The document discusses bowel elimination and defecation, outlining various factors that can affect regularity such as diet, fluid intake, medications, and medical conditions. It also covers common fecal elimination problems like constipation, diarrhea, flatulence, and hemorrhoids, and provides measures to help relieve each issue including lifestyle changes, medications, and surgical options when needed.

1. Bowel Elimination
By Richard Araneta

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)

5. Factors Affecting Defecation
 Psychologic Factors
 Anxious and angry – diarrhea
 Depressed – constipation
 Lifestyle – Ex: availability of toilet facilities
 Medications
 Laxatives – stimulate bowel movement
 Bentyl – suppresses peristaltic activity

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

9. Common Fecal Elimination Problems
 Constipation
 Fecal impaction
 Diarrhea
 Fecal incontinence
 Flatulence
 Hemorrhoids

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