Nursing diagnosis – CONSTIPATION



Decrease in normal frequency of defecation accompanied by difficult

or incomplete passage of stool and/or passage of excessively hard,

dry stool


• Palpable rectal or abdominal mass

• Borborygmi, hypoactive or hyperactive bowel sounds, or abdomi-

nal dullness on percussion

• Bright red blood with stools; bark-colored or black, tarry stools;

hard, dry stools; or oozing liquid stools

• Change in bowel pattern; decreased frequency and volume of stool

• Changes in mental status, urinary incontinence, unexplained falls,

or elevated body temperature in older adults

• Distended or tender abdomen and feeling of fullness or pressure

• General fatigue, anorexia, headache, indigestion, nausea, or vomiting

• Severe flatus; straining and possible pain during defecation


• Functional: habitual denial or

• Mechanical: electrolyte imbal-

ignoring urge to defecate,
irregular defecation patterns,
insufficient physical activity

ance, hemorrhoids, prostate
enlargement, rectal abscess,
anal fissure, or stricture

• Psychological: depression,

• Physiological: change in eating

emotional stress, mental

patterns or usual foods, dehy-
dration, inadequate dentition

• Pharmacological: aluminum-

or oral hygiene, insufficient

containing antacids, and drugs
that affect bowels

fiber or fluid intake

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Elimination

• Pharmacological function

• Nutrition

• Tissue integrity


The patient will

• Participate in development of bowel program.

• Report urge to defecate, as appropriate.

• Increase fluid and fiber intake.

• Report easy and complete evacuation of stools.

• Have elimination pattern within normal limits.

• Adopt personal habits that maintain normal elimination.


Bowel Elimination; Hydration; Nutritional Status: Food & Fluid




Determine: Monitor frequency and characteristics of patient’s stool

daily. Careful monitoring forms the basis of an effective treatment plan.

Monitor and record patient’s fluid intake and output. Inadequate

fluid intake contributes to dry feces and constipation.

Perform: Provide privacy for elimination to promote physiological


Plan and implement an individualized bowel regimen to establish

a regular elimination schedule; and exercise routine to promote

abdominal and pelvic muscle tone.

Inform: Emphasize importance of responding to urge to defecate. A

timely response to the urge to defecate is necessary to maintain nor-

mal physiological functioning.

Teach patient to locate public restrooms and to wear easily remov-

able clothing on outings to promote normal bowel functioning.

Teach patient to massage abdomen once per day and how to locate

and gently massage along the transverse and descending colon. In the

older patient, the neural centers in the lower intestinal wall may be

impaired, making it more difficult for the body to evacuate feces.

Massage may help stimulate peristalsis and the urge to defecate.

Teach patient sensible use of laxatives and enemas to avoid laxa-

tive dependency. Overuse of laxatives and enemas may cause fluid

and electrolyte loss and damage to intestinal mucosa.

Attend: Encourage patient to use a bedside commode or walk to toi-

let facilities to encourage normal position for evacuation. Encourage

intake of high-fiber foods to supply bulk for normal elimination and

improve muscle tone. Unless contraindicated, encourage fluid intake

of 6–8 glasses (1,420–1,900 ml) daily to maintain normal metabolic


Manage: Help patient understand diet modification plan along with

dietitian, if appropriate, to encourage compliance with prescribed



Bowel Management; Constipation/Impaction Management; Exercise

Promotion; Fluid Management; Nutrition Management


Wilson, L. A. (2005, November). Understanding bowel problems in older peo-

ple: Part 1. Nursing Older People, 17(8), 25–29.

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