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:1. Developmental considerations:Infant:Stool character depend on type of feedingNumber 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 & fluidII. Food & fluid::

Healthy elimination is facilitated by high fiber diet and daily fluid intake of 2000-3000

Constipating foods cheese, lean meat & eggsFoods with laxative effect fruits and vegetables, chocolateGas-producing foods onions, cabbage, beans

III. Activity and muscle toneIII. Activity and muscle tone::Regular exercise improve gastrointestinal motility and muscle tone.

IV. Life styleIV. Life style::A person daily schedule or occupation may contribute to habit of defecation at regular or irregular time or pattern.

V. Pathological conditionsV. 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. MedicationVI. 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. SurgeryVII. Surgery Anesthesia causes temporary cessation of Peristalsis

VIII. Daily patternVIII. Daily pattern::Most people have regular pattern involving frequency, timing, position and place. change of this pattern lead to constipation.

IX. Psychological variable:IX. Psychological variable:

Anxiety may lead to diarrhea, chronic worries may lead to constipation.

X. PregnancyX. Pregnancy

Advanced pregnancy is extended on the rectum, impairing the free passage of feces, leading to constipation

I.I. DiarrheaDiarrheaII.II. FlatulenceFlatulenceIII.III. Fecal incontinence Fecal incontinence IV.IV. Constipation Constipation V.V. Fecal impactionFecal impaction

Factors predispose to constipationFactors predispose to constipation::

1- Inadequate dietary fiber intake.2- Fluid intake less than 1500ml/day.

3- Consistent delay of bowel evacuation.4 -Decrease physical activity.

5- Chronic stress.6- Slower motility of GIT associated with aging.

7- Chemotherapy 8 -Physical inactivity

1- Increase high fiber food & fluids intake.

2- Use of laxatives & cathartics:

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 I. History takingtaking

Usual pattern of bowel elimination

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 II. Physical assessmentassessment

Items

1. Abdominal 1. Abdominal assessmentassessment

Inspect shape, symmetry, and skin color of 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

22 . .Rectal assessmentRectal assessment 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 III. Inspection of fecal characteristics

IV. IV. Diagnostic testsDiagnostic tests::

A.Stool analysisB.Barium enemaC.Endoscopy, permit direct visualization of structures

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.

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 shouldThe nurse should observe sstool 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.