Constipation Constipation refers to an abnormal infrequency or irregularity of defecation, abnormal hardening of stools that makes their passage difficult and sometimes painful, decrease in stool volume, or prolonged retention of stool in the rectum. It can be caused by certain medications; rectal or anal disorders; obstruction; metabolic, neurologic, and neuromuscular conditions; endocrine disorders; lead poisoning; connective tissue disorders; and a variety of disease conditions. Other causes may include weakness, immobility, debility, fatigue, and inability to increase intra-abdominal pressure to pass stools. Constipation develops when people do not take the time or ignore the urge to defecate or as the result of dietary habits (low consumption of fiber and inadequate fluid intake), lack of regular exercise, and a stress-filled life. Perceived constipation is a subjective problem that occurs when an individual’s bowel elimination pattern is not consistent with what he or she perceives as normal. Chronic laxative use contributes to this problem. Clinical Manifestations • Fewer than three bowel movements per week, abdominal distention, and pain and pressure • Decreased appetite, headache, fatigue, indigestion, sensation of incomplete emptying • Straining at stool; elimination of small volume of hard, dry stool •Complications such as hypertension, hemorrhoids and fissures, fecal impaction, and megacolon Constipation 239 Assessment and Diagnostic Methods Diagnosis is based on history, physical examination, possibly a barium enema or sigmoidoscopy, stool for occult blood, anorectal manometry (pressure studies), defecography, and colonic transit studies. Newer tests such as pelvic floor MRI may identify occult pelvic floor defects. Medical Management • Treatment should target the underlying cause of constipation and aim to prevent recurrence, including education, bowel habit training, increased fiber and fluid intake, and judicious use of laxatives. • Discontinue laxative abuse; increase fluid intake; include fiber in diet; try biofeedback, exercise routine to strengthen abdominal muscles. • If laxative is necessary, use bulk-forming agents, saline and osmotic agents, lubricants, stimulants, or fecal softeners. • Specific medication therapy to increase intrinsic motor function (eg, cholinergics, cholinesterase inhibitors, or prokinetic agents). Nursing Management Assessment Use tact and respect with patient when talking about bowel habits and obtaining health history. Note the following: • Onset and duration of constipation, current and past elimination patterns, patient’s expectation of normal bowel elimination, and lifestyle information (eg, exercise and activity level, occupation, food and fluid intake, and stress level). • Past medical and surgical history, current medications, history of laxative or enema use. • Report of any of the following: rectal pressure or fullness, abdominal pain, straining at defecation, and flatulence. • Sets specific goals for teaching; goals for the patient include restoring or maintaining a regular pattern of elimination by responding to the urge to defecate, ensuring adequate intake of fluids and high-fiber foods, learning about methods to avoid constipation, relieving anxiety
Posted on: Wed, 10 Sep 2014 11:11:26 +0000
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