Top Care Plan for Constipation

Constipation is a common gastrointestinal concern that healthcare practitioners frequently encounter. This article explores the assessment, diagnosis, and nutrition-focused interventions essential for developing effective care plan for constipation.

By addressing the multifaceted causes and implementing evidence-based strategies, we aim to empower practitioners in their mission to alleviate discomfort, restore regular bowel function, and enhance gastrointestinal health.

constipated person grabbing their stomach.

What is Constipation?

Constipation, a prevalent gastrointestinal disorder, is characterised by the infrequent and challenging passage of stool, often resulting in hard and dry fecal matter. This condition arises due to a complexity of factors involving both the gastrointestinal tract and neurological processes. 

In physiological terms, constipation primarily manifests as a delay in the transit of stool through the colon, leading to excessive water absorption and consequent stool hardening. The underlying causes of constipation can be multifactorial, encompassing lifestyle factors, dietary choices, medical conditions, medications, and psychological aspects. 

Causes

Constipation incidence increases with age. Rates of constipation aged 65 years old and older are 26% in women and 16% in men.  As we look to 85 years and older occurrences are 34% in women and 26% in men.

These numbers are also expected to be underreported, as a significant portion of people that deal with constipation may not report it to an official source such as a Doctor.

We do see some frequent causes that can be associated with constipation.  These include:

  • Less physical activity
  • Reduced overall movement daily
  • Medication addition or change
  • Stress
  • Slowed gastrointestinal system related to ageing
  • Significant weight loss
  • Older age
  • Hormone changes (Hypothyroidism, Diabetes)
  • Neurologic diseases (Dementia)
  • Chronic Kidney Disease
  • Cancer (and related treatments)
  • Metabolic issues (Hyper/hypo – calcemia, kalemia, magnesemia, uremia)

Diet Related Constipation Causes

  • Low fruit and vegetable intake
  • Low water intake
  • Low whole grains in diet
  • High processed food diet
  • High deep fried diet
  • Low fluid intake overall

Medications Causing Constipation

These are just a few common medications that can cause constipation, for a full list, look at this list.

  • Analgesics (NSAIDs, opioids)
  • Antipsychotic drugs
  • Anti-Parkinson’s drugs
  • Anticonvulsants
  • Antidepressants
  • Antidiarrheal drugs
  • Antiemetic drugs
  • Antihistamines
  • Antihypertensive drugs
  • Chemotherapy drugs

It’s important that if a medication is suspected to have caused constipation to evaluate the following factors:

  • When did the constipation begin?
  • When did the medication begin?
  • Was the dosage of the medication changed?
  • Was there any other diet or lifestyle factors that changed at the same time?
  • Is there an alternative medication that doesn’t affect bowel habits?

Signs and Symptoms

Constipation symptoms are fairly similar in all individuals, here are some that may be experienced:

  • Straining while pooping
  • Increased bloating and discomfort
  • Increased gas
  • A sense of incomplete evacuation after pooping
  • Failed or lengthy attempts at pooping
  • Hard consistency of poop
  • Bowel movements less than 3 times per week
  • Abdominal pain

Someone may experience one or all of the symptoms above when they are constipated.  Treating constipation can be life changing in terms of quality of life.  So let’s look at how to manage constipation and hopefully successfully treat someone.

Nutrition Assessment

Though constipation is multifactorial, it is important to look specifically at the diet of someone in order to improve their symptoms of constipation.  Constipation should be treated with a diet first approach before starting medications.

  1.  Review the patient’s past medical history for relevant diagnoses.
  • Dementia and other cognitive impairments, neurological disorders, Parkinson’s Disease, Stroke, Hypothyroidism, Endocrine disorders, Hypothyroidism, Kidney disease, Cancers, Inflammatory Bowel Disease, Irritable Bowel Syndrome and Diverticulitis.
  1.  Review their food and fluid intake
  • Evaluate their current fiber intake daily, as well total fluid intake. 
  1. Review their bowel history
  • Look at urine output regularity, as well bowel movements history for the past 3 months.  Note if there were any changes, when they occurred, and look through their chart to find if there were any health related changes around that time period.
  1. Review changes in physical ability
  • Evaluate the patient’s current physical ability and note if there have been any changes over the past 3 months, or since constipation began to occur.  This may mean speaking with other healthcare team members to discuss any recent changes. 
  1.  Interview the patient and/or their loved ones
  • Note if there has been a history of constipation, interventions that worked historically, as well as their current physical symptoms they report.

PES Statement for Constipation

Problem: Altered GI function (constipation)
Etiology: Inadequate dietary fiber intake
Signs/Symptoms: Infrequent bowel movements, hard and dry stool, abdominal discomfort, and straining during defecation.

Problem: Altered GI function (constipation)
Etiology: Medication side effects (e.g., opioid use) and comorbid medical conditions
Signs/Symptoms: Irregular bowel habits, bowel dysfunction secondary to medication, and compromised gastrointestinal motility.

Problem: Altered GI function (constipation)
Etiology: Delayed colonic transit and reduced peristalsis
Signs/Symptoms: Difficulty passing stool, sensation of incomplete evacuation, and bloating.

