Nursing Care Plan for Constipation (NANDA, NIC, NOC) Assessment, Goals, Interventions & Rationales

Constipation is a common nursing challenge across acute, long-term, and community settings. Clinically, it’s typically defined as infrequent bowel movements (fewer than three per week), hard/dry stools, straining, or a persistent sensation of incomplete evacuation. It can be functional (no structural cause) or secondary to medications, dehydration, immobility, metabolic/endocrine disorders, neurologic conditions, or obstruction.

Nurses play a central role in early identification, prevention, bowel training, and safe, stepwise intervention especially in high-risk groups (older adults, immobile patients, those on opioids). This care plan provides a practical, evidence-aligned framework using the nursing process with NANDA-I diagnoses, NIC interventions, and NOC outcomes.

Key outcomes you’re aiming for:

Soft, formed stool without straining (Bristol Stool Chart type 3–4)
Predictable bowel routine (ideally every 24–48 hours, individualized)
Reduced abdominal discomfort/bloating
Adequate hydration and fiber intake
Patient knowledge and self-management confidence

Table of Contents

Pathophysiology and Common Causes

Slowed colonic transit: Reduced peristalsis leads to prolonged stool retention and increased water absorption hard, dry stools.
Outlet dysfunction: Dyssynergic defecation or pelvic floor dysfunction causes difficulty evacuating stool.
Medication effects: Opioids, anticholinergics, calcium channel blockers (e.g., verapamil), iron supplements, aluminum-containing antacids, some antidepressants (TCAs), antipsychotics, antispasmodics, antiepileptics, diuretics, antihistamines.
Metabolic/endocrine: Hypothyroidism, diabetes (autonomic neuropathy), hypercalcemia, pregnancy.
Neurologic: Parkinson’s disease, multiple sclerosis, spinal cord injury.
Lifestyle/diet: Low fiber, low fluid intake, immobility, irregular toileting, ignoring the urge.
Structural/secondary: Strictures, colorectal cancer, rectoceles, megacolon; fecal impaction.

Red flags you must not ignore

New-onset constipation after age 50
Rectal bleeding, melena, anemia
Unexplained weight loss, fever, severe or persistent pain
Vomiting, inability to pass gas, significant abdominal distension
Family history of colorectal cancer or inflammatory bowel disease
Urgent escalation and provider evaluation are required if any are present.

Assessment: What nurses must capture

Subjective data

Baseline pattern: Frequency, time of day, usual stool form (Bristol Stool Chart), ease of passage.
Current symptoms: Hard stools, straining, incomplete evacuation, abdominal pain/bloating, nausea.
Onset/duration and precipitating factors: Changes in diet, hydration, activity, stress, travel.
Diet and fluids: Fiber intake (fruits/vegetables/whole grains), total fluids/day; alcohol/caffeine patterns.
Medications and supplements: Especially opioids, iron, anticholinergics, calcium-channel blockers.
Toileting habits: Routine after meals, privacy, ability to sit upright, foot support, suppression of urge.
Comorbidities: Endocrine/metabolic/neurologic conditions; pregnancy status.
Red flags: Bleeding, weight loss, severe pain, vomiting.

Objective data

General: Discomfort, restlessness, signs of dehydration (dry mucous membranes, poor skin turgor).
Abdomen: Inspection for distension; auscultation for bowel sounds; palpation for tenderness/masses.
Rectal exam (per protocol): Assess for stool in rectal vault, fissures/hemorrhoids; note tone and tenderness.

Stool characteristics (Bristol Stool Chart):

Type 1–2: Hard, lumpy- constipation
Type 3–4: Normal
Type 5–7: Looser-diarrhea

Labs/diagnostics (if ordered): Electrolytes (calcium, potassium), thyroid panel, glucose; imaging if obstruction suspected.

Assessment tools and tips

Use a stool diary (time, frequency, consistency, effort, associated symptoms).
Rome IV features of functional constipation: At least 2 of the following in >25% of defecations straining, hard stools, incomplete evacuation, obstruction sensation, manual maneuvers; plus <3 spontaneous BMs/week.

