Normal feces are described in terms of amount, color, and shape. Factors like age, diet, fluid intake, medications, physical activity, and medical procedures can affect bowel elimination. Constipation is defined as infrequent, difficult bowel movements and has causes like inadequate diet, medications, and medical issues. Diarrhea is the frequent passage of loose stool and can be caused by infections, allergies, medications, and diseases. Diagnostic tests may include exams, imaging, and stool/blood tests. Management involves monitoring, diet, hydration, medications, and lifestyle changes.

1. CHARACTERISTICS OF
FECES

2. Normal
• AMOUNT
• • Normal is 150 g to 200 g/day /variable based on type of diet eg: use of roughage.
• • Increased in steatorrhoea(excess fat in feces) diarrhea, indigestion of
carbohydrate

3. Colour
•Infant –Yellow ( rapid peristalsis) and adult- brown.
•Brown color- presence of stercobilin( bile pigment)
•Black – bleeding, red meat and dark green vegetables
,spinach
•Light brown – high in milk and milk product
•White or clay colour – absence of bile.
•Drugs – iron – black in colour and white colour due to
antacid

12. Shape
•Stool –tubular
•Pencil shaped – due to GI obstruction.
•Hard marble like mass – persist longer in
large intestine.

13. Factors affecting bowel elimination
• Age
• Diet
• fluid intake
• medications,
• physical activity
• psychological activity
• personal habits
• Position
• Pain
• Pregnancy
• surgery & anaesthesia
• diagnostic tests

14. 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 due to loss of
muscle tone ,decreased peristalsis movement.
Diet
•There many different ways that diet can affect bowel elimination ex: high fiber
diets & fruits promote regularity, while cheeses cause constipation. Regular fixed
eating pattern stimulate peristalsis.
Fluid intake
•The more intake of fluid - less likely to become constipated
•The less fluid intake - more likely to become constipated.
Physical activity
• Higher activity rate lessens the chances of constipation

15. Psychological factor
• Usually the source of ulcerative colitis or crohn's disease
• Depression causes peristalsis to decrease Personal
habits
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

16. Pregnancy
•The way the baby is lying on the mothers GI tract affects
peristalsis by slowing it • • Affects defecation by the slowing of
peristalsis or complete stoppage of it
Medications
• Different meds affect Bowel elimination differently • some
medications increase the process others may inhibit it or stop it
completely ex: laxative, anticholinergic medication.
Diagnostic tests
•These affect the patient because they usually require them to be
NPO/enema prior to it which in turn will limit their food intake
which limits Bowel elimination or stops them completely. Barium
ingestion may cause constipation.

17. ALTERATION IN BOWEL ELIMINATION
CONSTIPATION
• DEFINITION :
Constipation is defined as small ,infrequent or difficult bowel
movements.
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 ) and Change in defecation frequency (less than usual

18. Causes
• • Inadequate, irregular & restricted diet
• • Insufficient fluid intake • Excessive use of tea & coffee
• • Habit pattern regarding timing
• • Lack of exercise
• • Emotional upset
• • Unnatural position - supine
• • Overuse of laxatives , suppositories & enemas
• • Surgery of intestine & rectum ,radiation therapy
• • Malformation & obstruction of colon -cancer
• • Haemorrhoids & other lesions of anal canal
• • Use of certain drugs – opioid analgesics ,calcium channel blockers, antacid
with calcium, anticholinergic ,excess use of enema ,laxatives,

19. Other causes:
• Anal fissure ,anorecatal abscess
• Cirrhosis of liver
• Diabetic neuropathy –effect to vagus nerve
• Diverticulitis
• Hepatic porphyria
• Hypercalcemia
• Hypothyroidism
• Intestinal obstruction
• Irritable bowel syndrome
• Mesenteric artery ischemia
• Spinal cord lesion.

20. accompanying signs and symptoms…
Complaints of rectal fullness or pressure
Pain on defecation
Decreased frequency of bowel movements
Inability to pass stool
Changes in stool characteristics such as hard small stool
abdominal fullness or bloating and Abdominal
distention, decreased appetite
Borborygmus –gurgling sound due to gas passing
through intestine.
Headache ,fatigue ,indigestion ,

21. Constipation is classified into one of four distinct types 1. Primary 2.Secondary
3.Iatrogenic and 4. Pseudoconstipation
1.PRIMARY OR SIMPLE CONSTIPATION Primary or simple constipation results
from lifestyle factors such as inactivity, inadequate intake of fiber, insufficient fluid
intake, or ignoring the urge to defecate
2. SECONDARY CONSTIPATION Secondary constipation is a consequence of a
pathologic disorder such as a partial bowel obstruction. It usually resolves when the
primary cause is treated.
3.IATROGENIC CONSTIPATION Iatrogenic constipation occurs as a consequence of
other medical treatment. For example, prolonged use of narcotic analgesia tends to
cause constipation and other drugs slow peristalsis, delaying transit time.The
longer the stool remains in the colon, the drier it becomes, making it more difficult
to pass.
4.PSEUDOCONSTIPATION Pseudoconstipation, also referred to as perceived
constipation, is a term used when clients believe themselves to be constipated even
though they are not.

