2. Bowel Elimination
Defecation – is the expulsion of feces from anus and
rectum
3. Principles
Quality varies with the amount of food consumed
and absorbed
Consistency of stool depends on the length of time
the contents are in the GIT and the type of food
eaten
4. Factors Affecting Defecation
Age and development
Diet – some foods are impossible for some people to
digest
Fluid intake – in adequate, chyme becomes more
dry
Activity – it stimulates peristalsis (movement of food
in the small intestine)
6. Factors Affecting Defecation
Pathologic Conditions – Ex: spinal cord and injuries
Anesthesia and surgery – Ex: Paralytic ileus (no
movement in the small intestines)
Irritants – Ex: spicy foods, bacterial toxins
Pain
7. Normal Characteristics of Stool
Color
Yellow or golden brown (due to bile pigment derivative
known as stercobilin)
Amount
Depends on the bulk of food intake
8. Alterations in the Characteristics of Stool
Acholic Stools
Grey, pale, or clay colored, due to biliary obstruction
Hematochezia
Passage of stool with bright red blood due to lower GI
bleeding
Melena
Passage of black tarry stools due to upper GI bleeding
Steatorrlea
Greasy, bulky, foul smelling stool due to hepatobilary
pancreatic obstruction of disorders
10. I. Constipation
Passage of small, dry, hard stools of the non-
passage of stool for a period of time
11. Measures to Relieve Constipation
Adequate fluid intake
High fiber diet
Establish regular pattern of defecation
Respond immediately to the urge to defecate
Minimize stress
12. Measures to Relieve Constipation
Adequate activity and exercise
Laxatives as ordered
Avoid overuse, may lead to rebound effect
Enzymes
Cleansing or non-retention
Retention
Return flow
Suppositions
13. Types of Laxatives
Stool lubricants
Lubricates feces and facilitates its expulsion
Ex: Mineral oil
Stool/enrollment softeners
Soften and delays the drying of the feces; permits fat and
water to penetrate feces
Ex: Colace
Bulk formers
Ex: Metamucil
14. Types of Laxatives
Osmotic agents
Attracts fluids from intestinal capillaries to stool
Ex: Milk of Magnesia – lactose, magnesium citrate
Chemical irritants
Increase peristalsis
Ex: dulcolax, castor oil, cascera sagrado
15. II. Fecal Impaction
Is a mass or collection of hardened putty-like feces
in the folds of the rectum
16. Measures to Relieve Impaction
Increase fluid intake
Sufficient bulk in diet
Adequate activity and exercise
Manual extraction
Water out for vagal stimulation -> decrease cardiac
activity
17. III. Diarrhea
Passage of liquid feces and increased frequency of
defecating
18. Measures to Relieve Diarrhea
Replace fluid-electrolyte loss
Good peri-anal care
Promote rest
Diet bland foods: decrease fiber diet
BAR (banana, apple, rice am)
Avoid excessively hot and cold fluids
Give potassium rich foods
19. Measures to Relieve Diarrhea
Anti-diarrheal drugs
Demulcents – coat the irritated bowel, acts as protective
Absorbents – absorb gas and toxic substances from the
blood
Astringents – shrink swollen or inflamed tissues
20. IV. Flatulence
Presence of excessive gas in the intestines
(tympanism)
21. Measures to Relieve Flatulence
Avoid gas forming foods
Limit carbonated drinks, drinking straws, chewing
gum
Provide warm fluids to drink
Early ambulation: prone or knee chest positions
Adequate activity and exercise
Rectal tube – 3-4 inches; for 22-30
Cholinergic as ordered
Carminative enemas as ordered (60-180cc fluid or
herbal oils)
22. V. Fecal Incontinence
Inability of anal sphincter to control the discharge of
fecal and gaseous material
Ex: in neuromuscular disease, spinal cord injuries, aging
process, etc.
23. Nursing Care for Fecal Incontinence
Good peri-anal care
Use of fecal collector (pouch/ diapers)
Provide emotional support
24. VI. Hemorrhoids
Also called “piles”, distended veins in the anal area
25. Nursing Care and Management
Astringents to shrink tissues
Local anesthetics
Stool softeners
Surgery – hemorrhoidectomy
