This document discusses bowel elimination structures and processes. It describes how peristaltic waves move feces through the colon and into the rectum, triggering a need to defecate when sensory nerves are stimulated. Voluntary relaxation of sphincter muscles allows expulsion of feces, assisted by abdominal and diaphragm contractions in a sitting position. Factors like lifestyle, culture, age, and medical issues can affect bowel elimination.

1. BOWEL ELIMINATION

2. STRUCTURES RELATED TO BOWEL
ELIMINATION

3. Physiology of Defecation
 Peristaltic waves move the feces into
the sigmoid colon and the rectum
 Sensory nerves in rectum are
stimulated
 Individual becomes aware of need to
defecate
 Feces move into the anal canal when
the internal and external sphincter relax

4.  External anal sphincter is relaxed
voluntarily if timing is appropriate
 Expulsion of the feces assisted by
contraction of the abdominal muscles
and the diaphragm
 Feces moves through the anal canal
and expelled through anus
 Facilitated by thigh flexion and a sitting
position

5.  Lifestyle
 Personal habits
 Nutrition and fluid intake
 Physical activity
 Culture
 Norms of western culture
 Age
 Infancy
 Elders
FACTORS AFFECTING BOWEL
ELIMINATION

6. FACTORS AFFECTING BOWEL ELIMINATION
 Physiological factors
 Pregnancy
 Motor and or sensory disturbance
 Intestinal pathology
 Medications
 Surgery and anesthesia
 Psychosocial factors
 Anxiety
 Depression

7.  Color
 Odor
 Consistency
 Frequency
 Amount
 Shape
 Constituents
CHARACTERISTICS OF NORMAL
STOOL

10. BRISTOL STOOL CHART
The Bristol stool scale or Bristol stool
chart (BSC), is a diagnostic medical tool
designed to classify the form of human
faeces into seven categories. It is used in
both clinical and experimental fields.
Types 1 and 2 indicate constipation, with 3 and
4 being the ideal stools as they are easy
to defecate, and 5, 6 and 7 tending
towards diarrhoea.

13. ALTERATION IN BOWEL ELIMINATION
 Constipation - infrequent BM, usually less than
every 3 days
 Impaction - hard stool lodged in the rectum resulting
from unrelieved constipation
 Diarrhoea - increased number of stools and
character is liquid unformed feces
 Incontinence - inability to control passage of feces
and gas to the anus
 Flatulence - accumulation of gas in the intestines
causing the walls to stretch
 Hemorrhoid - dilated, engorged veins in the lining of
the rectum

14. ALTERED MEANS OF BOWEL ELIMINATION

15. OSTOMY
An ostomy, or stoma, is a surgically
created opening between the intestines and
the abdominal wall.
The most common types of ostomy connect
either the small intestines (ileostomy or
jejunostomy) or the large intestine
(colostomy) to the abdominal wall.
Ostomies can be temporary or permanent.

16. REASONS FOR AN OSTOMY
 Cancer
 Trauma
 Inflammatory bowel disease (IBD) such as
Crohn’s disease or ulcerative colitis.
 Bowel obstruction
 Infection
 Fecal incontinence (inability to control bowel
movements)
 Diverticular disease (small bulges or sacs that
form in the wall of the large intestine)

17. TYPES OF OSTOMY
 Ileostomy: Connects the last part of the small
intestines (ileum) to the abdominal wall.
 Jejunostomy: Connects the middle part of
the small intestines (ileum) to the abdominal
wall.
 Colostomy: Connects a part of the colon
(large intestine) to the abdominal wall.

18. TYPES OF OSTOMY
 Temporary ostomy: This is an ostomy that can
be removed surgically at a later time. It is
generally made from the small intestines
(ileostomy). It prevents the passage of stool
through the intestines below the stoma.
 Permanent ostomy: This is an ostomy that is
used when parts of the rectum, anus and colon
have been removed due to disease or treatment
of a disease. It is generally made from the large
intestines (colostomy).

19. COLOSTOMY

20. DEFINITION
Colostomy is an
opening, called a stoma
in the large intestine
brought to the surface of
the abdomen for the
purpose of evacuation of
bowel.

21. TYPES OF COLOSTOMY
ACCORDING TO DURATION
 Permanent Colostomy
 Temporary Colostomy

22. ACCORDING TO STOMA SITE
 Ascending Colostomy
 Transverse Colostomy
 Descending Colostomy

23. INDICATION FOR COLOSTOMY
1. Colon Cancer
2. Hirschprung’s
Disease
3. Ulcerative Colitis
4. Polyps in Intestine

24. THE OSTOMY BAG
 After an ostomy is created, bowel
movements occur through the
opening in the abdominal wall or
stoma.
 The ostomy appliance consists of
a wafer and bag. The wafer sticks
to the abdominal wall with
adhesive and is made of plastic.
 The bag catches and holds the
stool. The bag is disposable and
emptied or replaced as needed.

25. COLOSTOMY CARE

26. INTRODUCTION

27. PURPOSE OF COLOSTOMY CARE
1. Skin protection & care
2. Receptacle for drainage
3. For cleanliness and control odour
4. Empty fecal contents

28. ARTICLES REQUIRED

29. A clean tray
containing
 Mackintosh with draw
sheet
 Kidney tray/paper bag
 Pair of clean gloves
 Colostomy bag
 NS/Basin with warm
tap water
 Gauze pieces/Wash
cloth
 Towel
 Gauze pad/tissue
paper
 Skin barrier (zinc
oxide paste)
 Stoma measuring
guide
 Pen or pencils &
scissors
 Bed pan

30. PROCEDURE
1. Gather equipment.
2. Provide comfortable position to patient
3. Encourage clients to look at the stoma.
4. Explain the procedure to the patient.
5. Provide privacy.
6. Perform hand hygiene & wear gloves.

31. PROCEDURE
 Spread mackintosh & draw sheet.
 Remove used pouch & skin barrier gently by
pushing the skin away from the barrier.
 Remove clamp and empty the content into bed
pan. Rinse the pouch with tepid water/NS.
 Discard the disposable pouch in paper bag.

32. PROCEDURE
 Observe stoma for colour, swelling, trauma
& healing. Stoma should be moist & pink.
 Cover the stoma with a gauze piece.
 Clean peristomal region gently with
NS/warm water using gauze piece.
 Don't scrub the skin, dry by patting the
skin.
 Remove gauze & clean stoma with
gauze/tissue

33. PROCEDURE
 Measure the stoma
using measuring guide.
 Trace same circle
behind the skin barrier,
using scissors, cut an
opening 1/16 to 1/8
inch larger than stoma
before removing the
wrapper over adhesive
part.
 Put skin barrier & pouch
over the stoma, &
gently press on to the
skin, for 1-2 min.
RATIONALE
 Ensure accuracy in
determining correct
pouch size needed.
 -do-
 To prevent irritation to
skin.

34. PROCEDURE
 Attach skin barrier and colostomy bag
simultaneously to skin and press lightly for
atleast 5 minutes.
 Remove gloves and wash hands.
 Make the patient in comfortable position.
 Replace articles.

35. AFTER CARE
 Record procedure and findings regarding
date/Time, amount, colour, consistency of
faecal matter, sign of any infection.