RLE 103

BOWEL
ELIMINATIO
N
Prepared by:
Mira Bianca A. Decena, RN, OHN
 INTRODUCTION
● The elimination of waste from the bowel is
essential body function.
● Successful elimination in human beings
depends on the individual having an intact and
fully functional urinary tract, gastrointestinal
tract and nervous system.
● Though variations of what is normal occur in an
individual, there is a pattern in elimination that
every human being must have.
● Furthermore, bladder and bowel functioning
may be processes that are most often taken for
granted, until problems occur.
 INTRODUCTION
● The fecal matter may take 24 to 48 hours to
pass through the entire large intestine.
● Between 150 to 300 grams of feces is produced
daily.
● The fecal matter consists of unabsorbed food
residue, mucus, digestive secretions (gastric,
intestinal, pancreatic and liver), water and
microorganisms.
● The feces consist of 75% water and 25% solid.
● If the feces are moved rapidly through the large
intestine, less water is absorbed and the stool is
liquid.
● If the movement of the feces and elimination
are delayed, an excessive amount of water is
absorbed and the stool becomes hard and dry.
Review of the digestive system
 PHYSIOLOGY OF FECAL
● ELIMINATION
DEFECATION is the expulsion of feces from the
rectum. It has an INVOLUNTARY PHASE.

● FECES or STOOL - is the excreted waste

products of digestion.

○ When the feces enters the rectum, the local distention

and the pressure gives rise to the sensory impulses
that initiates reflex impulses to the internal anal
sphincter and to the muscle tissue of the sigmoid
colon and the rectum.

○ The sphincter relaxes and the muscle tissue contracts,

moving the feces into the anal canal.

○ The external anal canal sphincter is under a voluntary

control and must also relax for evacuation of the
rectum.
 PHYSIOLOGY OF FECAL
● ELIMINATION
VALSALVA MANEUVER - voluntary
contracting the abdominal muscles by forceful
expiration with glottis closed that increases the
abdominal pressure.

● If the defecation reflex is ignored and the

external sphincter is kept closed, the defecation
desires soon wanes.

● Consequently, with repeated ignoring the

defecation reflex, local stimulation by distention
and pressure is lost.
Characteristics of Normal and Abnormal Feces
 ALTERATIONS IN THE Characteristics of
Normal STOOL
● Alcoholic Stool
○ Gray, pale or clay colored stool due to absence or stercobilin caused by biliary
obstruction
● Hematochezia
○ Passage of stool with bright red blood, it is due to lower gastrointestinal bleeding
● Melena
○ Passage of black tarry stool due to upper GI bleeding
● Steatorrhea
○ Greasy, bulky, foul smelling stool, it is due to presence of undigested fats like
hepatobiliary-pancreatic obstructions/disorders
 Factors that affect defecation
● DEVELOPMENT
● DIET
● FLUID INTAKE AND OUTPUT
● ACTIVITY
● PSYCHOLOGICAL FACTORS
● DEFECATION HABITS
● MEDICATIONS
● DIAGNOSTIC PROCEDURES
● ANESTHESIA AND SURGERY
● PATHOLOGIC CONDITIONS
● PAIN
 FECAL ELIMINATION PROBLEMS
● CONSTIPATION - may be defined as fewer than
three bowel movements per week.

○ This infers the passage of dry, hard stool

or the passage of no stool.

○ Refers to difficult evacuation of stool and

increased effort or straining of the
voluntary muscles of defecation.

● FECAL IMPACTION - is a mass or collection of

hardened feces in the folds of the rectum.

○ Impaction results from prolonged

retention and accumulation of fecal
material.
 FECAL ELIMINATION PROBLEMS
● DIARRHEA - refers to the passage of liquid feces and an increased frequency of defecation.

○ It is the opposite of constipation and results from rapid movement of fecal contents through the large
intestine

● BOWEL INCONTINENCE- refers to the loss of voluntary ability to control fecal and gaseous discharges
through the anal sphincter.

○ The incontinence may occur at specific times, such as after meals, or it may occur irregularly.
○ 2 TYPES OF BOWEL INCONTINENCE:
i. Partial incontinence
● is the inability to control flatus or to prevent minor soiling.
ii. Major incontinence
● is the inability to control feces of normal consistency.
 FECAL ELIMINATION PROBLEMS
● FLATULENCE - is the presence of excessive flatus in the intestines and leads to stretching and inflation of
the intestines (intestinal distention).

● Flatulence can occur in the colon from a variety of causes, such as foods (e.g., cabbage, onions), abdominal
surgery, or narcotics.

● If the gas is propelled by increased colon activity before it can be absorbed, it may be expelled through the
anus.If excessive gas cannot be expelled through the anus, it may be necessary to insert a rectal tube to
remove it.

● THREE PRIMARY SOURCES OF FLATUS:

○ Action of bacteria on the chyme in the large intestine
○ Swallowed air
○ Gas that diffuses between the bloodstream and the intestine.
FLATUS
BOWEL DIVERSION OSTOMIES
An ostomy is an opening for the gastrointestinal, urinary, or respiratory tract onto the skin.

