This document discusses constipation as a common postoperative complication, outlining its clinical features and consequences such as nausea, vomiting, inability to eat, bowel distention, and patient discomfort. It notes constipation costs over $1 billion per year to treat. The document provides diagnostic criteria for functional constipation and references discussing treatment of chronic constipation and its role as a risk factor for postoperative ileus following orthopedic surgery. It outlines a medication pathway using bulk forming, osmotic, and irritant laxatives and emphasizes the importance of prescribing laxatives and patient education on laxative and opioid use.

1. Preventing Orthopedic Postoperative Constipation/Ileus
Nicole Taniguchi, SN
University of San Francisco, 2016
• Nausea/vomiting
• Inability to eat
• Bowel distention
• Patient discomfort
• Delayed enteral feeding
• No flatus/BM
• Cost >$1 billion/year
Constipation is an often overlooked and
misunderstood side effect of many
medications and surgical procedures.
Constipation affects clients in many
ways, causing extreme discomfort. To
diagnose functional constipation, the
client must display two or more of the
following diagnostic criteria:
a) Straining during at least 25% of
defecations
b) Lumpy or hard stools in at least 25%
of defecations
c) Sensation of incomplete evacuation
in at least 25% of defecations
d) Sensation of anorectal obstruction /
blockage for at least 25% of defecations
e) Manual maneuvers to facilitate at
least 25% of defecations
f) Fewer than three defecations per
week
Clinical features &
consequences
http://bestpractice.bmj.com/best-practice/monograph/154/treatment/step-by-step.html
Background
Hussain, Z. H., Everhart, K., & Lacy, B. E. (2015).
Treatment of Chronic Constipation: Prescription
Medications and Surgical
Therapies. Gastroenterology & Hepatology, 11(2),
104-114 11p.
Lee, T. H., Lee, J. S., Hong, S. J., Jang, J. Y.,
Jeon, S. R., Byun, D. W., & ... Lee, J. S. (2015).
Risk Factors for Postoperative Ileus Following
Orthopedic Surgery: The Role of Chronic
Constipation.
Mclean-Vickers, J. (2014). Bowel management
and day surgery: a look at constipation. Day
Surgery Australia, 13(2), 22-24.
Myatt, R. (2012). Constipation: A common
postoperative complication of cardiac
surgery. British Journal Of Cardiac Nursing, 7(4),
172-177 6p.
Sawh, S. B., Selvaraj, I. P., Danga, A., Cotton, A.
L., Moss, J., & Patel, P. B. (2012). Use of
Methylnaltrexone for the Treatment of Opioid-
Induced Constipation in Critical Care
Patients. Mayo Clinic Proceedings, 87(3), 255-259.
Trads, M., & Pedersen, P. U. (2014).
Constipation and defecation pattern the first 30
days after hip fracture. International Journal of
Nursing Practice Int J Nurs Pract, 21(5), 598-604
• Ensure laxatives are
prescribed on the MAR
• Begin laxatives once patient is
tolerating diet
• One stool has passed, ensure
laxatives are prescribed for
discharge if patient is on
opioids
• Educate patient on titrating
laxative and opioid to ensure
regular BM and pain
management
Patient Education
References
Medication Pathway
1. Bulk forming laxatives: psyllium (Metamucil,
Fiberall, Bulk-K, Firbo-XL), methylcellulose
(Citrucel)
2. Osmotic laxatives lactulose, sorbitol,
polyethylene glycol solution (Miralax)
3. Irritant laxatives (bisacodyl, senna)