Constipation Nursing Diagnosis & Care Plan

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Written by
Tabitha Cumpian, MSN, RN

Constipation is the decrease in normal frequency of bowel movements. It is also typically accompanied by difficult or incomplete passage of stool and stool that is often extremely hard and dry. Constipation is very common and one of the most frequently seen gastrointestinal complaints. It can affect anyone however the following individuals are more prone to constipation:  

  • Elderly: typically, these individuals are less active, have slower metabolisms, and less muscle strength along the digestive tract  
  • Women (particularly pregnant women or shortly after childbirth): changes in hormones can cause constipation and for pregnant women the baby often pushes on the intestines resulting in a slower passage of stool  
  • Individuals with neurological disease

Causes

There are several causes of constipation from lifestyle choices, to medications, and different medical conditions. A list of common causes is listed below. 

  • Low fiber diet
  • Dehydration
  • Low exercise/activity level
  • Changes in regular daily routine
  • Increased consumption of milk or cheese products
  • Stress
  • Resisting the urge to have a bowel movement
  • Medications
    • Pain medications, especially narcotics
    • NSAIDs
    • Antidepressants
    • Antacids with calcium or aluminum
    • Iron supplements
    • Allergy medications
    • Some blood pressure medications
    • Psychiatric medications
    • Antiemetics
    • Anticonvulsants
  • Endocrine Disease (i.e hypothyroidism)
  • Colorectal cancer
  • IBS
  • Diverticular Disease
  • Neurological diseases such as spinal cord injuries, stroke, or Parkinson’s disease
  • Intestinal obstruction
  • Structural defects within the digestive tract

Signs and Symptoms

  • Less than 3 bowel movements per week
  • Hard, dry stool
  • Lumpy stool
  • Difficulty/straining to pass stool, painful
  • Stomach pain, aches, or cramps
  • Sensation of feeling bloated or nauseous
  • Sensation that you have not fully emptied your bowel after a bowel movement

Assessment

  1. Assess medical history as it relates to potential constipation (history of constipation, activity level, medications used routinely for constipation) 
  2. Assess for abdominal pain using age appropriate pain scale
    1. Location of pain 
    2. Severity of pain  
    3. Duration of pain  
    4. Description of pain  
    5. Specific actions that improve or worsen pain  
  3. Complete comprehensive abdominal assessment
    1. Inspection
    2. Auscultation
    3. Percussion
    4. Palpation
  4. Assess stool characteristics per patient
    1. Color, consistency, amount 
    2. Use appropriate tools as needed (i.e. Bristol Stool Chart)

Nursing Interventions

  1. Treat pain/discomfort as needed with appropriate non-pharmacological and pharmacological methods as necessary
  2. Perform abdominal massage
  3. Administer appropriate stool softeners/laxatives as ordered
  4. Increase patient’s activity level as patient is able to tolerate
  5. Increase hydration
  6. Increase fiber rich foods in diet

Treatment

Unless it is a severe case of constipation, most cases are treated at home with self-care activities. Self-care activities that can help treat constipation include:  

  • Increase daily water intake 
  • Avoid caffeine 
  • Avoid alcohol 
  • Increase fiber within the daily diet 
  • Increase activity level 
  • Take over the counter medication (stool softener or mild laxative) as needed.

If these measures are not effective than it is possible a stronger medication could be prescribed. Although unlikely, surgery is needed in very rare instances if there is a structural problem with the colon.

Prevention

Prevention is a huge factor in the management of constipation. By eating a well-balanced diet rich in fiber, increasing hydration, and maintaining a regular activity level an individual can typically also maintain a regular bowel routine.

Fiber-rich foods:

  • Fruit: raspberries, strawberries, blueberries, pears, apples, bananas  
  • Vegetables: peas, broccoli, brussels sprouts, potatoes, sweet corn, cauliflower, carrots 
  • Grains: barley, quinoa, bran, oatmeal, brown rice, whole wheat bread 
  • Legumes and nuts: split peas, lentils, baked beans, black beans, chia seeds

Nursing Care Plan for Constipation

Nursing Diagnosis: At risk of constipation  

Desired Outcome: Patient maintains soft, formed bowel movements free of pain and straining and is successfully able to identify actions to take to prevent constipation in the future

Intervention Rationale 
Assess patient’s bowel habits (time of day for bowel movements, amount, frequency, consistency, previous need for bowel aid such as a stool softener or laxative) This allows the nurse to understand the patient’s normal habits and compare these to characteristics of “normal” bowel movements. The nurse can then tailor care to meet the patient’s specific needs.  
Assess the patient’s lifestyle choices (activity level, hydration status, diet) This allows the nurse to identify daily living routine changes the patient can make to treat constipation or prevent it in the future. 
Review patient’s medical history and medication list Some medical conditions or medications can cause constipation. Identifying these risk factors early can help in determining the appropriate treatment plan.  
Assess for emotional distress Stress and other emotions related to depression and/or anxiety can impact constipation. Identifying these risks and managing them appropriately can help to relieve constipation.  
Use Bristol Stool Scale to assess stool consistency  This allows all team members to use the same assessment stool to allow for consistent evaluation of stool.  
Perform abdominal assessment (including palpating, percussion, and auscultating)  Provides the nurse with objective data for treatment.  
Educate patient on lifestyle changes for constipation prevention (diet, hydration, exercise) Assists patient with being able to successfully manage and prevent constipation complications at home in the future.  
Perform gentle abdominal massage Abdominal massage encourages rectal loading by increasing intraabdominal pressure. 
Educate patient on how to perform gentle abdominal massage at home Allows patient to learn ways to prevent and manage constipation independently upon discharge.  
Administer medications (stool softeners and laxatives) as prescribed  Can be beneficial in the short term to assist with initiating first bowel movement while patient is making lifestyle choices to aid in constipation prevention.  

References and Sources

  1. Ackley, B.J., Ladwig, G.B., Flynn Makic M.B., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook: An evidence-based guide to planning care (12th edition). Mosby.
  2. Cleveland Clinic (2019). Constipation. https://my.clevelandclinic.org/health/diseases/4059-constipation 
  3. Mayo Clinic (2021). Constipation. https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253
  4. Mayo Clinic (2021). Nutrition and healthy eating. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/high-fiber-foods/art-20050948  
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Tabitha Cumpian, MSN, RN
Tabitha Cumpian is a registered nurse with a passion for education. She completed her BSN at Edgewood College Nursing School and her MSN with an emphasis in Nursing Education at Herzing University. She has a vast clinical background from years of traveling the United States providing nursing care. The majority of her time has been spent in cardiovascular care. She loves educating others in her field, as well as, patients and their family members through healthcare writing.