Problem: Altered GI function (constipation)
Etiology: Poor hydration status and electrolyte imbalances
Signs/Symptoms: Dehydration, electrolyte disturbances, and potential complications like fecal impaction.

Problem: Altered GI function (constipation)
Etiology: Psychological factors (e.g., anxiety, stress) affecting gut motility
Signs/Symptoms: Bowel irregularities influenced by emotional state, increased abdominal discomfort during periods of stress.

Nutrition Goals

Nutrition goals are developed with the patient and their loved ones, you can also get the healthcare teams involvement as well.  It’s important that all factors contributing to constipation are addressed. 

Here are some nutrition goals that can be used though:

  • Patient will have a bowel movement daily through increased dietary fiber intake.
  • Patient will have decreased physical symptoms of constipation through increased fiber diet.
  • Patient will have increased fluid intake to a minimum of 2000 mL daily.
  • Patient will have 40 grams of fiber in their diet daily.

As you can see from all of the nutrition goals they are specific to the patient’s nutrition care plan.  These will be individualized to the person having the diet.

A variety of high fiber foods including fruits,  vegetables and nuts on a white table.

Nutrition Interventions

Once again, nutrition interventions will be specific and developed in conjunction with the patient.  But here are a few that can be used.

  • Patient will be given 40 grams of fiber in their daily food and fluids daily.
  • Patient will have 2 tablespoons of ground flax seed added to their daily oatmeal at breakfast.
  • Patient will have whole wheat and whole grain products in place of white breads and pastas when on menu.
  • Patient will be offered 2000 mL of fluid daily, evenly distributed between breakfast, lunch, supper and hs and evening snacks.
  • Patient will be given a cup of fluids daily to have by their bedside.

By having a patient’s preferences you will be able to implement nutrition interventions that they enjoy and are more likely to try.

Current Fibre Recommendations

The current fibre recommendations are:

Women: 21-25 grams per day

Men: 30-38 grams per day

When adding fibre to your diet, it is important to increase fluid intake as well.  If you simply add fibre without adding in fluids, it can lead to very uncomfortable gas and bloating.  Both fluids and fiber are needed to manage constipation.

How is Having More Fibre Beneficial?

Research shows that having a high fibre diet can lead to:

Better gut microbiota and gut health
Improved insulin sensitivity
Moderated blood glucose control
Improved colon health
Faster gut motility
Improved metabolic factors
Improved cardiovascular health
Better regulation of appetite

There is also some research that suggests that a high fibre diet could be related to decreased risk of colon cancer.  If we look at all these factors, they can and do lead to improved quality of life.  It’s important that we don’t overlook it for treatment of constipation.  

Nutrition Monitoring and Evaluation

Nutrition monitoring and evaluation will be completed based on the nutrition interventions that were put in place.  Some things you should monitor for are:

  • Frequency of bowel habits after interventions are put in place
  • Physical symptoms reported after interventions are in place
  • Daily intake of new fiber rich interventions
  • Fluid intake and urine output relative to recommendations
  • Patient reported physical comfort and symptoms after interventions
  • Changes in physical activity
  • Changes in medications
  • Addition of medications

Nursing Interventions

There will be interventions in the care plan for constipation needed that are outside of the scope of practice for the Registered Dietitian.  Constipation is something that needs all healthcare practitioners to help with, so here are some interventions that should be encouraged.

  • Increase physical activity.  Simple arms and leg exercises in their wheelchair can be beneficial.
  • Team approach to assisting the individual with having drinks outside of meal times.
  • Prune-lax can be delivered with MedPass.  This is an extra dose of fiber.
  • Instituting a bowel and/or toileting routine and ensuring the individual is taken to the bathroom at the right times.
  • Reduce time on the toilet to maximum 5 minutes.
  • Metamucil and Miralax can assist the individual in pooping more frequently.

Closing Thoughts

Building a care plan for constipation necessitates a comprehensive and multidisciplinary approach. Understanding the underlying causes, which can be multifactorial, is crucial for tailoring effective care plans. 

By focusing on nutrition assessment, personalized PES statements, and setting specific nutrition goals, healthcare practitioners can address the unique needs of each patient. Nutrition interventions, such as increasing dietary fiber and fluid intake, play a pivotal role in alleviating constipation symptoms and improving overall well-being. 

Monitoring and evaluation of the implemented interventions, coupled with nursing interventions and a team-based approach, are essential components of a holistic constipation care plan. Through these concerted efforts, we can strive to enhance the quality of life for individuals struggling with constipation, promoting regular bowel habits and improved gastrointestinal health.

Foods High in Fibre

Fruits

fruits high in fibre and content
High Fibre Fruits

Vegetables

High fibre vegetables and content
High Fibre Vegetables

Whole Grain Foods

High fibre whole grains and their contents
Whole Grain Foods Fibre Content

Nuts and Seeds

High fibre nuts and seeds and their content
High Fibre Nuts and Seeds

Other Articles You May Find Helpful

Does Oat Milk Make You Poop?

Can Almond Milk Make You Constipated?

The Best High Fiber Cereals List.

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Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.

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