Constipation is the inability to open the bowel for at least once a day for a minimum of three days, accompanied by the passage of dry, hard, small faeces.
Causes of Constipation
1. Inadequate fibre in diet
2. Inactivity (Sedentary lifestyle)
4. Postponement or neglect of the urge to defecate
5. Hypo-motility of the Colon
6. Weakened abdominal muscles
7. Hyper-motility of the Colon (spasm leading to narrowing of the lumen)
8. Systemic conditions such as Congestive cardiac failure, liver cirrhosis, etc.
Signs and symptoms
1. Passage of dry, hard, small faeces
2. Pain on defecation
3. Rectal bleeding
4. Systemic response e.g. Headache, anorexia, coated tongue, flatulence, etc.
Pathophysiology of constipation
Hypomotility of the colon, inadequate fibre in diet or inactivity leads to the absorption of water from the faeces as it moves along the large intestine. The absorption of water makes the faeces small and unable to stimulate the defecation centre. This leads to further absorption from the faeces making it dry, hard and small.
Excessive muscular exertion and strain are required to provide sufficient intra abdominal pressure to propel the hard faeces along the colon to the rectum and out of the body. The hard faeces causes injury to the rectum producing pain and haemorrhage. Pain may further worsen the fear to defecate. Chronic constipation may cause faecal impaction, especially in older patients or those with neurological impairment.
Systemic responses such as headache, anorexia, flatulence, weakness, malaise and coated tongue may result due to prolonged distension of the rectum and anxiety aroused by constipation. Crack in the rectum may result in the passage of blood stained faeces.
1. Diagnosis can be made based on patient’s history of diet, activity as well as bowel habit.
2. Proctosigmoidoscopy: Used to rule out other pathological conditions of the colon.
1. Anal fissure: (painful crack in the mucous membrane of the anus)
2. Abdominal hernia
3. Rectal bleeding
4. Faecal impaction
5. Anaemia due to prolonged bleeding
Management of constipation
1. Mild laxative: To increase colonic motility e.g. Dulcolax and liquid paraffin
2. Cathatics: e.g. Milk of magnesia
3. Fruits: e.g. Oranges or vegetables to provide roughage (to stimulate peristalsis)
4. Regulated enema: e.g. Normal saline enema
5. Stool softeners
6. Methyl cellulose: To increase bulk of the diet
7. Exercise: Encourage regular exercise as this usually aids normal defecation
8. Observation: Monitor patient with neurological problem for faecal impaction. Carry out manual removal of impacted faeces if any.
The nurse should advise the patient in the following areas:
1. Prevention of dehydration
2. Adequate fibre in diet
3. Complete emptying of the bowel any time of defecation
4. Daily or regular moderate exercise
5. Avoidance of indiscriminate use of laxatives or anti-constipation drugs
6. Adequate fluid intake
7. Patient should establish a routine time for defecation.