Bowel Elimination

By Richard Araneta

Bowel Elimination Defecation – is the expulsion of feces from

anus and rectum

Principles Quality varies with the amount of food

consumed and absorbed Consistency of stool depends on the length of

time the contents are in the GIT and the type of food eaten

Factors Affecting Defecation Age and development Diet – some foods are impossible for some

people to digest Fluid intake – in adequate, chyme becomes

more dry Activity – it stimulates peristalsis (movement

of food in the small intestine)

Factors Affecting Defecation Psychologic Factors

Anxious and angry – diarrhea Depressed – constipation

Lifestyle – Ex: availability of toilet facilities Medications

Laxatives – stimulate bowel movement Bentyl – suppresses peristaltic activity

Factors Affecting Defecation Pathologic Conditions – Ex: spinal cord and

injuries Anesthesia and surgery – Ex: Paralytic ileus

(no movement in the small intestines) Irritants – Ex: spicy foods, bacterial toxins Pain

Normal Characteristics of Stool Color

Yellow or golden brown (due to bile pigment derivative known as stercobilin)

Amount Depends on the bulk of food intake

Alterations in the Characteristics of Stool Acholic Stools

Grey, pale, or clay colored, due to biliary obstruction

Hematochezia Passage of stool with bright red blood due to lower

GI bleeding Melena

Passage of black tarry stools due to upper GI bleeding

Steatorrlea Greasy, bulky, foul smelling stool due to

hepatobilary pancreatic obstruction of disorders

Common Fecal Elimination Problems Constipation Fecal impaction Diarrhea Fecal incontinence Flatulence Hemorrhoids

I. Constipation Passage of small, dry, hard stools of the non-

passage of stool for a period of time

Measures to Relieve Constipation Adequate fluid intake High fiber diet Establish regular pattern of defecation Respond immediately to the urge to defecate Minimize stress

Measures to Relieve Constipation Adequate activity and exercise Laxatives as ordered

Avoid overuse, may lead to rebound effect Enzymes

Cleansing or non-retention Retention Return flow

Suppositions

Types of Laxatives Stool lubricants

Lubricates feces and facilitates its expulsion Ex: Mineral oil

Stool/enrollment softeners Soften and delays the drying of the feces; permits

fat and water to penetrate feces Ex: Colace

Bulk formers Ex: Metamucil

Types of Laxatives Osmotic agents

Attracts fluids from intestinal capillaries to stool Ex: Milk of Magnesia – lactose, magnesium citrate

Chemical irritants Increase peristalsis Ex: dulcolax, castor oil, cascera sagrado

II. Fecal Impaction Is a mass or collection of hardened putty-like

feces in the folds of the rectum

Measures to Relieve Impaction Increase fluid intake Sufficient bulk in diet Adequate activity and exercise Manual extraction

Water out for vagal stimulation -> decrease cardiac activity

III. Diarrhea Passage of liquid feces and increased

frequency of defecating

Measures to Relieve Diarrhea Replace fluid-electrolyte loss Good peri-anal care Promote rest Diet bland foods: decrease fiber diet

BAR (banana, apple, rice am) Avoid excessively hot and cold fluids Give potassium rich foods

Measures to Relieve Diarrhea Anti-diarrheal drugs

Demulcents – coat the irritated bowel, acts as protective

Absorbents – absorb gas and toxic substances from the blood

Astringents – shrink swollen or inflamed tissues

IV. Flatulence Presence of excessive gas in the intestines

(tympanism)

Measures to Relieve Flatulence Avoid gas forming foods Limit carbonated drinks, drinking straws,

chewing gum Provide warm fluids to drink Early ambulation: prone or knee chest

positions Adequate activity and exercise Rectal tube – 3-4 inches; for 22-30 Cholinergic as ordered Carminative enemas as ordered (60-180cc

fluid or herbal oils)

V. Fecal Incontinence Inability of anal sphincter to control the

discharge of fecal and gaseous material Ex: in neuromuscular disease, spinal cord injuries,

aging process, etc.

Nursing Care for Fecal Incontinence Good peri-anal care Use of fecal collector (pouch/ diapers) Provide emotional support

VI. Hemorrhoids Also called “piles”, distended veins in the anal

area

Nursing Care and Management Astringents to shrink tissues Local anesthetics Stool softeners Surgery – hemorrhoidectomy