constipation /kon′stipā″shən/ [L, constipare, to crowd together] , difficulty in passing stools or incomplete or infrequent passage of hard stools. There are many causes, both organic and functional. Among the organic causes are intestinal obstruction, diverticulitis, and tumors. Functional impairment of the colon may occur in elderly or bedridden patients who fail to respond to the urge to defecate. For constipation that is not organically caused, the health care provider can encourage a liberal diet of fruits, vegetables, and plenty of water. The patient should be encouraged to exercise moderately, if possible, and to develop regular, unhurried bowel habits. See also atonic constipation. See also atonic constipation. −constipated, adj. ▪ OBSERVATIONS: Manifestations of constipation range from vague abdominal discomfort and a feeling of “fullness” to acute abdominal pain and nausea and vomiting. Decreased history of stools; hard, dry stools; small stools; bloody stools; increased flatulence; increased rectal pressure and pain; straining to evacuate; and decreased appetite are also common. A Valsalva maneuver during straining to pass stool can cause serious problems for individuals with cardiac disease or cerebral edema. Complications include fecal impaction and perforation of the colon. Chronic constipation can lead to diverticulosis and mucosal ulcers of the rectum, particularly in older adults. Most constipation is diagnosed on clinical exam, although abdominal x-rays or sigmoidoscopy may be helpful. ▪ INTERVENTIONS: Most cases of constipation are managed with diet therapy, increased activity levels, stool softeners, bulk forming agents, laxatives, and enemas. Constipation from slowed or absent GI motility requires a long-term bowel program. ▪ PATIENT CARE CONSIDERATIONS: The overall goals of care are to relieve the constipated state, produce regular soft, well-formed stools, and prevent complications, such as mucosal tears or bleeding hemorrhoids. Laxatives and/or enemas may be used for immediate relief. Assessment of elimination, nutrition, and activity patterns will assist the nurse in tailoring an educational approach aimed at preventing a pattern of chronic constipation. Emphasis on a high fiber diet, adequate fluid intake, and regular exercise is the cornerstone. Specific exercises to improve abdominal tone may be needed. Health professionals should discourage regular use of laxatives and enemas for fecal elimination because it may lead to constipation, electrolyte imbalances, and enlarged colon with chronic use.
