How to assess and respond to your resident’s constipation
Residential Care Line supports residential aged care staff to provide care in place, where appropriate, to reduce the need for unnecessary emergency department presentations and hospital admissions. It aims to provide timely access to appropriate care pathways and to improve the quality-of-life of older people living in residential care.
If you need help managing a resident’s constipation and their GP is happy for referral, phone Residential Care Line on 6457 3146
Bowel assessments are a very important aspect to your resident's care. Good assessment and intervention can prevent complications and discomfort.
Constipation, as per the Rome iii classification is defined by a person having 2 or more of the following:
- Straining
- Lumpy or hard stool
- Sensation of incomplete bowel action
- Sensation of anorectal obstruction / blockage
- Manual manoeuvres
- Less than 3 bowel motions a week
Complications from constipation include:
- Severe and acute abdominal pain
- Indigestion / gastritis
- Loss of appetite
- Fatigue and loss of energy
- UTI
- Delirium
- Falls
- Skin conditions
- Diarrhoea (fecal impaction)
- Dehydration
- Septicaemia (fecal impaction)
- Death
Causes of constipation can be primary or secondary
- Primary: slow transit or difficult defecation
- Secondary: lifestyle issues, medical conditions, medication issues, mechanical abnormalities
Classification of constipation can fall into acute (less than 3 months) or chronic (greater than 3 months)
When to be alarmed and call the doctor:
- Sudden weight loss
- Delirium
- Fever
- Cramping
- New abdominal pain
- New back pain
- Rectal bleeding (not haemorrhoids)
- Rectal pain
- New urinary incontinence
- Vomiting
Assessment of constipation should include looking into the following:
- Bowel chart/diary
- Identifying all symptoms
- Look at fluid and fibre intake
- Look at exercise and mobility
- Look at medical history
- Look at medications
- Physical assessment
Physical assessment should include (in order):
- Observe the abdomen (shape, distention, mass, skin)
- Auscultation (bowel sounds in all four quadrants)
- Palpate (tenderness, masses, fecal loading)
- Percussion (tympany= gas, dull = feces / fluid)
- Per rectum digital exam looking for content, fissures, haemorrhoids and prolapse.
Constipation remedies
Non-pharmacological interventions
- 1.5L of fluid per day if not contraindicated
- If ambulant walking 15min twice a day
- If non ambulant pelvic tilts, leg lifts and lower trunk rotations
- Consume soluble and insoluble fibre (caution in those at risk of aspiration / have dysphagia or don’t drink 1.5L per day)
- Toilet resident 15 minutes after meals / breakfast even if cognitively impaired.
Pharmacological interventions
There are 4 classes of laxatives.
Bulking agents: absorb water, increase fecal bulk and peristalsis (equal to fibre e.g. benefibre). Caution for use = reduced fluid intake, reduced mobility and decline in condition
Softening agents: Alter surface tension of fecal mass promoting smoother passage (docusate and poloxamer = detergent, liquid paraffin = lubricant). Caution for use = should be given with a stimulant
Osmotic agents: promote water retention, increasing pressure and motility (e.g. movicol / lactulose). Caution for use = reduced mobility and fluid intake
Stimulants: stimulate colonic nerve endings to increase motility. This should be last line therapy. Caution for use = do not give if there are any alarm symptoms. Medical review required and potential abdominal x-ray.