The document provides information on the physiology of bowel elimination or defecation. It discusses the normal process of defecation including the role of muscles in moving fecal material through the digestive tract. It describes factors that influence defecation frequency and the signals that stimulate the urge to defecate. The document also covers the composition of feces, normal and abnormal characteristics of feces, and factors that can affect bowel elimination such as diet, medications and medical conditions.

1. Good morning

2. BOWEL ELIMINATION
Mr.MelvinJacob
MSc(N)

3. Physiologyof bowelelimination
Bowelelimination ordefecation
Defecation, also called bowel movement, the act
of eliminating solid or semisolid waste materials/ faces
from thedigestivetract.
• In human beings, wastes are usually removed once or
twice daily, but the frequency canvary from severaltimes
daily to three times weekly and remain within normal
limits.

4. • Muscular contractions- move fecal material to the
rectum.
• Therectum -temporary reservoir for the waste.
• As the rectal walls expand with filling, stretch
receptors from the nervous system, located in the
rectalwalls,stimulatethe desireto defecate.
Cont….

5. • The urge passes within one to two minutes if not
relieved , and the material in the rectum is then
often returned to the colon where more water is
absorbed
• If defecation is continuously delayed, constipation
and hardened feces result.
Cont….

6. • When the rectum is filled, pressure within it
is increased.
• This increased intra rectal pressure initially forces the
walls of the anal canal apart and allows the fecal
material to enterthe canal
• In the anus there are two muscular constrictors, the
internal and external sphincters, that allow the feces
to bepassedorretained Cont….

7. • While defecation is occurring, the excretion of
urine is usuallystimulated.
• The chest muscles, diaphragm, abdominal-wall
muscles,andpelvic diaphragm all exert pressure on the
digestivetract. Cont….

8. • Respiration temporarily ceases as the filled lungs
pushthe diaphragm down to exert pressure.
• Blood pressure rises in the body, and the amount
of blood pumped by the heart decreases.

10. Composition offeces
1.Water
• 65-85%of stools arewater.
• All the water drank by an individual is completely
absorbed in the small and largeintestine.
• In case of diarrhoea, the water content of stools is
morethan 85%.

11. 2.Protein
Protein from food is digested completely in
the small intestine and is converted into amino
acids before being absorbed inblood.

12. 3.Fat
• 95% of all fat consumed is absorbed in the small
intestine.
• Tracesof fat candefinitelybefoundin stools.
• Fats in excess of 6% in stool are abnormal.
(Steatorrhea.)

13. 4.Carbohydrate
• Simple and complex carbohydrates - sugar and starches in
diet.
• They are completely absorbed in the small intestine
and assimilated in blood as glucose, fructose or
galactose.
• Undigested carbohydrates in normal stools should
be below0.5%.

14. 5.Fiber
• Fiber is completely indigestible and gives volume and bulk to
stools.
• The more fiber one eats the more of undigested food wastes can
be dischargedfrom the body.
• Fiber diet- undigested food would account for 5-7% of the
total stool volume.
• High fiber diet, 10-15% of the undigested wastes could be
dischargedfrom thebody.

15. Besides thefive majorcomponents:
• Mineral salts which are insoluble.
• They too cannotbedigestedbythe body.
• This indigestible component of feces is known asAsh. 0.2 to 1.2% of
normal stools isash.
• The stools also contain mucous shed from the inner lining of digestive
tract.
• The mucus helps to bind together undigested food, intestinal bacteria
and metabolicdebrislikedeadcellsorbilesecretedbythe liveretc.

16. Characteristicsof feces
Normal colour:
• Adult: brown
• Infant: yellow

17. Abnormal colour:
• Clay or white: Absence of bile pigment (bile
obstruction)ordiagnosticstudyusingbarium
• Blackor tarry: Drug (e.g., iron), bleeding from upper
gastrointestinal tract (e.g., stomach, small intestine), diet
high in red meat anddark green vegetables (e.g.,spinach)
• Red: Bleeding from lower gastrointestinal tract (e.g.,
rectum),somefoods(e.g.beets)
• Pale: Malabsorption of fats, diet high in milk and milk
productsandlowinmeat

