How to Help Your Patients with Chronic Constipation

The Pulse | Wednesday, January 16, 2019

Constipation affects more people than most realize: Nearly 20 percent of adults in the U.S., and one third of adults over 60, have had constipation symptoms, according to the National Institute of Health. While we associate constipation with poor diet, there are a lot of things that can contribute to the condition.

Other health conditions, dehydration, travel—among many other factors—can change your bowel movements. While most people assume constipation is a result of doing something “wrong,” the reality is there are a myriad of factors—some even out of a patient’s control—that contribute to the condition.

Simply telling someone to “change their lifestyle” won’t always help with constipation. Paula Gallagher, MFN, RD, LD, who runs a private practice called The Gutsy RD, says patients with constipation often get frustrated when they’re told eating more fiber or exercising more are the only remedies to fix their constipation.

Nearly 20 percent of adults in the U.S., and one third of adults over 60, have had constipation symptoms.

“Often these recommendations are not enough for this population,” she says. “While a lack of fiber will certainly make bowel movements more difficult, there are many other causes for constipation. Some of these are modifiable … but there are many factors that cannot be altered including age, gender, abdominal adhesions, medications and certain diseases.”

Kyle Staller, MD, MPH, is an instructor in medicine at the Harvard Medical School. He says while constipation and fecal incontinence are considered the “ugly stepchildren” of gastroenterology, it’s an international problem that affects millions of people and should be taken seriously. Understanding the complexities of how constipation happens can prevent the condition from happening in the first place, and give those experiencing symptoms faster relief.

“For patients with chronic constipation, the major factor is most often some biologic impairment in colonic motility that has very little to do with lifestyle or diet,” Staller says. “Many of the chronically constipated patients whom I take care of eat more fiber, drink more water and get more exercise than I could imagine.”

Prescription and over-the-counter medications can cause changes in your bowel movements. Pregnant women are more likely to be constipated, as are those over the age of 60. Also, certain foods—while healthy—might not contain the right probiotics or the right kind of fibers. Depending on the patient, this can actually make constipation worse, Gallagher says.

Understanding the complexities of how constipation happens can prevent the condition from happening in the first place, and give those experience symptoms faster relief.

So what can GI nurses do? It starts with correcting assumptions. Staller says many patients assume if they have a clean bill of health from a colonoscopy (i.e. no signs of colorectal cancer), constipation will not be an issue down the road, or previous instances of constipation were one-time occurrences. While that could be the case for some, it’s not always true, as colorectal cancer – or lack thereof – is not an indication of constipation. Staller and Gallagher agree it’s a wise move for GI nurses and associates to use these screenings as an opportunity to share basic information with patients about what makes a healthy bowel movement. People are often too embarrassed to talk about something like incontinence, but GI nurses and associates can create a welcoming and informative environment for patients by explaining how common the condition is.

“GI nurses can provide patients with basic information on relieving chronic constipation through diet. They can start with the basic instructions of eat more fiber, drink more water, and move your body,” she says. “Moreover, GI nurses can provide a referral to a GI knowledgeable dietitian who can assist the patient in altering their diet and lifestyle to decrease symptoms.”

Staller underscored how important it is for GI nurses to ask about bowel functions, saying it’s a great opportunity to educate patients while they’re already thinking about their GI tract.

“These conditions affect such a large portion of the population, yet many patients never seek medical attention,” he says. “[A colonoscopy] may be the patient’s one contact with people knowledgeable about their bowels, so it represents an incredible opportunity for teaching.”

Gallagher and Staller will be speaking at SGNA’s 2019 Annual Course. Gallagher’s session “The Sluggish Gut Chronicles: Chronic Constipation & Diet” will be held on April 16, and Staller’s session “Understanding Constipation and Fecal Incontinence: A Guide for Understanding Testing and Treatments for Nurses and their Patients” will be on April 12. For more information about Annual Course and to register, visit SGNA’s website.