NANDA-I Nursing Diagnoses (examples)

Constipation related to insufficient dietary fiber and fluid intake, decreased physical activity, and medication effects (e.g., opioids), as evidenced by hard stools, straining, and fewer than three bowel movements per week.
Risk for Constipation related to immobility, inadequate fluid intake, opioid therapy, and change in environment.
Perceived Constipation related to misinterpretation of normal bowel patterns and fear of discomfort, as evidenced by frequent use of laxatives/enemas.
Fecal Impaction related to prolonged retention of fecal mass and dehydration, as evidenced by liquid stool seepage, abdominal distension, and palpable fecal mass.
Knowledge Deficit (Bowel Regimen) related to unfamiliarity with fiber/fluid needs, bowel training, and medication side effects.

NOC Outcomes (sample, make SMART)

Bowel Elimination: Soft, formed stool (Bristol 3–4) without straining within 48–72 hours.
Hydration: Intake ≥ 1.5–2.0 L/day unless contraindicated; urine pale yellow.
Nutrition Status: Fiber intake 25–38 g/day (individualize and titrate gradually).
Comfort Level: Reports decreased abdominal pain/bloating.
Knowledge: Bowel Regimen: Demonstrates bowel training techniques and identifies trigger foods/meds.

NIC Interventions with Rationales

Bowel management and training

Establish a toileting routine: Offer toileting 20–30 minutes after breakfast (gastrocolic reflex is strongest). Provide privacy and allow unhurried time.
Rationale: Synchronizes with physiologic colonic activity to facilitate regularity.
Optimize positioning: Feet supported on a footstool, hips flexed, slight forward lean; avoid dangling.
Rationale: Improves anorectal angle, making defecation easier and reducing straining.
Respond to urge promptly: Encourage patients not to ignore the urge to defecate.
Rationale: Suppressing urges reduces rectal sensitivity and worsens constipation.

Dietary fiber and fluids

Gradually increase fiber: Add 5 g/week up to ~25 g/day (adult women) or 30–38 g/day (adult men), guided by tolerance.
Rationale: Fiber increases stool bulk and water content, stimulating peristalsis; gradual increase prevents gas/bloating.
Prioritize soluble fiber: Psyllium has good evidence for chronic constipation; incorporate oats, legumes, and fruits.
Rationale: Soluble fiber retains water and forms a soft gel, improving stool form.
Ensure adequate fluids: Encourage 1.5–2.0 L/day water unless fluid-restricted; tailor for HF/CKD.
Rationale: Adequate fluid intake is needed for fiber to work and to prevent stool desiccation.
Practical plate method: Aim for half the plate fruits/vegetables, a quarter whole grains, a quarter lean protein.
Rationale: Easy, sustainable way to meet fiber targets.

Mobility and activity

Ambulate and mobilize as tolerated: At least 20–30 minutes of walking daily or frequent in-room mobility.
Rationale: Activity stimulates bowel motility and reduces constipation risk.
Core/pelvic floor exercises: Teach gentle abdominal tightening and relaxation techniques; consider PT referral for pelvic floor dysfunction.
Rationale: Supports coordinated defecation mechanics.

Medication management (per provider order)

Review and reconcile medications: Identify and reduce/replace constipating agents when possible (e.g., switch calcium-channel blocker class; evaluate iron formulation).
Rationale: Removing contributors is foundational and may resolve constipation.

Initiate evidence-based laxatives stepwise:

Osmotic: Polyethylene glycol (PEG 17 g daily in 8 oz water) as first-line; lactulose as alternative.
Rationale: Strong evidence for efficacy and safety in chronic constipation.
Stimulant (rescue/short-term): Senna or bisacodyl, typically at bedtime or as suppository if rapid effect needed.
Rationale: Increases intestinal motility; useful adjunct if osmotic alone insufficient.
Stool softener: Docusate may help some patients but has limited evidence; do not rely on monotherapy.
Rationale: Low risk but not strongly effective; use adjunctively if needed.
Enemas/suppositories: Glycerin/bisacodyl suppositories; saline or mineral oil enemas for impaction. Avoid sodium phosphate enemas in older adults or renal/cardiac disease.
Rationale: Rectal agents bypass oral route and act quickly; mineral oil softens impaction.
Refractory cases (provider-prescribed): Secretagogues (lubiprostone, linaclotide, plecanatide) or prokinetic (prucalopride).
Rationale: For chronic idiopathic constipation not responding to OTC therapy.
Opioid-induced constipation (OIC): Start bowel regimen proactively—PEG plus stimulant laxative; consider peripherally acting mu-opioid receptor antagonists (naloxegol, methylnaltrexone, naldemedine) if refractory.
Rationale: OIC mechanisms resist fiber/osmotics alone; targeted therapies may be required.