Types of intestinal ostomies:

1. Gastrostomy is an opening through the abdominal wall into the stomach

2. Jejunostomy opens through the abdominal wall into the jejunum
3. Ileostomy opens into the ileum (small bowel)
4. Colostomy opens into the colon (large bowel)

Gastrostomies and jejunostomies are generally performed to provide an alternate feeding route. The
purpose of bowel ostomies is to divert and drain fecal material.

Classification of bowel diversion ostomies:

5. Permanence
6. Anatomic location
7. Surgical Construction of the Stoma

A stoma is generally red in color and moist. Initially, slight bleeding may occur when the stoma is
touched and this is considered normal.

A person does not feel the stoma because there are no nerve endings in the stoma.
 PERMANENCE
1. Temporary colostomies are generally performed for
traumatic injuries or inflammatory conditions of the bowel.
They allow the distal diseased portion of the bowel to rest
and heal.
2. Permanent colostomies are performed to provide a means
of elimination when the rectum or anus is nonfunctional as
a result of a birth defect or a disease such as cancer of the
bowel.
Anatomic location
Surgical Construction of the Stoma
 Promoting Regular Defecation
1. Provision of privacy
○ The nurse should therefore provide as much privacy as possible for such clients but may
need to stay with those who are too weak to be left alone.
2. Timing
○ A client should be encouraged to defecate when the urge is recognized. Other activities,
such as bathing and ambulating, should not interfere with the defecation time.
3. Nutrition and fluids
○ The diet a client needs for regular normal elimination varies, depending on the kind of
feces the client currently has, the frequency of defecation, and the types of foods that the
client finds assist with normal defecation.
4. Exercise
○ Regular exercise helps clients develop a regular defecation pattern.
5. Positioning
○ Although the squatting position best facilitates defecation, on a toilet seat the best
position for most people seems to be leaning forward.
 NURSING RESPONSIBILITIES
FACILITATING TOILETING
● Ensure safe and easy access to the toilet. Make sure lighting is appropriate, scatter
rugs are removed or securely fastened, and so on.
● Facilitate instruction as needed about transfer techniques.
● Suggest ways that garments can be adjusted to make disrobing easier for toileting
(e.g., Velcro closing on clothing).
MONITORING BOWEL ELIMINATION PATTERN
● Instruct the client, if appropriate, to keep a record of time and frequency of stool
passage, any associated pain, and color and consistency of the stool.
DIETARY ALTERATIONS
● Provide information about required food and fluid alterations to promote defecation or
to manage diarrhea.
MEDICATIONS
● Discuss problems associated with overuse of laxatives, if appropriate, and the use of
alternatives to laxatives, suppositories, and enemas.
● Discuss the addition of a fiber supplement if the client is taking a constipating
medication
Giving and Removing a Bedpan
Giving and Removing a Bedpan
Types of Laxatives
 Administering Enemas
● An ENEMA is a solution introduced into the rectum and
large intestine.
● The action of an enema is to distend the intestine and
sometimes to irritate the intestinal mucosa, thereby
increasing peristalsis and the excretion of feces and flatus.
● The enema solution should be at 37.7°C (100°F) because a
solution that is too cold or too hot is uncomfortable and
causes cramping.
 4 types of enema
1. Cleansing
2. Carminative
3. Retention
4. Return-flow enemas
 Cleansing ENEMA
Cleansing enemas are intended to remove feces. They are given chiefly to:
1. Prevent the escape of feces during surgery.
2. Prepare the intestine for certain diagnostic tests such as x-ray or visualization tests (e.g., colonoscopy).
3. Remove feces in instances of constipation or impaction.
 Carminative ENEMA
● A carminative enema is given primarily to expel
flatus.
● The solution instilled into the rectum releases
gas, which in turn distends the rectum and the
colon, thus stimulating peristalsis. For an adult,
60 to 80 mL of fluid is instilled.
● Traditionally the enema consisted of two ounces
of glycerin, one ounce of magnesium sulfate
(epsom salts) and three ounces of water. The
combination of ingredients stimulate peristalsis
resulting in a bowel movement in which feces
and flatus are expelled.
 Retention ENEMA
● A retention enema introduces oil or
medication into the rectum and sigmoid
colon.
● The liquid is retained for a relatively long
period (e.g., 1 to 3 hours).
● An oil retention enema acts to soften the
feces and to lubricate the rectum and anal
canal, thus facilitating passage of the feces.
● Antibiotic enemas are used to treat
infections locally, anthelmintic enemas to
kill helminths such as worms and intestinal
parasites, and nutritive enemas to
administer fluids and nutrients to the
rectum.
 Return-flow enemas
● Also known as Harris flush, a return-
flow enema is done on people with
trouble pooping due to intestinal gas.
● In this method, a large fluid volume is
used, which is injected in 100-200 ml
increments. The fluid is then drawn out
along with the flatus (intestinal gas)
Administering an Enema
Administering an Enema
Ostomy Management
Changing a Bowel Diversion Ostomy
Appliance
Changing a Bowel Diversion Ostomy
Appliance
Changing a Bowel Diversion Ostomy
Appliance
END of
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