📚 Deeper Dive · Scenario 21 of 57

Bowel Care, In Depth

Constipation, ileus & the bowel regimen — the why behind assessing first
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Coach Katie
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Constipation, and the red flag that isn't

The bowel slows down for predictable reasons — being in bed, opioids, dehydration, and low fiber. After surgery the gut can temporarily stop moving altogether (an ileus). The nurse's job is to tell ordinary constipation apart from a warning cluster that signals an ileus or obstruction.

Think of traffic on a highway. Constipation is slow, heavy traffic that keeps inching along. An ileus or obstruction is a complete standstill — and flooring the gas (a stimulant laxative) against a wall of stopped cars only causes a crash.

Assess before you treat

  • Last bowel movement, and whether they're passing gas.
  • Bowel sounds — present, hypoactive, or absent.
  • Abdominal distension, and any nausea or vomiting.
The red-flag cluster: distended abdomen + absent bowel sounds + vomiting + no flatus suggests ileus or obstruction — hold oral intake as indicated, assess, and notify; do NOT push stimulant laxatives.
Don't over-trust bowel sounds: they are a weak stand-alone sign. Their presence or absence alone should not drive the decision to feed or withhold food — read the whole clinical picture (distension, flatus, nausea/vomiting, and the patient's trajectory).

Prevent ordinary constipation

Mobility, fluids, fiber, a toileting routine, and ordered stool softeners — a bowel regimen is standard for anyone on opioids.

Help the gut restart after surgery

When the gut is recovering from a post-op ileus, motility returns faster with early feeding as tolerated, early mobilization, gum chewing (sham feeding), and opioid-sparing pain control — not prolonged bed rest and NPO.