bowel elimination
TRANSCRIPT
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