18. Consistency
Normal consistency:Formed,soft,semisolid,
moist
Abnormalconsistency
• Hard, dry, constipatedstool
• Dehydration, decreased intestinal motility resulting
from lack of fiber in diet, lack of exercise, emotional
upset,laxativeabuse
• Diarrhoea:Increasedintestinal motility

19. Shape
Normal shape: Cylindrical , about 2.5 cm (1
inch)indiameter in adults
Abnormal shape: Narrow, pencil-shaped,
or string likestool
• Obstructiveconditionalof the rectum

22. Normal amount :
• Varieswithdiet (About 100to 400 g perday)
Normal odour: Aromatic, affected by ingested
foodandperson’sownbacterialflora
Abnormal odour: Pungent (sharply strong)
• Infection, blood

23. Factors affecting bowel
elimination

24. • Age
• Diet
• fluid intake
• medications,
• physical activity
• psychological activity
• personal habits
• Position
• Pain
• Pregnancy
• surgery & anaesthesia
• diagnostic tests

25. Age
• Must be of a certain age or physical maturity
to be able to control your bowels
• Humans also can lose control of their bowels
after a certain age

26. Diet
• There many different ways that diet can affect
bowel elimination
• ex: high fiber diets & fruits promote regularity,
while cheeses cause constipation

27. Fluid intake
• The more fluid you take in the less likely you
are to become constipated
• The less fluid you take in the more likely you
are to become constipated.
Physical activity
• Higher activity rate lessens the chances of
constipation

28. Psychological factor
• Usually the source of ulcerative colitis or crohn's
disease
• Depression causes peristalsis to decrease
Personal habits
• A person not wanting to go for an extended period of
time can cause harm to their body and can make it
harder to go later
• They may not want to use those facilities

29. Positions
• Normal positioning for Bowel elimination is
sitting or squatting
Pain
• Person may be hesitant about going if they
think it will cause them pain
• usually due to haemorrhoids, rectal surgery, or
Abdominal surgery

30. Pregnancy
• The way the baby is lying on the mothers
GI tract affects peristalsis by slowing it
• Force the mother to go in between
Surgery & anaesthesia
• Affects defecation by the slowing of peristalsis
or complete stoppage of it

31. Medications
• Different meds affect Bowel elimination differently
• some medications increase the process others may
inhibit it or stop it completely
Diagnostic tests
• These affect the patient because they usually require
them to be NPO prior to it which in turn will limit
their food intake which limits Bowel elimination or
stops them completely

32. ALTERATION INBOWEL ELIMINATION

33. CONSTIPATION
• Constipation occurs when stool moves
through the large intestine too slowly or
remains in the large intestine for too long
• Involves a change in stool consistency ( harder
& drier than usual )
• Change in defecation frequency (less than
usual )

34. Causes
• Inadequate, irregular &
restricted diet
• Insufficient fluid intake
• Habit pattern regarding timing
• Lack of exercise
• Emotional upset
• Unnatural position
• Overuse of laxatives ,
suppositories & enemas
• Surgery of intestine & rectum
• Malformation & obstruction
of colon
• Systemic disorders
• Haemorrhoids & other lesions
of anal canal
• Use of certain drugs
• Excessive use of tea & coffee

35. Prevention & management
• Health teaching
• Adequate intake of diet & fluid
• Adequate intake of fibre in diet
• Establishing a habit pattern
• Relaxation
• Privacy
• Posture
• Exercise
• Use of laxatives , suppositories & enemas

36. Diarrhoea
• Diarrhoea is manifested by frequent evacuation of watery
stool due to increased intestinal motility
• Rapid passage of faecal contents through the lower GI
tract
• Reduces the time available for reabsorb water &
electrolytes
• Water, Mucus (major content)
• Light brown to yellow to green (Colour)

37. Causes
• Food poisoning
• Intestinal infection
• Allergies to certain foods & fluids
• Medications like antibiotics
• Inflammatory bowel disease (crohn’s disease )

38. Symptoms
• Intense urge to defecate
• Abdominal cramps
• Nausea
• Painful burning sensation at the anus
• Anal soreness
• Inflamed skin around anus

