This document outlines the process and assessments involved in bowel elimination, describing the mechanisms of defecation, and common alterations such as constipation, fecal impaction, diarrhea, and fecal incontinence. It also provides guidelines for nursing management, health education on bowel health, and procedures for bowel irrigation and gas relief. Key points include recognizing symptoms, identifying types of constipation, and the importance of regular assessments, especially for older adults.

1. Bowel elimination
Dr . Hoda alkamali

2. Learning objectives :
On completion of this chapter the student should
be able to :
1- Describe the process of defecation
2- Name two components of a bowel elimination ,
assessment
3- List five common alterations in bowel elimination
4- Name four types of constipation
5- Identify nursing measure for treating
constipation

3. of Defecation (bowl
Definition
elimination )
Is the act of expelling faces (stool ) from the
body .
* A remarkable volume of water is reabsorbed in
the large intestine , causing the bowel’s content
of a residue
consolidated mass
to become a
before being eliminated

4. peristalsis
It is the rhythmic contractions of intestinal smooth muscle that
facilitate defecation .
__ It moves fiber , water and nutritional wastes a long the ascending ,
transverse , descending
And sigmoid colon toward the rectum .
__ peristalsis becomes even more active during eating , it is called the
gastro colic reflex
precedes defecation it is accelerated wave like
Gasrocolic reflex
__
movement , sometimes perceived as slight abdominal cramping ,
propel stool …

5. peristalsis
As the rectum distends ,the person feels the
urge to defecate
Stool is eventually released when the anal
sphincter relax .

6. Assessment bowel elimination
assessment of bowel elimination involves collecting data
about the clients elimination pattern ( bowel habits ) and the
actual characterized of faces
Elimination pattern :
-
A
1- frequency of elimination
2- effort required to expel stool
3- elimination aids , if any used ?
Stool characteristics
-
B
_ inspecting the stool or asking the client to describe its
appearance
_ information that is particularly diagnostic include stool color ,
odor , consistency ,shape , and unusual components
_ the incidence of colorectal cancer increase with age .
Therefor advice older adults to have regular endoscopic bowel
examination after 50 years of age .

7. Health education regarding
bowel elimination
- Adults should identify their own patterns of
bowel regularity which can range from 3times a
day to 3 times a week .
- Daily exercise .
- Eat high fiber foods on regular basis .
- Drink 8—10 glasses of liquid a day

8. Common alterations in bowel
elimination
Constipation
-
1
It’s an elimination problem characterized by dry , hard
stool that is difficult to pass easily
Sings and symptoms :
- Inability to pass stool easily
- Complains of abdominal fullness or bloating
- Abdominal distention
- Complains of rectal fullness or pressure
- Pain on defecation
- decreased frequency of bowel movement
- Stool Ch- by hard or small stool

9. Common alterations in bowel
elimination
Constipation
-
It is classified into four distinct types :
A- primary constipation
Primary or simple constipation can be treated by nurse . It results from
lifestyle factors such as inactivity , inadequate intake of fibers ,
insufficient fluid intake , or ignoring the urge to defecate .
B- secondary constipation (R/T disease )
It is a consequence of a pathologic order such as a partial bowel
obstruction .
It usually resolves when the primary cause is treated .
C- Iatrogenic constipation
It occurs as a consequence of prolonged use of narcotic analgesia
These drugs slow peristalsis delaying transit time

10. Common alterations in bowel
elimination
Constipation
-
D- Pseudo constipation
Is a term use when clients believe themselves to be
constipated even through they are not diagnosed as
perceived constipation
- It may occur in people who are extremely
concerned about having a daily bowel movement
- They often overuse or abuse laxatives ,
suppositories and enemas

11. Common alterations in bowel
elimination
Fecal impaction
-
2
It occurs when a large , hardened mass of stool
interferes with defecation , making it impossible for
the client to pass faces voluntarily .
Causes of fecal impaction :
- Un relieved constipation
- Retained barium from an intestinal X ray
- Dehydration
- Weakness of abdominal muscles

12. Fecal impaction
Manifestations :
- Usually report a frequent devise to defecate but
unable to do so .
- Rectal pain may result from unsuccessful efforts to
evacuate the lower bowel .
- Some clients may pass liquid stool , which may be
misinterpreted as diarrhea .
To determine whether or not a fecal impaction is
present it may be necessary to insert a lubricated
,gloved finger into the rectum . If the rectum is
filled with a mass of stool .

