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Key areas in which the client should be asked questions include:
- The length of time the change in bowel pattern has existed.
- The frequency with which bowels are opened.
- Whether there is any straining when defaecating.
- Whether stools are lumpy or hard.
- If there has been any recent changes in diet or fluid intake.
- If a changed lifestyle has led to a reduction in exercise levels.
- If medication is being taken.
- If any nausea, vomiting or abdominal pain is experienced (Stilwell 1992).
An abdominal and rectal examination may be necessary. This will identify the presence of an abdominal mass, tenderness, or distension and whether the rectum is full.
Patients with the following symptoms require referral to their GP:
- Constipation alternating with diarrhoea.
- Blood/slime in the stools.
- Abdominal pain or vomiting (Stilwell 1992).
Primary management
Where appropriate, dietary fibre and increased daily fluid intake should be implemented.
Secondary management
Laxative or rectal preparations.
Indications for prescribing laxatives include:
- Painful defaecation e.g. following surgery.
- In the elderly, when diet is poor, or abdominal and perineal muscles are weakened.
- When constipating medication has caused reduced bowel motility.
- To expel parasites when treating with anthelmintics.
- In preparation for surgery.
- To reduce the risk of rectal bleeding e.g. anal fissures or prevent straining (Bateman & Smith 1988, Scottish Medicines Resource Centre 1996).
The laxatives listed in the Nurse Prescribers Formulary (NPF) include... (see following pages)
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