In this section
Constipation is one of the most frequent, adverse reactions that can occur post-operatively secondary to a reduction in fluid intake, immobility and medications such as opioids. Faecal impaction may occur causing pain and discomfort for patients as well as
increasing the length of hospital stay. Conversely, the patient’s medical condition and medications such as antibiotics can also lead to diarrhoea.
The aim of this guideline is to assist nurses who work within the paediatric field around the prevention and management of constipation in the post-operative patient.
All post-operative patients are at risk of developing constipation due to a variety of factors, such as changes in mobility status, reduced oral intake and as a side effect of medications. Constipation is a common adverse effect from opioid medication use due to the action upon opioid receptors in the gastrointestinal
tract. This leads to a reduction in gastrointestinal propulsion and an increase in fluid absorption.
If the patient reports difficulty passing stools, has not had a bowel action since surgery, or is currently taking opioids, then the following should be considered:
Source: UpToDate® (2021), Constipation
in infants and children: proper positioning on toilet for child,
Prior to giving aperients, the nurse should:
Multiple forms of aperients are usually needed to relieve opioid induced constipation in post-operative patients (see
Appendix 1). Recent studies suggest macrogol preparations may produce more frequent stools in the paediatric population compared with other commonly used aperients. If the patient does not already have their own bowel regime in place, consider administering the following (in consultation with medical teams):
Clinical Practice Guidelines
Kids Health Info
Nausea and vomiting
Dissolve sachet in 125ml of water or cordial (has salty taste)
Available in several flavours
Mix with 120-250ml of hot or cold liquid depending on dose
(no salty taste)
Abdominal discomfort Dehydration
Can mix in formula, water or juice
For children 0-3yrs
* Can be nurse initiated (at RCH). Must be documented in MAR and immediately communicated to treating medical team.
* from breastmilk or formula
# from breastmilk, formula, plain water and other beverages
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The development of this nursing guideline was coordinated by Tineke Fitzgerald, CNS, Platypus Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated May 2023.