Fecal impaction management

Confirm with rectal exam (per protocol). If present, consider mineral oil retention enema, followed by warm saline enemas, or manual disimpaction with monitoring (provider order).
Rationale: Bulk-forming fiber is contraindicated in impaction; mechanical/rectal methods may be necessary.
Monitor for vagal response during manual disimpaction (bradycardia, hypotension); have atropine and monitoring per policy.
Rationale: Safety during invasive procedures is critical.

Patient education and self-management

Teach fiber/fluid goals with food examples: Berries, pears, prunes, leafy greens, oats, beans, chia/flax seeds; whole-grain breads and cereals.
Introduce simple habits: Warm beverage in morning; prune or kiwi intake; regular timing; do not ignore urge; gentle abdominal massage clockwise.
Caution on laxative overuse: Avoid daily stimulant laxatives without guidance; cycle off when bowel pattern stabilizes.
Clarify when to seek help: Bleeding, severe pain, sudden change in pattern, vomiting, or no BM despite escalating measures.

Monitoring and documentation

Track outcomes daily: Stool frequency/consistency, straining, abdominal symptoms, hydration, PRN use, and response.
Use standardized tools: Bristol Stool Chart, stool diary, pain scale, hydration markers.
Reassess and titrate: If no response in 48–72 hours, escalate per protocol; consider different class or add rectal agent.

Comprehensive Nursing Care Plan Table (example)

Nursing Diagnosis	Goals/Outcomes (NOC)	Interventions (NIC)	Rationale	Evaluation
Constipation r/t low fiber/fluid intake, decreased activity, and opioid use AEB hard stools (Bristol 1–2), straining, BM every 4–5 days	-Soft, formed stool (Bristol 3–4) in 48–72 h. -BM every 24–48 h without straining. -Hydration ≥1.8 L/day unless restricted	-Initiate toileting 20–30 min after breakfast; ensure privacy and footstool. -Increase fiber by ~5 g/week toward 25–38 g/day; add psyllium. -Encourage water intake to 1.5–2 L/day; monitor I&O -Start PEG 17g daily; add senna HS if no BM in 48 h (per order). -Ambulate TID as tolerated.	-Aligns with gastrocolic reflex and improves anorectal angle. -Fiber + fluids softens stool and increases bulk. -PEG has strong evidence for CIC; stimulant as rescue. -Mobility enhances motility	-Document stool type/frequency daily. -Note reduction in straining and abdominal discomfort. -Adjust regimen if no BM within 48–72.
Risk for Constipation r/t immobility and hospitalization	-Maintain usual bowel pattern during admission. -Reports no discomfort	-Encourage fluids with each med pass. -Offer warm beverage morning. -Schedule toileting post-meals. -Early mobilization plan	-Preventive habits preserve normal motility	-No decrease in frequency; no new complaints
Knowledge Deficit (Bowel Regimen)	-Verbalizes fiber/fluid goals. -Demonstrates proper toileting posture. -Can name red flags	-Teach using handout and food list; demonstrate footstool posture; review meds that constipate. -Have patient “teach-back”	-Improves adherence and safety	-Patient accurately teaches back and sets a home plan

Pharmacologic options: quick reference for nurses

Class	Examples	Nursing Considerations
Osmotic laxatives	Polyethylene glycol (PEG), Lactulose, Magnesium hydroxide	PEG often first-line for chronic constipation; lactulose can cause gas; avoid magnesium salts in renal impairment; ensure hydration
Stimulant laxatives	Senna, Bisacodyl (oral or suppository)	Use short-term or as rescue; can cause cramping; avoid long-term reliance without provider guidance
Stool softeners	Docusate	Limited evidence as monotherapy; may be adjunctive
Bulk-forming fiber	Psyllium, Methylcellulose	Require adequate fluids; avoid in fecal impaction or severe motility disorders
Enemas/suppositories	Glycerin, Bisacodyl suppository; Saline or mineral oil enema	Rapid effect; avoid sodium phosphate in older adults, renal, or cardiac disease; monitor response
Secretagogues/prokinetics (Rx)	Lubiprostone, Linaclotide, Plecanatide, Prucalopride	For refractory chronic idiopathic constipation; educate on correct use and potential diarrhea; provider-managed.
OIC-specific agents	Naloxegol, Methylnaltrexone, Naldemedine	For opioid-induced constipation unresponsive to laxatives; monitor for abdominal pain/diarrhea; check interactions

Special populations and considerations

Older adults

Higher risk due to decreased motility, polypharmacy, limited mobility, and dehydration. Avoid sodium phosphate enemas due to risk of electrolyte abnormalities and nephropathy. Start low, go slow with fiber; ensure fluids to prevent bloating/obstruction. PEG is generally well tolerated; monitor for electrolyte disturbances if using magnesium products.

