Assessment and Management of Constipation
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Transcript Assessment and Management of Constipation
Assessment and Management
of Constipation
Emily Booth RN BScN MN PHC-NP
NURSE LED OUTREACH TEAM
Agenda
Definition
Types/Classification
Causes
Anatomy and Physiology
Bowel Assessment
Treatment
Summary/Conclusion
What is Constipation?
One or more of…
Excessive straining with bowel movement
Sense of incomplete emptying with BM
Failed or lengthy attempts to defecate
Hard stools
Decreased stool frequency
Prevalence
Most common digestive complaint
4.53 million people per year
2.5 million physician visits per year
Twice as common in women than men
2 fold increase in LTC residents
Types of Constipation
Types of Constipation
Primary Causes:
Disorder of neuromuscular function and brain- gut
function
Slow transit time (decreased propulsion of stool)
Evacuation disorders (incoordination of contractions
or inadequate relaxation of pelvic floor muscles
during defecation)
IBS (genetic, environmental, social, biological, psych
factors)
Types of Constipation
Secondary Causes: other conditions
Dietary – inadequate fluid intake and dietary fibre
Behavioural – decrease physical activity, failure to
respond to initial urge to defecate, chronic use of
stimulant laxatives
Metabolic – hypercalcemia, hypothyroid
Neurologic – parkinsons, spinal cord lesions, DM
Disease of the colon – strictures, fissures, ca
Anatomy and Physiology
Anatomy and Physiology
Colon – divided into ascending colon ( from cecum
to edge of liver border), goes across the abdomen
under the stomach called the transverse colon and
then descends down the left side of the abdomen
(descending colon)and leads into the sigmoid colon
and rectum
Ascending and transverse colon absorb H2O and
electrolytes
Descending and sigmoid colon stores fecal matter until
eliminated
Smooth muscle of colon contracts and relaxes in
response to distension and mixing movements occur
Contents of colon enter the rectum usually q am
Spinal reflex to defecate occurs and the anal sphincter
relaxes or contracts with pelvic and abdominal muscle
movement
Risk Factors for Older Adults
Diet low in fibre
Poor or reduces oral fluid intake
Low level of physical activity or immobility
Advanced age
Overuse of laxatives
Endocrine/metabolic disease (diabetes, hypothyroid,
hypercalcemia, hypokalemia)
Neurologic disease (stroke, MS, parkinsons)
Disease of the colon (diverticulitis, IBS)
Medications (anticholinergic drugs)
Drug Induced Constipation
OPIOIDS Cause Constipation
Codeine, morphine, oxycodone, fentanyl patch
The Hand that Writes the Narcotic Writes
the Cathartic
Drug Induced Constipation
Antinauseant
Antiparkinson meds
Alzheimers meds
Iron supplements
Incontinence meds
Antacids
Ulcer meds
Antidepressants
Antipsychotics
Antihypertensives
Lipid lowering drugs
Quality of Life
Pain, discomfort, bloating
Lack of appetite
Nausea
Fatigue
Irritability
Change in behaviour
Haemorrhoids, prolapse
Fecal impaction , diarrhea
Bowel Assessment
The most essential step is determining the etiology or
cause
Usual bowel pattern and measures currently used
Hx of problem
Ability to sense urge to defecate
Daily fluid and fibre intake
Relevant medical/surgical hx
Functional abilities
7 day bowel record
Physical assessment
Treatment
First line acute
Treat underlying cause
Diet and lifestyle measures
Prunes and /or stool softener
If impacted , enema/suppository/disimpaction and
stimulant laxative
Ongoing Constipation
First line
Treat underlying cause
Diet/lifestyle measures
Bulk laxative (metamucil/psyllium) or prunes, and/or
stool softener
Second line
Diet/lifestyle measures
Osmotic laxative (lactulose, mg containing laxatives)
Third line
Diet/lifestyle measures
Osmotic laxative (lactulose, glycerin, PEG or mg
containing products – MOM, citromag fleet)
Stimulant laxative (senna, castor oil or dulcolax) if no
BM x 3 days
Laxatives
Caution with bulk forming laxatives in elderly , may
cause obstruction
Stool softeners are not to be used alone for
constipation. Little value for chronic constipation.
Help with pain and straining with defecating
Pharmacologic Considerations
Meds do have a place in the treatment of
constipation
Short term, time limited
Choose laxatives based on resident symptoms and hx
Use homes bowel protocol
Summary
Focus is on prevention
Resident specific interventions
Staff communication ( 7 day bowel record and
ongoing monitoring)
In house bowel protocol
Pharmacological interventions
The End