BOWEL ELIMINATION

Prepared by: NORIE V. PALAS, R.N.

 PHYSIOLOGY OF DEFECATION - Diagnostic procedures: colon (colonoscopy), the client is restricted from ingesting food
Elimination of the waste products of digestion from the body is essential to health, the excreted or fluid.
waste products are referred to as feces or stool - Anesthesia and Surgery - Cease or slow the normal colonic movements, usually lasts
 DEFECATION 24 to 48 hours.
It is the expulsion of feces from the anus and rectum. called a bowel movement. The  FECAL ELIMINATION PROBLEMS
frequency of defecation is highly individual. The amount defecated also varies from person  CONSTIPATION
to person. - Decreased frequency of defecation
- When peristaltic waves move the feces into the sigmoid colon and the rectum, the - Hard, dry, formed stools
sensory nerves in the rectum are stimulated and the individual becomes aware of the - Painful defecation
need to defecate. - Causes include:
- After the individual is seated on a toilet or bedpan, the internal and external anal  Insufficient fiber and fluid intake
sphincter relaxes, feces move into the anal canal.  Insufficient activity
- Expulsion of the feces assisted by contraction of the abdominal muscles the  Irregular habits
diaphragm, and pelvic floor moves the feces through the anal canal and expelled  DIARRHEA
through anus - Passage of liquid feces and increased frequency of defecation
- Normal defecation is facilitated by: thigh flexion and sitting position - Spasmodic cramps, increased bowel sounds
 IGNORANCE OF DEFECATION - Fatigue, weakness, malaise, irritation of the anal region
- If the defecation reflex is ignored, or if defecation is consciously inhibited by - Major causes:
contracting the external sphincter muscle, the urge to defecate normally disappears for  Stress, medications
a few hours before occurring again.  Allergies
- Repeated inhibition of the urge to defecate can result in expansion of the rectum to  intolerance of food or fluids
accommodate accumulated feces and eventual loss of sensitivity to the need to defecate.  disease of colon
CONSTIPATION can be the result.  BOWEL INCONTINENCE/ FECAL INCONTENENCE
 CHARACTERISTICS OF FECES/ STOOL - Loss of voluntary ability to control fecal and gaseous discharges through the anal
- Normal feces are made of 75% water and 25% solid materials make it soft. sphincter.
- If the feces are propelled very quickly along the large intestine, there is not time for - Generally associated with:
most of the water in the chyme to be reabsorbed and the feces will be more fluid,  Impaired functioning of anal sphincter or nerve supply
containing perhaps 95% water.  Neuromuscular diseases
- Normal feces require a normal fluid intake; feces that contain less water may be hard  Spinal trauma
and difficult to expel.  Tumor
- Feces are normally brown.  FLATULENCE
- The fecal color affected by the action of bacteria such as Escherichia coli, which are - Excessive flatus in intestines
normally present in the large intestine. - Leads to stretching and inflation of intestines
- The action of microorganisms is also responsible for the odor of feces. - Can occur from variety of causes:
 FACTORS THAT AFFECT DEFECATION:  Foods
1. Developmental  Abdominal surgery
2. Diet  Narcotics
3. Fluid  BOWEL DIVERSION OSTOMIES
4. Psychological Factors OSTOMY- is an opening for gastrointestinal, urinary, or respiratory tract onto the skin
5. Activity 1. GASTROSTOMY- is an opening through the abdominal wall.
- Defecation habits 2. JEJUNOSTOMY- Opens through the abdominal wall into the jejunum.
- Pathologic conditions 3. ILEOSTOMY- Opens into the ileum.
- Pain 4. COLOSTOMY- Opens into the colon.
- Medications

NVPalas NCMFNP 1 – FECAL ELIMINATION

THE LOCATIONS OF BOWEL DIVERSION OSTOMIES ADMINISTERING AN ENEMA

 MANAGEMENT OF STOOL
DRAINAGE
The location of the ostomy
influences the character and
management of the fecal
drainage. The further along the
bowel, the more formed the
stool (because the large bowel
reabsorbs water from the fecal
mass) and the more control
over the frequency of stomal
discharge can be established.

 CHARACTERISTICS FECAL DRAINAGE FROM OSTOMY Assuming a left lateral position for an enema. Rolling up a commercial enema container.
a. Ileostomy- produces liquid fecal drainage. Drainage is constant and cannot be Note the commercially prepared enema.
regulated. Odor is minimal because fewer bacteria are present.
b. Ascending colostomy is similar to an ileostomy. Odor, is a problem requiring control.  DIGITAL REMOVAL OF A FECAL IMPACTION
c. Transverse colostomy produces a malodorous, (aromatic) mushy drainage. - Digital removal involves breaking up the fecal mass digitally and removing it in
d. Descending colostomy produces solid fecal drainage. portions.
e. Sigmoid ostomy are of normal frequency of discharge can be regulated. People have - Because the bowel mucosa can be injured during this procedure, some agencies
not to wear an appliance at all times, and odors can usually be controlled. restrict and specify the personnel permitted.
 TEACHING ABOUT MEDICATIONS  STOMA CARE FOR CLIENTS WITH AN OSTOMY
1. Cathartics are drugs that induce defecation. CHANGING A BOWEL DIVERSION OSTOMY APPLIANCE
2. Laxative - is mild in comparison to a cathartic, and it produces soft or liquid stools
that are sometimes accompanied by abdominal cramps. Contraindicated in the client Cleaning the skin. A guide for measuring the stoma.
who has nausea, cramps, colic, vomiting, or undiagnosed abdominal pain. These act in
various ways: by softening the feces, by releasing gases, or by stimulating the nerve
endings in the rectal mucosa.
3. Antidiarrheal Medications - slow the motility of the intestine or absorb excess fluid
in the intestine.
4. Anti-flatulent Medications - facilitate the passage of the flatulence through the
mouth or through the anus.
 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.
 TYPES OF ENEMAS:
1. Cleansing
- Prevents escape of feces during surgery
- Prepare intestines for certain diagnostic tests
- Removes feces in instances of constipation or impaction
2. Carminative and return-flow
- Used primarily to expel flatus
3. Retention
- Introduces oil or medication into the rectum and sigmoid colon.

NVPalas NCMFNP 1 – FECAL ELIMINATION

The nurse is making a stoma opening on a
disposable one- piece pouch.

Centering the skin barrier over the stoma.

Pressing the skin barrier of a disposable one-piece pouch for 30 seconds to activate the adhesives
in the skin barrier.
 EVALUATING
- The goals established during the planning phase are evaluated according to specific
desired outcomes.
- If outcomes are not achieved, the nurse should explore the reasons.

NVPalas NCMFNP 1 – FECAL ELIMINATION