Constipation

4 April 14, 2025

Constipation is the irregular, infrequent or difficult evacuation of the bowels1.

Possible causes include:

  • General debility, low food and fluid intake
  • Drug therapy, e.g opioids, codeine, iron, anti-parkinsonian drugs.
  • Spinal cord compression
  • Hypercalcaemia
  • Bowel obstruction
  • Depression, fear of diarrhoea, incontinence.

Symptoms include:

  • Anorexia
  • Vomiting/ nausea
  • Abdominal discomfort or cramping
  • Diarrhoea/ overflow
  • Confusion
  • Anxiety
  • Bowel obstruction
  • Pain

Management of Constipation:

  • The following two pages (Constipation and Gastro intestinal Care Guide) from Waitemata District Health Board2 (2012) is a useful resource for assessment and treatment of constipation. Copies are available online, or through nznogerontology@gmail.com
  • For residents who have a specialist palliative care need (Hospice), then management may differ slightly, and therefore it is important to keep regular contact with your Palliative Care Co-ordinator.
  • When opioids are prescribed anticipate constipation. Attached is the algorithm for the management of constipation for residents taking opioids. If bowel obstruction is suspected it is imperative to seek specialist palliative care advice.
  • All patients on opioids (except those with malabsorption or an ilesotomy) require regular aperients.
  • Use of the Bristol Stool Chart is recommended for identifying bowel motion types, and constipation
  • Do not perform a PR or insert suppositories in patients who are neutropenic without consultation with the GP, or specialist palliative care service
  • Faeces consist of approximately 50% water, 25% bacteria, and 25% food residue so even if the resident is not eating there will be faeces in the bowel1.

CONSTIPATION IN THE OLDER PERSON2

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Management of constipation for residents taking opioids

Residents taking opioids

Reference: Adapted from PWIG (2017), with thanks to Canterbury District Health Board (Constipation Flowchart)

1Macleod, R., Vella-Brincat, J., & MacLeod, S. (2016). The Palliative Care Handbook. Retrieved from http://www.hospice.org.nz/cms_show_download.php?id=1243

2 Waitemata District Health Board (2012). RN Care Guides for Residential Aged Care. Retrieved https://www.healthpoint.co.nz/public/older-peoples-health/waitemata-dhb-residential-aged-care-integration/

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