Learn why it happens and how to speak up early for your care.
Today, we’re going to talk about constipation—one of the most common and frustrating problems patients face during a hospital stay. In my opinion, it sits right at the top of the list of hospital complaints. It impacts your comfort, nutrition, recovery, and sometimes even your discharge date.
I can’t count how many times I’ve walked into a patient’s room for my initial morning assessment, introduced myself, and asked: “When was your last bowel movement?”
The answers never fail to astound me:
“Five or six days ago.”
“Not since I was admitted.”
This should never happen in a hospital setting.
One of the very first questions any nurse coming on shift should ask is when the patient last had a bowel movement. The longer it’s been, the more difficult and uncomfortable it becomes to reverse. It’s not just about regularity—it’s about avoiding serious complications and improving the patient’s overall hospital experience.
Constipation in the hospital is often a silent issue. Why?
- Patients assume the hospital is monitoring it.
- Staff may assume the patient will mention it.
This disconnect can lead to days without a bowel movement—until it becomes a crisis.
Inside the hospital, normal bowel patterns are disrupted by:
- Dietary changes
- Reduced activity or bed rest
- New medications
- Interrupted sleep
- Stress, pain, and lack of privacy
Unless we speak up and plan proactively, constipation gets overlooked.
A prospective study of 556 hospitalized patients found that 55.6% experienced constipation during their stay. Risk factors included:
- Older age
- Higher frailty scores
- Heart failure
- Use of calcium channel blockers
Shockingly, in 64% of cases, constipation was unrecognized by the treating team. That means patients were suffering in silence while their care team was unaware.
In my experience, that number is likely even higher. Constipation is underreported, under-recognized, and under-treated.
Common Causes:
- Slow Movement Through the Colon: Stool sits too long; the colon absorbs water, making stool hard.
- Dehydration: Not enough fluids means drier stool.
- Low Fiber Intake: Less fiber = less bulk and moisture.
- Muscle Weakness: Abdominal or pelvic muscles may not coordinate effectively.
- Nerve Disorders: Diabetes, Parkinson’s, spinal injuries, and aging interfere with bowel signaling.
- Medications: Opioids, calcium channel blockers, anticholinergics, antidepressants.
- Psychological Factors: Stress, anxiety, embarrassment.
In short: Constipation is about water, movement, and timing—and hospitals disrupt all three.
When a patient is admitted, many doctors automatically prescribe Colace (docusate sodium). It’s a good start, but Colace alone isn’t enough.
- Colace softens stool but doesn’t stimulate movement.
- A proactive bowel plan is needed for high-risk patients.
That means adding stimulant or osmotic laxatives early, especially in older adults or those on opioids.
Waiting too long can lead to:
- Nausea
- Abdominal distention
- Loss of appetite
- Need for suppositories or enemas
Many newer nurses hesitate to use these, even when needed.
Before jumping to medications, try heated prune juice. It’s available on most units, and I’ve had great luck with it. Simple, natural, and effective.
Now, let’s talk medications.
- Stool Softeners Example: Colace (docusate sodium) Note: Prevents hard stool; not helpful once constipation starts
- Bulk-forming Agents Example: Psyllium (Metamucil) Caution: Needs lots of water; not great for frail patients
- Osmotic Laxatives Examples: MiraLAX (polyethylene glycol), Lactulose Use: Pulls water into stool; gentle and effective
- Stimulant Laxatives Examples: Senna, Dulcolax (bisacodyl) Use: Stimulates colon contractions Caution: Not for long-term use
- Saline Laxatives Example: Milk of Magnesia Use: Strong, fast-acting Caution: Can cause electrolyte imbalance, especially in older adults
Laxative choice depends on: hydration, kidney function, frailty, and current medications.
Constipation delays healing. It causes discomfort, affects nutrition and mobility, and often delays discharge.
Yes—patients can’t be sent to rehab or home until they’ve had a bowel movement.
This should never be the reason someone is stuck in the hospital.
A friend had back surgery with a planned 2-day stay. It stretched into two weeks.
After she got home, I asked, “Have you had a bowel movement?”
She said, “Not in over a week.”
I was stunned—and angry. That’s a preventable problem. She needed:
- Multiple medications
- Suppositories
- A lot of discomfort
That kind of oversight wouldn’t have happened 20 years ago.
Here’s something ironic I’ve seen too often:
No one checks on constipation until discharge day.
Why?
- Rehab facilities won’t accept patients who haven’t had a bowel movement in 2+ days.
- Suddenly, nurses are expected to “get results” fast.
It becomes a scramble—and it’s not fair to the patient.
The goal of The Art of Being ILL is to give you the knowledge to advocate for yourself.
Constipation should not be an afterthought.
Know the signs. Know the medications. Ask the questions.
You deserve care that treats the whole you—including your digestive health. It will come.
Please post comments, like and share to friends and come back for more.
For personal questions contact me at artofbeingill@gmail.com
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