Difficulty in passing stools or an incomplete emptying of the rectum
Simple constipation - No underlying pathology
Low residue diet Dehydration
Environment, (type and availability of toilet) Incomplete emptying or delayed defaecation
Factors include, poverty, education, dentition, lack of exercise,
Increased transit time, (normal 3-7 days). Idiopathic slow transit time can lead to megacolon. Older people have slower transit times (up to 8 - 15 days). Often the lower colon is never completely emptied causing terminal distension.
Irritable bowel syndrome Idiopathic megacolon
Increasing age, ("terminal reservoir syndrome")
Remember reduced frequency of defaecation can be normal with increasing age and does not usually require "medical" treatment
Depression Confusion Anorexia nervosa
Remember in the elderly constipation may cause confusion, (ie differentiate between cause and effect)
Anal fistula Prolapse Haemorrhoids Any painful condition may inhibit defaecation
Diverticulitis Hirschsprung's disease, (aganglionic congenital megacolon)
Endocrine disorders, (diabetes autonomic neuropathy and hypothyroid) Carcinoma
Drug induced Immobility Nursing management, (eg use of bed pans) Laxative abuse
Drugs include, analgesics, (especially opiate), codeine, anticholinergics and anti-Parkinsonian.
Frequency Volume Change Unduly offensive smell Blood, (frank, fresh, altered, occult) Pus Pain Straining History of laxative use/abuse
Urgency Diet Incontinence PR Peri-anal problems
Preoccupation Anxiety Hypochondriasis
Natural variation Regular daily bowel action is desirable 3 times per day to 3 times per week Therefore establish the normal for the individual Consider changes to factors necessary to the maintance of the normal rhythm.
Factors effecting variation
Diet Exercise Fluid intake Normal pattern Anxiety Depression
Record normal pattern and frequency
Nature of the faeces, soft? well formed? associated pain or discomfort?
Does the faeces indicate diarrhoea which may be caused by constipation?
How long has there been a problem?
When were the bowels last opened?
Are the bowels normally stimulated by a particular event, eg. gastrocolonic reflex?
Are laxatives taken, any other drugs which may effect GI function taken, eg.
What is the normal fluid intake?
What is the nature of the diet? eg. re. non water soluble fibre
Rectal digital examination may be indicated
Possible radiological examination
Presence of abnormal components, eg blood, mucous. Blood in the faeces may indicate underlying pathology.
Faecal odour, check for changes, particularly offensive stools may indicate mal absorption.
Is there a need to defecate, how much notice do they have, does passing a motion leave the desire to pass more or a feeling of continued fullness.
What is the mental state of the individual.
Your key decision is,
a. to educate and treat yourself.
b. to refer for medical opinion
Factors discovered in your assessment which merit a medical opinion are,
Management clearly depends on the cause,
Enemas, suppositories, access to toilet, manual evacuation, medication drugs, surgery.
Social management, (including relationships)
* liquid paraffin
* Castor oil
* Dorbanex (carcinogenic)
* Glycerine, bisacodyl suppositories
* Phosphate, microenemas