BOWEL ELIMINATION

BOWEL ELIMINATION• Bowel elimination is a basic physical need. • It is the excretion of wastes from the

digestive system.• As a health care worker, you will deal with

bowel elimination on a regular basis.• Remember, this can be embarrassing and

uncomfortable for the pt.• Some people have BM’s OD, and some

have them q2-3 days. It is important to know what is normal for that specific pt.

BOWEL ELIMINATIONOBSERVATIONS• As a health care worker you must be able to

make the following observations regarding bowel elimination and report/record any abnormalities.

• Colour – brown, white, black/tarry, coffee grounds red/melena, pale, yellow, green,

• Amount - (if diarrhea)• Consistency- soft, formed, liquid, hard• Odour – may be affected by food, infection• Shape – should be shaped like the rectum• Size – Lg, mod, sm• Frequency- varies• C/O Pain – constipation, nausea• Constituents – undigested food, blood, pus,

worms, mucous

BOWEL ELIMINATION

Many factors affect bowel elimination including:

• Age• Fluid intake• Personal habits• Pain• Surgery• Infection

• Physical activity• Disability• Pregnancy• Medications• Diet• Psychological• Positioning• Anesthesia• Dx tests

COMMON BOWEL

PROBLEMS

BOWEL ELIMINATIONCOMMON PROBLEMSCommon problems include:

Constipation: a condition in which BM’s are less frequent and stool is hard and dry as well as difficult to pass. • Defecation many cause pain and the client may only

pass a very small amount of stool. • Constipation occurs when peristalsis slows down and

more water is absorbed by the large intestine. There are many causes including:• low fiber diet * medications• ignoring the urge to defecate * aging• ↓ fluid intake * certain diseases• inactivity

BOWEL ELIMINATION• Fecal impaction: is the prolonged

retention and accumulation of feces in the rectum when constipation is not relieved.

• The feces becomes extremely hard and cannot be expelled.

• If left untreated, a fecal impaction can lead to a complete bowel obstruction requiring surgery.

• Most fecal impactions are manually removed. Signs/symptoms may include:• abd. swelling/cramping * fullness/pain in • N & V * fever• ↑ need to urinate• Liquid feces seeping from the anus

BOWEL ELIMINATIONDiarrhea: the frequent passage of liquid stools. • The feces moves through the intestines at a rapid

rate and fluid is not absorbed. • This causes urgency as well as cramping & nausea.• Causes can include anxiety, infection, food and

medication intolerances. • Dehydration is a concern c diarrhea d/t the

excessive fluid loss. • Dehydration can cause death, be aware of the

signs/symptoms including:• pale, dry skin * oliguria• dry, cracked lips * thirst• weakness * dizziness• confusion * ↓ BP , P & R

BOWEL ELIMINATIONFecal Incontinence: is the inability to control the passage of feces and gas through the anus.

Causes can include:• intestinal & nervous system diseases• injuries • fecal impaction • diarrhea• medications• Those with mental health issues, dementia or

other cognitive disorders may not recognize the need to defecate.

• They may also play with their stool.

BOWEL ELIMINATION• Flatulence: is the

excessive formation of gas or air in the stomach and intestines.

• The gas and air that is passed is called flatus. There are many causes including:

• swallowing air• bacteria• gas forming foods• constipation• surgery • medications

BOWEL ELIMINATIONSUPPOSITORIES• A bullet shaped solid medication that is inserted

into a body opening.• Supps melt at body temperature • Rectal suppositories are usually given to relieve

constipation and results take about 30 mins• Supps can also be used to relieve fever, nausea,

and pain• Suppositories can be inserted by an RN,RPN, or

PSW• Some pt.’s can self medicate.

BOWEL ELIMINATIONENEMAS• An enema is the introduction of fluid into

the rectum and lower colon. • They are given to remove feces and

relieve constipation or fecal impaction. • The most common type of enema is the

commercial enema. • They irritate and distend the rectum to

promote defecation.• Takes approx. 5-10 mins for results

BOWEL ELIMINATIONOSTOMY• Surgical removal of part of the intestine is

sometimes necessary. • This can be d/t cancer, disease or trauma. • An ostomy is the surgical creation of an

artificial opening. This opening is called a stoma.

• Stool consistency depends on the location of the ostomy.

• The higher the ostomy the more liquid the stools

BOWEL ELIMINATIONCOLOSTOMY• A colostomy is the surgically created

opening b/t the colon and the abd. wall. • Part of the colon is brought out onto the

abd. wall and a stoma is made. • Feces and flatus pass through the stoma

into a pouch. • Colostomies can be temporary ( diseased

bowel can heal) or permanent (diseased bowel is removed).

BOWEL ELIMINATIONILEOSTOMY• An ileostomy is the surgically created opening b/t

the ileum and the abd. wall. • The entire large intestine is removed. • Liquid feces drains constantly from an ileostomy. • Good skin care is essential. Ostomy pouches: • must fit well• must be emptied and cleaned frequently• An ostomy is a serious body image change. • It is imperative that health care professionals be

empathetic to the needs of those with ostomies.

ILEOSTOMY