Pregnancy/postpartum

Prefer nonpharmacologic measures first (fiber, fluids, activity). Bulk-forming fiber and PEG are commonly considered safe; glycerin suppositories for short-term relief. Avoid castor oil; use stimulant laxatives cautiously and short-term if needed. Encourage pelvic floor awareness and gentle bowel routines postpartum.

Pediatrics (brief overview)

Functional constipation is common; withhold behaviors frequent. Disimpaction may be needed first (provider directed), followed by maintenance (often PEG). Dosing is weight-based (provider prescribes). Emphasize routine toileting after meals, positive reinforcement, and adequate fiber/fluid for age.

Neurologic injury or pelvic floor dysfunction

Scheduled bowel program: Timing, rectal stimulants, digital stimulation as ordered.
Consider pelvic floor PT for dyssynergia; biofeedback can be helpful. Assess autonomic dysreflexia risk in high spinal cord injury during rectal procedures.

Opioid therapy

Initiate a prophylactic bowel regimen with the first opioid dose (e.g., PEG + stimulant). OIC often does not respond to fiber alone; escalate early if inadequate response.

Patient education and discharge plan

Bowel routine: Set a consistent time daily, ideally after breakfast; don’t ignore the urge.
Positioning: Knees higher than hips with a footstool; lean forward; relax pelvic floor and exhale gently rather than straining.
Fiber goals: Aim for 25–38 g/day. Add gradually: berries, pears (with skin), prunes/prune juice, kiwi, leafy greens, beans, oats, bran, whole grains, chia/flax.
Fluid goals: 6–8 cups of water daily unless restricted; herbal teas or warm water in the morning can help.
Movement: Walk daily; even 10-minute bouts help. Gentle abdominal massage clockwise can promote motility.
Medications: Understand your regimen, when to use PRNs, and when to stop. Avoid daily stimulant use without guidance.
Triggers to minimize: Low-fiber processed foods, excessive cheese, dehydration, suppressing the urge to go.
When to call the provider: Bleeding, severe pain, no BM for several days despite treatment, vomiting, fever, new/worsening abdominal distension, or sudden changes in pattern.

Documentation tips

Assessment: Baseline pattern; current stool frequency/consistency (Bristol), straining, abdominal findings, hydration, appetite, meds.
Interventions: Diet changes, fluids encouraged, mobility sessions, toileting schedule, footstool provided, laxatives/enemas given (dose/route/time).
Response: Time to BM, stool characteristics, relief of symptoms, side effects.
Education: Content covered and patient “teach-back” results.
Communication: Escalations to provider, new orders, consults (dietitian, PT, GI).

Sample SBAR to provider

Situation: K has had no BM in 4 days with abdominal discomfort and hard stools.
Background: On oxycodone for post-op pain; low fiber intake; minimal ambulation.
Assessment: Abdomen mildly distended, hypoactive bowel sounds, Bristol type 1 on last BM; no red-flag signs; rectal exam shows firm stool.
Recommendation: Request order for PEG daily and senna at bedtime; consider a glycerin suppository today if no BM by afternoon; dietitian consult for fiber optimization.
Evaluation: Are we meeting outcomes?

Within 48–72 hours, reassess:

Stool: Frequency and consistency improved to Bristol 3–4?
Straining: Reduced or absent?
Symptoms: Less pain/bloating?
Intake: Fiber and fluid targets achieved?
Adherence: Toileting routine and positioning used consistently?

If not improving:

Verify adherence and technique (footstool, routine).
Titrate PEG; add or switch agent class (e.g., add stimulant PRN).
Consider rectal interventions.
Reassess for secondary causes; escalate for Rx therapies or workup.
Screen again for red flags; consider imaging if obstruction suspected.

