"...and it came to pass"


Frank Booth, RGN (Rtd)

Background reading

In his preamble to this series of articles, Frank  says:

Nursing is a wonderful profession that requires considerable skills and knowledge. The interpretation and passing of this knowledge to the public can be very difficult and requires different skills altogether. Get this right and patient care will be enhanced, get it wrong and not only will you be criticised but complaints may also follow.

The articles will follow the following format:

  • Concept - this sets out the logic of what I will be trying to say
  • Principles - what systems are in play, how do they work, what has gone wrong (the subject matter)?
  • "Kis" - Keep It Simple. Your knowledge is legion, but will your patient actually understand things at the same level as you do? This is not to say that your patients are not clever people, but there are clearly a number of differences between you and your patients. It doesn't matter if you are a hospital or primary care nurse your patients deserve the best from you
  • And Finally - this section will round everything up  and give you some 'patients insights' from someone who may know (Me!)


Constipation, although common, is not ‘normal’. It can affect babies, young people and adults of any age, but it is likely that you will see it mostly in your elderly patients.

At best, constipation is embarrassing, at worst it is painful. Consequences include faecal incontinence and even death.


Any food and drink that we put into our mouth will typically take approximately two days to leave the body. As food passes through the gut, appropriate nutrients and liquid are extracted and the resulting waste products will generally be detoxified by the liver and excreted via the bowel.

The bowel is a hollow pipe, amazingly small in width for the function it performs. It is in the region of 42 feet in length, neatly packaged inside the abdominal cavity. Anatomically it is dived into the following sections:

  • the oesophagus
  • the stomach
  • the small bowel, comprising the duodenum and the jejunum and terminally the ileum
  • the large bowel comprising the ascending, transverse and descending elements of the colon, ending in the sigmoid colon, caecum, rectum and anus.

Along its length other organs are attached. The gall bladder and liver is admitted via the middle of the 'c' shape of the duodenum and the appendix is attached to the beginning of the large bowel around the base of the ascending colon. The common bile duct changes the consistency of fluid in the system. In the mouth the liquid we produce (saliva) is alkaline, with a pH value of over 7; within the stomach, the gastric juices are acid and have a pH as high as 1.

Solid food mixes with and both liquid consumed and intestinal juices, to produce a substance called chime. The chime is moved through the digestive system by peristaltic waves, a near continuous action of squeezing, relaxing and resting movements that propel everything towards the end of the system. It is this propulsion, moving at a regular pace that will prevent constipation.

The motility of the intestines are directly linked to the mobility of the body; as we age or become unwell and our mobility reduces, so too does bowel motility, which may lead to constipation.


It is not always possible to prevent constipation and therefore you will need to understand the 'why' it happened before putting in place an action plan.

How do you know that your patient is constipated? You need to establish what is normal for that individual (typically between one evacuation daily to one evacuation every three days). You will also need to examine the stool, using for example, the Bristol Stool Chart which identifies 7 "types" of stool shapes and constituency.

There is little better than the personal or human touch. Speak to your patience, reassure them that you have the knowledge and skill to ensure that if it is at all possible you will cure them of their constipation, be assured that in most cases you are able to cure. Sometimes full cure is not possible but you should always be able to enhance the quality of their lives.


If constipation is not dealt with quickly and effectively the outcome could be disastrous. In early stages it can be easily remedied by increasing ones fluid intake and where possible, mobility (addressing the causes of reduced mobility such as arthritis, may help).

Early and ‘simple’ interventions can result in less traumatic, less expensive and less demanding (on your time and services) outcomes. The incidence of reoccurance may also be reduced, thereby giving the maximum patient benefit for the minimum of input.

Returning the body's normal functions back to whatever was "normal" for the patient should be your ultimate goal and remember it is achievable if you KIS it!


At best, constipation is embarrassing, at worst it is painful. Consequences include faecal incontinence and even death.