This document discusses bowel elimination and defecation. It covers the anatomy and physiology of the digestive system and large intestine. The large intestine absorbs water from waste products, with only about 100 mL of fluid excreted daily as feces. Defecation is facilitated by abdominal muscle and diaphragm contraction, along with thigh flexion in a sitting position. Factors that influence defecation include age, diet, fluid intake, activity level, psychological factors, habits, and medical conditions or procedures. Maintaining regular bowel elimination is important for normal body functioning.

1. Bowel elimination
Meeting patient needs

2. Learning Outcomes
1. Describe the physiology of defecation.
2. Distinguish normal from abnormal characteristics
and constituents of feces.
3. Identify factors that influence fecal elimination and
patterns of defecation.
4. Identify common causes and effects of selected fecal
elimination problems.
5. Describe methods used to assess fecal elimination.
6. Identify examples of nursing diagnoses, outcomes,
and interventions for clients with elimination
problems.
7. Identify measures that maintain normal fecal
elimination patterns

3. Learning Outcomes
8. Describe the purpose and action of commonly used
enema solutions.
9. .Recognize when it is appropriate to delegate
assistance with fecal elimination to unlicensed
assistive personnel
10.Verbalize the steps used in:
a. Administering an enema
b. Changing a bowel diversion ostomy appliance
11.Demonstrate appropriate documentation and
reporting related to fecal elimination

4. Introduction
 Regular elimination of bowel waste products is
essential for normal body functioning
 Elimination patterns and habits vary among
individuals
 Excreted waste products are referred to as feces or
stool.

5. Anatomy and physiology of
bowel elimination

6. Anatomy of digestive system

7. Large Intestine

8. Large Intestine
 Ileocecal valve to anus
 Shorter longitudinal muscles of large intestine cause
pouches (haustra).
 Most waste products excreted within 48 hours of
ingestion
 Main function of colon is absorption of water and
nutrients after eating (ingestion).
 Chyme
 As much as 1500 mL moves from small to large intestine
daily but only about 100 mL of fluid is excreted.
 The rest is absorbed.

9.  Mucus in colon protects lining from acid in feces and
from bacterial activity.
 Products excreted are flatus and feces.
 Air
 By-products of digestion
 Three types of movements in large intestine
 Haustral churning
 Movement of chyme within haustra
 Peristalsis
 Wavelike movement that propels intestinal contents forward
 Mass peristalsis
 Usually after eating

10. Rectum and anal canal
 Rectum (4–6 in) and anal canal (1–2 in)
 Vertical folds with vein and artery
 If veins distended, hemorrhoids
 Internal sphincter under involuntary control
 External sphincter under voluntary control

11. The rectum, anal canal, and anal sphincters: A, open; B, closed.

12. Defecation
 Expulsion of feces assisted by contraction of the
abdominal muscles and diaphragm
 Feces move through anal canal and are expelled
through anus.
 Normal defecation is facilitated by:
 Thigh flexion
 Sitting position

13. Composition or characteristics of
feces / stool

14. Feces
 About 75% water, 25% solid materials
 Normally brown
 Stercobilin and urobilin derived from bilirubin
 Amount of gas produced per day varies per
individual

15. Feces

17. Factors affecting defecation

18. Factors affecting defecation
 Development /age
 Newborns and infants
 Meconium
 Frequent passing of stool
 Toddlers
 Some control at 1.5–2 years
 School-age children and adolescents
 Defecation may be delayed.
 Older adults
 Systemic changes (GIT,CNS, PNS and CVS)
 Loose muscle tone in the perineal floor and anal sphincter

19. Factors affecting defecation
 Diet
 Fiber ( non digestible residue) eg: whole grains, fresh
fruits and vegetables
 Gas forming foods Eg: onion
 Fluid intake and output
 Activity
 Stimulates peristalsis
 Immobilization and position
 Psychological factors
 Anxiety, anger
 Increased peristaltic activity followed by nausea, diarrhea

20. Factors affecting defecation
 Defecation habits / personal habits
 Privacy
 When urge ignored, ultimately lost
 Busy work schedule
 Sharing bathroom facilities
 Medications
 Affect appearance, timing, quality
 Laxatives
 Diagnostic procedures
 Colonoscopy
 Endoscopy
 Anesthesia and surgery
 General anesthetics cause movements to cease, slow
 Listen to bowel sounds after surgery

21. Factors affecting defecation
 Pregnancy
 Pressure exerted on rectum, temporary obstruction
 Straining ……. permanent hemorrhoids
 Pathologic conditions
 Spinal cord, head injuries decrease sensory stimulation
 Poorly functioning anal sphincter
 Pain
 If discomfort experienced, suppression of urge may
follow.
 Constipation
 Narcotic analgesics

22. Thank you