1. Source: Palliative Care Nursing- A Guide to Practice, 2003.
733 Dr. Geminer St., Karkafa, Bethlehem –Palestine. P.O. Box: 19960 East Jerusalem 97200
Telefax: 972 2 2767337 , Mobile: 972 522495249 , E-mail: sadeelsoc@yahoo.com
2. Constipation Assessment Scale
Directions: Circle the appropriate number to indicate
whether, during the past three days, you have had No
problem, Some problem or a Severe problem with each
of the items listed.
No Some Severe
Item problem problem problem
1. Abdominal distension or 0 1 2
bloating
2. Change in amount of gas 0 1 2
passed rectally
3. Less frequent bowel 0 1 2
movements
4. Oozing liquid stool 0 1 2
5. Rectal fullness or 0 1 2
pressure
6. Rectal pain with bowel 0 1 2
movement
7. Smaller stool size 0 1 2
8. Urge but inability to pass 0 1 2
stool
Patient’s name Date
Source: Palliative Care Nursing- A Guide to Practice.
733 Dr. Geminer St., Karkafa, Bethlehem –Palestine. P.O. Box: 19960 East Jerusalem 97200
Telefax: 972 2 2767337 , Mobile: 972 522495249 , E-mail: sadeelsoc@yahoo.com