Sample case study (putting it all together)

Patient: 67-year-old female admitted for hip fracture repair, POD 3. On oxycodone 5–10 mg q4–6h PRN, calcium supplement, and iron.

Assessment

Reports last BM 5 days ago; usual at home was every other day.
Complaints: Bloating, abdominal pressure; straining; passing small hard pellets.
Diet: Low appetite; low fiber since admission; ~600 mL fluids/day.
Exam: Mild distension, hypoactive bowel sounds; tender LLQ. Rectal exam: firm stool present, no fissures/bleeding.
No red flags: Afebrile, hemodynamically stable, no vomiting.

NANDA Diagnosis

Constipation r/t opioid use, low fiber/fluid intake, and immobility AEB hard stools, straining, and no BM in 5 days.

Goals (NOC)

BM within 24–48 hours with Bristol 3–4.
Reports reduced abdominal discomfort within 24 hours.
Fluid intake ≥ 1.5 L/day; fiber intake increasing toward 25 g/day.

Interventions (NIC)

Initiate toileting after breakfast with privacy; footstool provided; education on posture and gentle exhalation.
Dietitian consult; add oatmeal at breakfast, fruit at each meal, and prunes; fiber to increase by ~5 g/day.
Encourage and track fluids to ≥ 1.5 L/day; offer warm tea in AM; monitor I&O.
Meds (per order): Start PEG 17 g daily AM; senna 17.2 mg HS PRN if no BM by day’s end; avoid bulking fiber supplement until impaction excluded/resolved.
Mobility: Ambulate with PT TID as tolerated.
If no BM by afternoon and discomfort persists: Bisacodyl suppository per order.
Education: OIC explained; plan for home bowel regimen while on opioids; red flags reviewed.

Evaluation

Day 1 evening: Small BM after bisacodyl; less distension.
Day 2 morning: Larger, soft BM (Bristol 4) after breakfast toileting; abdominal discomfort improved; fluid intake 1.6 L.
Plan: Continue PEG daily during opioid therapy; use senna PRN; maintain fiber/fluid and toileting routine.

Frequently asked questions (for patient-facing education)

How much fiber do I need? Most adults benefit from 25–38 g/day. Increase slowly to avoid gas/bloating. Drink extra water as you increase fiber.
What is the best first-line laxative? Polyethylene glycol (PEG) often works well and is well tolerated. Your nurse/provider will guide the choice.
Are stool softeners enough? Docusate alone often isn’t effective for chronic constipation. It may be used with other agents.
How can I avoid constipation with pain meds? Start a bowel regimen as soon as opioids are started: hydration, fiber, PEG, and often a stimulant like senna at bedtime.
When should I worry? Seek care for severe pain, vomiting, blood in stool, black stools, significant distension, fever, or a sudden change in bowel habits especially if over age 50.

Quality and safety considerations

Avoid stimulant laxative dependence by reserving them for short-term/rescue unless otherwise directed. Avoid sodium phosphate enemas in older adults and those with renal or cardiac conditions. Avoid bulk-forming fiber in suspected fecal impaction or significant obstructive symptoms. Monitor for electrolyte changes if using magnesium-based agents or in patients with comorbidities. Prevent complications of straining (hemorrhoids, fissures, syncope in cardiac patients) by prioritizing posture, relaxation, and stool softening.

Collaboration and referrals

Dietitian: Fiber optimization and meal planning.
Physical therapy: Mobilization, pelvic floor coordination.
Pharmacist: Medication reconciliation, OIC management, interactions.
Gastroenterology: Refractory constipation, suspected pelvic floor dysfunction, or need for advanced therapies.

Quick checklist for daily rounds

BM in last 24–48 hours? Type and ease?
Hydration: Intake adequate? IV/PO plan?
Diet: Fiber sources present at each meal?
Toileting: Routine established? Footstool available?
Activity: Ambulation/mobility sessions completed?
Meds: Laxatives given as ordered? Any side effects?
Red flags: New/worsening pain, bleeding, vomiting, distension?

Conclusion

A high-quality nursing care plan for constipation blends early assessment, routine-based bowel training, dietary/fluid optimization, progressive use of evidence-based laxatives, and patient education. Tailor the plan to the patient’s risks (age, mobility, medications) and reassess within 48–72 hours to adjust therapy. Proactive prevention especially in hospitalized and opioid-treated patients reduces discomfort, length of stay, and complications such as impaction and delirium.