Bowel Elimination (Defecation):
Is a natural process by which the soiled waste products of
.digestion (feces or stool) are eliminated from the bowel
Stool:
It is feces that have been excreted.
Peristalsis:
It is the alternating contraction and relaxation of the
intestinal muscles.
Hemorrhoids:
Hemorrhoids are dilated, engorged veins, in the lining
of the rectum. They are either external or internal.
Mouth
Esophagus
Stomach
Small intestine
Large intestine
Anus
Primary organ of bowel elimination
1.5 m. length, 6 – 7 cm. diameter
Functions
Completion of absorption of H2O, Nutrients
Formation of feces
Expulsion of feces from the body
When waste content enter the large intestine
the content are liquid or watery (ascending
colon). When leave the transverse they are
semisolid & most water are absorbed (800-
1000).
Allowing for the formed, semisolid consistency
of the normal stool.
When the waste product reach the end of the
colon they are called feces.
The sigmoid colon contain feces ready for
exertion and empties into the rectum.
When stool distended the rectum
parasympathetic are stimulated causing
contraction of the descending and sigmoid
colon, rectum, anus and relaxation of the
internal anal sphincter.
This
stimulus response sequence not under
voluntary control
Defecation will automatically follow unless the
external anal sphincter remains contracted
Defecation
is assisted by contracting abdominal
muscles and contracting pelvic floor muscle.
1. Developmental considerations:
Infant:
Stool character depend on type of feeding
Number of stool: 2-4 for breast fed, 1-2 for bottle fed
Toddler:
Neuromuscular structures not developed until
15 – 18 mos.
Voluntary control 2- 4 yrs.
Child, adult old age:
Defecation pattern vary in quantity, frequency,
rhythm.
:II. Food & fluid
Healthy elimination is facilitated by high fiber
diet and daily fluid intake of 2000-3000
Constipating foods cheese, lean meat &
eggs
Foods with laxative effect fruits and
vegetables, chocolate
Gas-producing foods onions, cabbage, beans
:III. Activity and muscle tone
Regular exercise improve gastrointestinal
.motility and muscle tone
:IV. Life style
A person daily schedule or occupation may
contribute to habit of defecation at regular or
.irregular time or pattern
:V. Pathological conditions
Changes in stool characteristics or frequency may be
one of the first clinical manifestation of a disease.
Pathological conditions result in diarrhea include,
infection, malabsobtion disease and food poison.
:VI. Medication
Medication available to either promote peristalsis
(laxatives) or inhibit peristalsis (antidiarrheal)
other medications affect bowel elimination
:include
Antacids (can cause constipation).
Antibiotics (20%) cause diarrhea
Narcotic/analgesics depress peristalsis
Iron salts cause black stool.
VII. Surgery
Anesthesia causes temporary cessation of
Peristalsis
:VIII. Daily pattern
Most people have regular pattern involving
frequency, timing, position and place. change
.of this pattern lead to constipation
IX. Psychological variable:
Anxiety may lead to diarrhea, chronic worries
may lead to constipation.
X. Pregnancy
Advanced pregnancy is extended on the
rectum, impairing the free passage of feces,
leading to constipation
I. Diarrhea
II. Flatulence
III. Fecal incontinence
IV. Constipation
V. Fecal impaction
:Factors predispose to constipation
.Inadequate dietary fiber intake -1
.Fluid intake less than 1500ml/day -2
.Consistent delay of bowel evacuation -3
.Decrease physical activity -4
.Chronic stress -5
.Slower motility of GIT associated with aging -6
Chemotherapy -7
Physical inactivity -8
.Increase high fiber food & fluids intake -1
:Use of laxatives & cathartics -2
Laxatives are drugs that induce emptying of the
intestinal tract, they act as stimulating peristalsis
.& soften fecal material
Habitual use of laxatives is common cause of
.constipation
People with fecal impaction need medication to remove the impacted
stool.
Laxatives, enemas & manual removal of the stool are possible measures.
Enemas
Rectal suppositories
Rectal catheters
Digital stool removal
Oil-retention - lubricate the stool and intestinal mucosa
easing defecation
Carminative - help expel flatus from rectum
Medicated - provide medications absorbed through
rectal mucosa
Anthelmintic - destroy intestinal parasites
Nutritive - administer fluids and nutrition rectally
I. History
Usual pattern of bowel elimination
taking
Any routines follows to promote normal
elimination
Identify any routines follows to promote
normal elimination
Character of stool (odor, color, shape-
consistency, volume).
Diet history/ daily fluid intake
Recent change in bowel elimination (blood,
mucous).
Problem with bowel elimination (diarrhea,
constipation).
Risk identification (immobility, life style
change, surgical procedure)
II. Physical
Items
assessment
1. Abdominal Inspect shape, symmetry, and skin color of
assessment the abdomen
Inspection note masses, scars or lesions,
distension.
Daily measurement of the abdominal girth
reveals whether distension is increasing
The nurse records bowel sounds as normal,
audible or absent
Rectal assessment .2 Inspect the area around the anus for lesions,
discolorations, inflammation, hemorrhoids.
Use gentle palpation of all sides of the rectal
wall for nodules or texture irregularities. Rectal
mucosa is normally smooth and soft.
III. Inspection of fecal characteristics
Consistency Soft, formed
Shape Cylindrical
Color Brown
Amount 100- 400 gm/day depending on amount of diet.
Frequency 1-3 times a day to once every 2-3 days.
IV. Diagnostic tests:
A.Stool analysis
B.Barium enema
C.Endoscopy, permit direct visualization of structures
Problems of bowel elimination may also affect other
:human functioning
Anxiety related to lack of voluntary control of fecal
elimination.
Fluid volume deficit related to prolonged diarrhea.
Pain related to intestinal distention.
Maintenance of proper fluid & food intake
Promotion of regular exercise
Promotion of regular bowel habits
positioning: squatting position best facilities defecation
Laxatives, the nurse teaches clients about the harmful effects
of repeated use of laxatives
Maintenance of skin integrity The client with diarrhea, fecal
incontinence is at risk for skin breakdown:
cleansing the anal area with mild soap and water
use any lubricate as zinc oxide.
Evaluate the patient condition, as the reports return to
normal bowel habit or relieve the problem.
The nurse should observe stool carefully before disposal
color, amount, consistency, odor, shape, frequency, patient
complaints of pain.
Figure: the locations of bowel diversions ostmoies
Keep patient as free of odors as possible; empty
appliance frequently.
Inspect the patient’s stoma regularly.
Note the size, which should stabilize within 6 to 8
weeks.
Keep the skin around the stoma site clean and dry.
Measure the patient’s fluid intake and output.
Explain each aspect of care to the patient and self-care
role.
Encourage patient to care for and look at ostomy.
Community resources are available for assistance.
Initially encourage patients to avoid foods high in
fiber.
Avoid foods that cause diarrhea or flatus.
Drink two quarts of water daily.
Teach about medications.
Teach about odor control (intake of dark green
vegetables).
Resume normal activity including work and sexual
relations.
