This document discusses various gastrointestinal disorders including constipation, impaction, diarrhea, incontinence, flatulence, and hemorrhoids. It provides information on causes, signs and symptoms, and management for each condition. Nursing considerations are outlined and include maintaining regular bowel habits, diet, fluid intake, exercise, positioning, and bowel training programs. Surgical procedures for severe cases such as fecal pouches, artificial sphincters, and ostomies are also mentioned.

2.  Constipation
 Impaction
 Diarrhea
 Incontinence
 Flatulence
 Hemorrhoids

3.  It is the term is used to describe an
infrequent bowel movements or irregularity
of defecation ,abnormal hardening of stool
that makes their passage difficult and painful.

4.  Causes
◦ Irregular bowel habits and ignoring the urge to
defecate
◦ Chronic diseases
◦ Low fiber diet and high in animal fat
◦ less fluid intake
◦ Anxiety, depression, cognitive impairment
◦ Immobilization or lack of exercise
◦ Laxative misuse
◦ Illnesses (neurological illnesses & organic illnesses)
◦ Medications

5.  Signs and symptoms
◦ Decreased frequency of defecation
◦ Hard, dry, formed stools
◦ Straining at stool; painful defecation
◦ Feeling of fullness, discomfort in rectum, abdomen
◦ Anorexia or nausea
◦ Headache

6.  Medical management
◦ Treat the under lying cause
◦ Increase fiber and fluid intake
◦ Routine exercises
◦ Biofeedback
◦ Use of laxatives
 Nursing management
◦ Maintain a regular pattern of elimination
◦ Dietary pattern
◦ Exercises
◦ Privacy
◦ Psychological support
◦ Posture
◦ Laxative administration
◦ Administration of suppositories or enema

7.  It is the accumulation of hardened feces in
the rectum, as a result of which the person is
unable to voluntarily evacuate the stool.
◦ Mass or collection of hardened feces in folds of
rectum
◦ Passage of liquid fecal seepage and no normal stool
 Usual causes
◦ Poor defecation habits
◦ Untreated or un relieved Constipation

8.  Signs and symptoms
◦ Feeling of fullness in rectum and abdomen
◦ An urge for defecation and inability to pass stool
◦ Generalized malaise
◦ Loss of appetite
◦ Nausea/vomiting
◦ Abdominal distension
 Management
◦ Laxatives , enema or manual removal of the
stool(digital evacuation)

9. Defined as frequent passage of loose,
fluid unformed stools due to increased
gastro intestinal motility
◦ Manifested by frequent evacuation of watery stool
◦ Besides the intense urge to defecate, there may
be abdominal cramps, nausea & painful burning
sensations at the anus

10.  Causes
◦ Intestinal infections (enteritis)
◦ Nervous tension (emotional or psychogenic diarrhea
……excessive stimulation of parasympathetic
nervous system
◦ Medications ( antibiotics &iron supplements)
◦ Abuse of cathartics
◦ Mechanical causes : incomplete obstruction
….stenosis,adhesions and tumors
◦ Other causes :Malabsorption syndrome, irritable
colon, narcotic withdrawal. Etc.

11.  Management
◦ Replace the fluid and electrolytes
◦ Treat the cause
◦ Drug therapy
 Antibiotics/antimicrobials
 Antimotility agents (loperamide)
 Nursing care
◦ Replacements of fluid and electrolytes ( potassium)
◦ Small frequent diet.. Avoid spicy foods
◦ Use of bedpan and commodes
◦ Skin care
◦ Adequate rest
◦ Psychological support
◦ Medications
◦ Healthy eating habits

13.  The loss of voluntary ability to control fecal and
gaseous discharges through the anal sphincter
 Types :
◦ Partial :inability to control flatus or to prevent minor
soiling
◦ Major : inability to control feces of normal consistency
 Causes
◦ Neuromuscular disease
◦ Spinal cord trauma
◦ Tumors
 Treated with surgery
◦ Repair of sphincter
◦ Fecal incontinence pouch
◦ Bowel diversion or colostomy

14.  Flatulence is the presence of excessive flatus in
the intestines and leads to stretching and
inflation of the intestines (intestinal distensions)
 Causes
◦ Action of bacteria on the Chyme in L.intestine
◦ Swallowed air
◦ Gas that diffuses between the blood stream and the
intestine
◦ Foods (cabbage, onions)
 Signs
◦ Gastric distension
 Management :insertion of rectal tube

15.  Hemorrhoids are dilated, engorged vein in
the lining of the rectum
◦ External or internal

16.  External
 Clearly visible as protrusions of skin
 If underlying vein is hardened or purple colored
 Pain
 Need to be excised
 Internal
 An outer mucus membrane
 Causes :
 Increased venous pressure due to straining
 Pregnancy
 Heart failure
 Chronic liver diseases
 Treatment
 Hemorrhoidectomy

17. Nursing process

18.  History
 Physical examination
 Food and fluid intake
 Chewing ability
 Medications
 Recent illnesses or stressors

19.  Fecal characteristics & Review of relevant results
◦ Examination of fecal specimen for
 Occult blood
 Stool culture
 Fecal fat
◦ Laboratory tests
 Total bilirubin
 Alkaline phosphate
 Amylase
◦ Direct visualization (Endoscopy & colonoscopy)
◦ Indirect visualization (x ray film with contrast medium)

20.  Constipation
 Risk for constipation
 Perceived constipation
 Chronic functional constipation
 Risk for chronic functional constipation
 Diarrhoea
 Dysfunctional gastrointestinal motility
 Bowel incontinence

21.  As etiology
◦ Risk for electrolyte imbalance
◦ Risk for imbalanced fluid volume
◦ Deficient fluid volume
◦ Risk for deficient fluid volume
◦ Impaired skin integrity
◦ Risk for Impaired skin integrity
◦ Impaired comfort

22.  Goals / objectives
◦ Maintain or restore normal bowel
elimination pattern
◦ Maintain or regain normal stool
consistency
◦ Prevent associated risks

23. Promoting regular defecation
Privacy
Timing
Nutrition and fluids
For constipation, diarrhea, flatulence
Exercise
Positioning
Commode
Bedpan

24.  Decreasing flatulence
◦ Avoid gas-producing foods
◦ Exercise
◦ Movement in bed ( position)
◦ Ambulation
◦ Probiotics
 Administering enemas
 Rectal suppositories
 Bowel wash
 Digital removal of a fecal impaction
 Bowel training programs
◦ Based on factors within client's control
◦ Goal of establishing normal defecation pattern

25.  Bowel training programs
◦ Major phases
 Determine client's usual habits and factors that help or
hinder defecation
 Design plan with client
 Determine fluid, fiber, hot drinks, exercise
 Maintain routine for 2–3 weeks
 Cathartic suppositories
 Prompt response to urges
 Privacy
 Effective physical positioning
 Provide positive feedback for successful defecation
 Offer support; encourage client to have patience with the
process

26.  Fecal incontinence pouch
◦ Collect and contain large amounts of liquid feces
 Artificial sphincter
 Ostomy
◦ Is a term for a surgically formed opening from the
inside of an organ to the out side ( eg: ileostomy or
colostomy)
◦ Stoma ( the part of the ostomy that is attached to
the skin, is formed by suturing the mucosa to the
skin)
◦ skin care

27. A B

29. Loop colostomy