1. Constipation Management 

Assessment 

Frequency, consistency, and ease of stool passage. 

Bristol Stool Chart to assess and document consistency:



– Diet and fluid intake. 
– Medication history (opioids, anticholinergics, iron supplements). 
– Mobility and neurological status. 
– Abdominal assessment for distension or tenderness. 

Non-Pharmacological Interventions 

Encourage adequate hydration (1.5–2 L/day unless contraindicated). 
High-fibre diet (fruits, vegetables, whole grains). 
Promote physical activity if possible. 
Establish a regular toileting routine (same time each day). 
Provide privacy and dignity: assist patient to bathroom or bedside commode. 

Pharmacological Interventions 

Bulk-forming laxatives: e.g., psyllium (take with fluids). 
Osmotic laxatives: e.g., lactulose, macrogol. 
Stimulant laxatives: e.g., senna, bisacodyl (short-term use if needed). 
Stool softeners: e.g., docusate sodium. 
Suppositories/enemas for acute relief if oral agents fail. 
Monitor for electrolyte imbalance, especially in older adults. 

Tissue Viability 

Assess for skin breakdown from straining (perianal tears, haemorrhoids). 
Promote gentle cleaning and barrier creams if needed. 

2. Diarrhoea Management 

Assessment 

Onset, frequency, volume, consistency of stool (refer to Bristol Stool Chart)
Associated symptoms: fever, abdominal pain, blood/mucus in stool. 
Medication and antibiotic use. 
Hydration status, electrolyte imbalance, weight changes. 

Fluid and Electrolyte Management 

Oral rehydration solutions (ORS) for mild-moderate dehydration. 
Monitor fluid balance chart, bowel chart and vital signs. 
IV fluids if severe dehydration, electrolyte disturbances, or inability to tolerate oral fluids. 

Pharmacological Management 

Usually supportive; anti-motility agents (e.g., loperamide) only if not infectious. 
Treat underlying cause (e.g., antibiotics for bacterial infections, C. diff requires specific therapy – oral vancomycin or fidaxomicin – consult local policy/micro advice). 

Infectious Diarrhoea: C. difficile 

Strict contact precautions (gloves, gown, hand hygiene with soap and water – alcohol does not kill spores). 
Isolate patient. 
Avoid anti-motility agents. 

Specific treatment: 

Mild-moderate: Oral vancomycin or fidaxomicin. 
Severe: Higher doses, possible IV support. 
Monitor for complications: toxic megacolon, dehydration. 

Tissue Viability 

Frequent perineal skin assessment. 
Use barrier creams, absorbent pads, or continence products. 
Gentle cleansing after each episode. 
Consider pressure-relieving surfaces if patient is immobile. 

3. Patient Dignity and Comfort 

Provide privacy and confidentiality during toileting. 
Offer assistance discreetly without rushing. 
Educate patient on bowel management plan. 
Respect patient preferences in management (e.g., bedside commode vs. bathroom). 

4. Utilisation of Bowel Management Systems 

Consider rectal catheters or faecal management systems for: 
Immobile patients. 
Patients with incontinence risking skin breakdown. 
Severe diarrhoea or C. diff with high output. 
Regular monitoring and cleaning of devices. 
Avoid long-term use if possible to prevent mucosal injury. 

5. Special Considerations 

Medication review: opioids → constipation, antibiotics → diarrhoea/C. diff. 
Nutrition support: Adjust diet to fibre, fluid, and electrolyte needs. 
Education: Patients and carers on hydration, dietary management, and when to seek help. 

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