Decrease in normal frequency of defecation accompanied by difﬁcult
or incomplete passage of stool and/or passage of excessively hard,
• 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.)
• Pharmacological function
• 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.
SUGGESTED NOC OUTCOMES
Bowel Elimination; Hydration; Nutritional Status: Food & Fluid
INTERVENTIONS AND RATIONALES
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
SUGGESTED NIC INTERVENTIONS
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.