Escalation from diet and hydration to medications and procedures should be structured and safety-focused.
Pathophysiology
Constipation develops when stool transit through the large intestine slows, allowing excess water reabsorption and creating dry, hard stool. Common contributors include low activity, low fiber intake, dehydration, medication effects, depression, and postoperative changes.
As stool burden increases, patients may develop cramping, abdominal fullness, bloating, and hypoactive bowel sounds. Persistent straining raises risk for hemorrhoids and anal-fissure, while prolonged stool retention can progress to fecal-impaction with severe discomfort and impaired elimination.
Classification
- Functional and lifestyle-related: Low fiber, poor hydration, inactivity, or altered bowel routine.
- Medication-associated: Opioids, antacids, antidepressants, and diuretics increase constipation risk.
- Complicated constipation: Impaction, severe pain, vomiting, or signs of possible bowel obstruction.
Nursing Assessment
NCLEX Focus
Priority questions often ask which findings indicate simple constipation versus escalation for impaction or obstruction risk.
- Assess stool frequency, consistency, straining, and associated pain using a structured bowel history.
- Screen for reversible causes: diet pattern, fluid intake, mobility, and current medications.
- Evaluate abdominal discomfort, bloating, bowel sounds, and signs of worsening stool retention.
- Watch for red flags such as severe pain, inability to pass stool, or vomiting that suggest urgent escalation.
Nursing Interventions
- Implement first-line prevention: fiber-rich foods, hydration goals, and regular physical activity.
- Teach bowel-routine strategies, including prompt response to urge and consistent toileting times.
- Use ordered agents in stepwise fashion (stool softener, laxative, suppository, enema) and reassess effect.
- Coordinate medication review with the team when bowel-affecting drugs worsen symptoms.
- Escalate severe retention for provider-directed interventions, including possible digital-disimpaction.
Escalation Threshold
Persistent inability to evacuate stool, severe abdominal pain, or vomiting requires urgent reassessment for impaction or obstruction rather than repeated unsupervised laxative use.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| stool-softeners | Docusate sodium | Softens stool; useful when straining should be minimized. |
| laxatives | Psyllium, polyethylene glycol, senna | Match mechanism to symptom pattern; avoid prolonged unsupervised dependence. |
| rectal-suppositories | Glycerin, bisacodyl suppository | Local effect for short-term relief; assess comfort and response after insertion. |
Clinical Judgment Application
Clinical Scenario
A postoperative patient reports no bowel movement for four days, progressive bloating, and painful straining despite reduced oral intake.
Recognize Cues: Infrequent hard stool, abdominal discomfort, and risk factors including immobility and medication use. Analyze Cues: Pattern suggests constipation with rising risk of fecal-impaction. Prioritize Hypotheses: Immediate priority is relieving stool retention while preventing bowel injury. Generate Solutions: Reinforce hydration and mobility, review medications, and initiate ordered bowel regimen. Take Action: Implement stepwise interventions and notify provider if severe symptoms persist. Evaluate Outcomes: Stool passage improves, discomfort decreases, and bowel routine stabilizes.
Related Concepts
- comprehensive-abdominal-assessment - Guides focused exam and escalation cues in bowel complaints.
- abdominal-distention-and-the-five-fs - Helps differentiate stool retention from other distention causes.
- diarrhea-assessment-and-management - Contrasts opposite bowel-pattern disruption and fluid risk.
- fecal-incontinence-and-bowel-retraining - Chronic constipation can contribute to overflow leakage.
- fluid-volume-deficit-hypovolemia-and-dehydration - Poor hydration worsens stool hardening and transit delay.
Self-Check
- Which constipation findings should trigger urgent reassessment for impaction?
- Why is a stepwise bowel regimen safer than repeated unsupervised stimulant use?
- How do hydration and activity interventions change stool physiology?