Constipation

What I can do

Work with the healthcare team to assess what’s causing the constipation. Consider:

• Medications such as opioids, anticholinergics, and iron supplements
• Reduced movement or low fluid intake
• Neurological conditions, particularly dementia and Parkinson’s disease.

Give care and support by:

• Offering privacy and reassurance as constipation can be distressing
• Encouraging a small increase in fluids, which could include fruit juice (particularly prune/pear juice)
• Facilitate regular assisted toileting if the older person is anxious about increasing fluids and incontinence
• Introducing laxatives (‘aperients’), only if needed.

Monitor any approaches for effectiveness and recognise when to escalate care by:

• Tracking bowel function daily with the Bristol Stool Chart
• Considering the person’s ability to swallow safely and how close they are to the end of life
• Watching for changes in appetite and weight loss or signs of severe issues (e.g. no bowel movements, bloating, vomiting, intense pain), which could indicate bowel obstruction or spinal cord compression and need urgent medical review.

Tips for Careworkers: Constipation

 

Tips for Nurses: Constipation

What I can learn

The palliAGED Practice Tips give helpful guidance on supporting older people with constipation. There is a version for nurses as well as one for careworkers.

Nurses can read more on this topic in the CareSearch Nurses Hub.

Explore the current research evidence on this topic by reading the Constipation CareSearch Clinical Evidence Summary.

What I can give

Families and carers of an older person often worry about constipation but may not feel comfortable talking about it. These resources can help:

• The Bowel care and constipation near the end of life factsheet from PalAssist
• Constipation advice for carers on the Tips for managing common symptoms at the end of life webpage by CarerHelp.

What I can suggest

Develop staff knowledge and confidence by:

• Having clear bowel care protocols, including when to consult medical staff
• Involving dietitians and palliative care specialists in staff training to help with recognising and managing constipation as part of palliative care
• Supporting staff to have sensitive conversations with families about reduced bowel function near the end of life.

Ensure staff have access to appropriate equipment such as commodes, and incontinence aids.

Monitor and improve practice through bowel care audits and feedback from care recipients and their families.

Page created 25 February 2025