Prevention of Constipation and Fecal Impaction

Constipation occurs when a person has difficulty having bowel movements. Stools may be hard, making them difficult to pass. It is important to treat constipation as it leads to discomfort and hemorrhoids due to straining. Severe consequences of constipation are a bowel obstruction and fecal impaction, which could lead to death.

Under state and federal guidelines, the occurrence of a fecal impaction is a considered a sentinel event, and is quite significant because it often indicates that the resident has suffered from neglect, often including dehydration and malnutrition. Nursing staff are responsible for monitoring the frequency of bowel movements and ensuring the physician is notified if the resident does not have a bowel movement at least every three days so an order for medication to facilitate the bowel movement may be given. Some residents have orders on their charts to give such medications when indicated.

Often times, we find that nursing home staff fails to document the frequency of bowel movements. Sad to say, most charting is done at the end of the shift and staff may not remember what occurred with each resident over the course of the day.

What are the signs and symptoms of severe constipation, which can develop into an impaction?

  • Abdominal cramping
  • Bloating
  • Firm and/or distended abdomen
  • Straining during elimination
  • Small, hard, dry feces
  • Backache
  • Low grade fever (use oral or tympanic method, if possible)
  • Nausea and/or vomiting
  • Lethargy
  • Small liquid stools (liquid stool may be moving around an impaction)
  • Pain, fullness, discomfort in rectum

How can constipation and fecal impaction be prevented in the nursing home?

  • Proper assessment and documentation of the occurrence of a bowel movement by nursing home staff.
  • A care plan to address constipation if there is a problem.
  • Toileting elders when they say they need to have a bowel movement. Delaying the urge to have a bowel movement contributes to constipation.
  • Providing a consistent time each day to sit residents on the toilet to have a bowel movement if they cannot express their need to go. After breakfast is an ideal time.
  • Making sure residents are eating plenty of fiber, drinking adequate fluids, and getting plenty of exercise.

Resources

The Constipation Crisis in Long-Term Care

Texas Department of Aging and Disability Services