Medical Protocol And Procedure - Bowel And Constipation Management printable pdf download

Medical Protocol and Procedure

Bowel and Constipation Management

Policy

Constipation is defined as infrequent, incomplete or difficult evacuation of the bowels and is

subjectively defined in comparison to what is normal for that individual; it is not based solely on the

frequency of stool. Nursing and direct caregivers, in coordination with the individuals primary care

physician, will assist the individual to manage bowel habits to increase independence, decrease

discomforts and increase the sense of well-being.

Procedure

1. A thorough history and physical examination to be completed by licensed nurse or primary care

physician to include the following elements:



Patient’s normal bowel pattern prior to illness



Current stool characteristics, volume, consistency, color, odor, blood



Patient’s perception of the ease/difficulty (straining) of passing stool



Sense of complete evacuation



Frequency of stools per day/week



Any psychosocial factors that may be inhibiting defecation



Compliance with/intolerance to bowel medication

•

Review of medications prescribed, over-the-counter and natural products/ reassess

unnecessary medications that may be contributing to constipation

•

Assessment of symptoms such as lack of appetite, early satiety, nausea, bloating,

distension, passing flatus, pain, colic

•

Digital rectal examination (DRE) if no BM for 3 days, if not contraindicated

(neutropenia, painful conditions, risk for bleeding); assess for anal sphincter tone,

presence/absence of stool, possible obstructing masses, hemorrhoids, anal

fissures, dilated rectum (may indicate constipation higher in sigmoid area)

•

Special considerations for assessment and treatment for patients with rectal stent,

colostomy, ileostomy

•

Determining if diarrhea is overflow diarrhea; rule out other etiologies for true

Diarrhea

2. A patient’s environment affects how a patient manages bowel functioning. There are

many factors to consider including:

•

Toileting at time of maximum peristalsis: upon waking or after meals (30-60 minutes)



Proper positioning: over the toilet/commode versus bedpan



If the patient must have bowel movement lying down, then place him/her in the

left lying position with the hips and knees flexed at 90 degrees

•

Encourage fluids as tolerated



Respect privacy/cultural sensitivity



Stool chart/ bowel performance scale for a common language for proper

Medical Protocol LFSVA 6/2016

Medical Protocol And Procedure - Bowel And Constipation Management

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