39. Management
• Replacement of fluid & electrolyte
• Avoid spicy & allergic food
• Make arrangement of use of bed pan or commode
• Care of skin
• Adequate rest
• Psychological support
• Medication like ant diarrhoeal

40. Faecal impaction
• It is the accumulation of the hardened faeces in the rectum ,
as a result of which the person is unable to voluntarily
evacuate the stool
• Develops usually R/T untreated or unrelieved constipation
• As the faeces remains in the rectum & sigmoid colon , the
water is reabsorbed making the faeces harder , drier & more
difficult to pass
• More faeces continued to produced, which get accumulated
in the colon proximal to the impacted stool

41. Signs & symptoms
• Feeling of fullness of rectum & abdomen
• Swelling or tightness/Bloating of abdomen
• Urge of defecation but an inability to pass stool
• Feeling of malaise-general discomfort
• Loss of appetite
• Nausea & vomiting

42. Management
• Laxatives
• Enema
• Manual removal of stool (digital evacuation )

43. Faecal incontinence
It is the involuntary elimination of bowel
contents , often associated with neurologic ,
mental or emotional impairments

44. Causes
• Anal sphincters muscle damage
• Vaginal childbirth
• Diarrhoea
• IBD
• Alzheimer's disease

45. Management
• Eat 20 to 30 grams of fiber per day
• Avoid caffeine
• Medications - Imodium, Lomotil
• Exercise
• Bowel training

46. Flatulence
Flatulence is the accumulation of
excessive amounts of gas ( flatus ) in the GI
tract , leading to distension of the abdomen

47. Causes
• Excessive swallowing of air with anxiety or rapid food
or fluid ingestion, (usually eliminated by burping)
• Gases produced by bacterial activity in large intestine
(eliminated through anus)
• Certain gases from foods such as cabbage , onions etc
• Post operative patients because of effect of
anaesthesia
• Gas that diffuses from blood stream into the intestine

48. Abdominal distension
It is accumulation of excessive amounts of
flatus, liquid or solid intestinal content

49. Causes
• Long period of bed rest can slow the
peristalsis
• An obstruction that blocks the passage of flatus
& faeces
• Surgery causes decreased peristalsis
• Constipation

50. Types andcollection of specimen

51. A specimen of freshly passed faces of 0.5
to 1 ounce (15 g to 30 g) is collected, without
contamination of urine or toilet tissue, into a
small container that may have a small spoon or
spatula attached inside the lid of the cup for
easier collection of the sample.

52. Equipment
• Clean bed pan or disposable receiver – ensure
the bedpan is not contaminated with detergent
or disinfectant as this may affect the results
• Sterile specimen pot with an integral spoon;
• Non-sterile gloves
• Apron

53. Procedure
• Ensure privacy and dignity
• Wash hands with soap and water
• Assemble the equipments
• Put on non-sterile gloves and apron
• Ask the patient to pass urine before taking the
stool sample

54. • Ask the patient to defecate into the bedpan or
receiver
• If the patient is incontinent, a sample can be
taken from the bed linen
• Use the integral spoon in the sample pot to
collect enough faeces to fill around a quarter of
the specimen pot

55. • Secure the top of the container – this will
prevent leakage
• Remove gloves and apron and dispose of them
• Wash hands with soap and water
• Examine the specimen and record the colour,
consistency and odour of the stool as part of
the nursing assessment.

56. • Label the sample and complete the microbiology
form including any factors such as recent
antibiotic treatment and suspected food poisoning
(accurate laboratory result)
• Put the sample in a specimen bag.
• Send the sample to the laboratory as soon as
possible
• Document the procedure in the patient’s notes

58. Ova and parasites
Supplies: Clean plastic stool cup
1. The stool should be passed into a clean, dry
container. Urine will contaminate the spicemen
cannot be collected directly out of the toilet.
2. Transfer stool specimen to stool cup and send to
the Laboratory within 2 hours of collection,
refrigerate if > than 2 hours.

59. Occult Blood
• Transfer stool specimen to stool cup. Transport to
lab.
NOTE: If using wooden applicator stick to
transfer stool, do not leave stick in stool container;
specimen will dry out.

60. Thank you