13. Common alterations in bowel
elimination
Fecal impaction
Nursing measure for removal of impaction :
_ Some times nurses administer enemas , another intervention is to remove
the stool digitally or irrigation by rectal tube .
_ Flatulence
3
Flatulence or flatus ( an excessive accumulation of intestinal gas ) result from
a – swallowing air while eating
b – sluggish peristalsis
c_ bacterial fermentation in the bowel
When the clients are extremely uncomfortable and ambulating does not
eliminate flatus , the nurse may insert a rectal tube to help the gas escape

14. Common alterations in bowel
elimination
Diarrhea
-
4
_ diarrhea is the urgent passage of watery stool
and commonly is accompanied by abdominal
cramping .
- Usually diarrhea is a means of eliminating an
irritating substance such as tainted
,contaminated food or intestinal pathogens
- Simple diarrhea usually begins suddenly and
lasts for a short period

15. Common alterations in bowel
elimination
Diarrhea
-
Causes of diarrhea :
- Emotional stress
- Dietary food
- Laxative abuse
- Bowel disorder
Nursing management :
- Resting the bowel temporarily may relieve simple diarrhea
- Encourage the client to drink clear liquids but
avoids solid food for 12-24 hrs.
- Resumed eating begins with bland food and these low in residue such as
bananas and apple sauce
- If the diarrhea not relieved within 24hrs ,it is best to consult the physician

16. Common alterations in bowel
elimination
Fecal incontinence
-
5
It is the inability to control the elimination of stool .
Causes of incontinence :
- Neurologic changes or when a person can not
reach a toilet in time to eliminate .
Chronic fecal incontinence can be disturbing socially
and emotionally .
Client with chronic fecal incontinence and their
families require much support and understanding

17. Bowel wash ( rectal
irrigation )

18. Definition
It is washing out of colon with large quantities of
solution to clear colon of feces .
Bowel irrigation is defined as the procedure when
water is introduced into the bowel via the rectum
using a rectal catheter .
Rectal irrigations are the best method to clean
(wash out ) the colon of stool and to prevent “stasis
“ of stool in the colon .

19. Purposes
_ To prepare colon for specific surgical or
diagnostic procedure
_ To dilute and remove toxic agents that may be
present in the large intestine
_ To reduce temperature in the hyperpyrexia
and heat stroke
_ To stimulate peristalsis
_ To keep person clean in case of fecal
incontinence or constipation

20. Colon cleanse side effect
__ Nausea
__ Abdominal pain
__ Vomiting
__ Diarrhea
__ Loss of electrolytes

21. Contraindications
_ Bleeding hemorrhoids
_ Chronic diarrhea
_Intestinal obstruction
Anal fistula
_
_ Rectal surgeries ,infection
_ Massive colon carcinoma
_ painful skin lesion a round anus

22. Equipment
1-One silicon Foley
catheter .
2-60 ml catheter tip
syringe .
3-Lubricant jelly .
4-Two kidney basin .
5-Saline solution .
6- Mackintosh .

23. procedure
- Wash hands
- Prepare equipment
- Introduce your self and explain the procedure to the patient
-provide privacy
Sims’ position)
)
-Put patient in appropriate position _ lateral position
- Pour normal saline solution into a non sterile basin
- Using a 60 ml syringe , draw up 20ml of normal saline solution.
- Lubricate 2 inches (5cm ) the distal parte of the Foley .
- Gently insert the Foley into the rectum ,approximately 4-6 inches (10-15cm) ,depending on the size of
the child
- Allow the gas and stool to pass freely
- Place the syringe into the end of the silicone catheter and inject 20 ml of warm normal saline solution
into the rectum
-
-Disconnect syringe from the end of the catheter , allow the normal saline solution to drip into an
empty basin
-Repeat this process until the discarded fluid is clear
-Return equipment
-Remove gloves and wash hands
-Record

24. Insert flatus tube
* A rectal tube is inserted into the rectum relives the
flatulence and gaseous distention of the abdomen .
_ Prepare client as for enema .
_ Lubricate flatus tube and insert about 4-6 inches into
the anal canal while the free end is kept under the water
in the kidney tray
_ Watch the expulsion of the gas which is seen bubbling
through the water .
_ The tube is left in lace for not more than 20minutes
,longer periods leads to permanent sphincter damage .
_ Tube can be reinserted every 3-4 hrs. .