22. PHYSICAL EXAMINATION
•Mental status examination:- It can be evaluated by
listening to the client’s responses to questions-
frequency consistency , pain , type of diet ,fluid
medication, eating habits ,job exercise ,GI disorders etc
and by observing interaction with others
•Mobility :- Mobility may be evaluated by observing the
client - move onto a table, chair or bed.

23. Inspection:-
•Abdominal distension.
• Rectal examination are particularly important for both
men and woman.
• The anus inspected for prolapse gapping, indicating
significant weakness of anal sphincters.
•Auscultate the bowel sounds.
•Percuss the four quadrants and palpate for abdominal
tenderness, mass and hepatomegaly.
•Obtain stool sample for occult blood( blood that is not
visualized) – guaiac test

24. DIAGNOSTICTEST
1.Defecography:- X-rays images of rectum and
anal sphincter obtained during defecation .
2.Anorectal ultrasonography:- imaging motility
for evaluating lower rectum, inner sphincter and
pelvic floor in patient with various anorectal
disease
3. Colonoscopy:- It is used to visualization of the
colon

25. Prevention and management
AVOID ALCOHOL AND SMOKING
Avoid alcohol and smoking because alcohol irritates the intestine
and bowel, causing inflammation and causes increased
elimination of fluid into the stool, resulting diarrhea.
Smoking stimulates the bowel through the action of nicotine
caused increased bowel tone and motility result is diarrhea.
STRESS MANAGEMENT- relaxation technique.
POSITIONING: squatting position.
REGULAR EXERCISE and abdominal tonic exercises
Elimination habits:- maintain your elimination habbit.

26. • Health teaching
• Adequate intake of diet & fluid • Adequate intake
of fiber in diet
• Establishing a habit pattern
• Privacy
• Use of laxatives , suppositories & enemas and
avoid excessive use.

27. • Complications of chronic constipation include:
• Swollen veins in your anus (hemorrhoids). Straining to have a bowel
movement may cause swelling in the veins in and around your anus.
• Torn skin in your anus (anal fissure). A large or hard stool can cause
tiny tears in the anus.
• Stool that can't be expelled (fecal impaction). Chronic constipation
may cause an accumulation of hardened stool that gets stuck in your
intestines.
• Intestine that protrudes from the anus (rectal prolapse). Straining
to have a bowel movement can cause a small amount of the rectum
to stretch and protrude from the anus.

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

29. Causes
• • Food poisoning –E-COLI ,salmonella , camphylobacter.
• • Intestinal infection-viral infection –Rota virus ,cytomegalovirus
herpes simplex ,viral hepatitis.
• Parasites
• Food borne disease : cholera
• • Allergies to certain foods & fluids
• • Medications like antibiotics ,cancer drugs ,antacids ,hypertensive
• • Inflammatory bowel disease (crohn’s disease ),colitis ,celiac disease(
immune reaction to eating gluten-protein in wheat).
• Irritable bowel syndrome/gastroenteritis.

30. Symptoms
• • Intense urge to defecate
• Loose stool
• • Abdominal cramps
• • Nausea
• • Painful burning sensation at the anus
• • Anal soreness
• • Inflamed skin around anus
• May be bloody stool
• Complication – dehydration( thirst ,dry skin ,sunken eye
,oliguria)

31. Note the characteristics of stool
Provide fluid replacement orally / IV
• Replacement of fluid & electrolyte –oral fluids juices ,vegetable soups , ORS
• • Avoid spicy & allergic food -Bland diet
• • Make arrangement of use of bed pan or commode
• • Care of skin- perineal care
• • Adequate rest
• • Psychological support
• • Ensure privacy
Management

32. •Monitor intake output chart
•Obtain serum sample for electrolyte
• Medication like anti diarrheal
•Analgesics for pain
Antimotility agent – lomotil , loperamide
•Patient teaching – medical care for inflammatory
bowel disease, importance of hydration , explain
the food and fluid should avoid ,food hygiene ,use
of sanitary latrines ,use of boiled water.

33. fecal impaction
•Definition
• 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

34. CAUSES
• • Develops DUETO 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)

35. • 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

36. • management • Laxatives • Enema • Manual removal of stool
(digital evacuation )
Faecal incontinence
It is the involuntary elimination of bowel contents , often
associated with neurologic , mental or emotional impairments
Causes • Anal sphincters muscle damage •Vaginal childbirth •
Diarrhoea • IBD • Alzheimer's disease
Management • Eat 20 to 30 grams of fiber per day • Avoid
caffeine • Medications - Imodium, Lomotil • Exercise • Bowel
training

37. Flatulence/tympanites
• Flatulence is the accumulation of excessive amounts of gas (
flatus ) in the GI tract leading to distension of the abdomen
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

38. Management
•Passing of flatus tube( 4-6 inches) through rectum
distal end to K-basin with water for 15-
20minute.watch the expulsion of gas in water
which is seen bubbling.
•Medication- laxatives , carminatives
•Gastric lavage
•Avoid the use of gas producing foods.
LASSIFICATIONOF LAXATIVES

39. FACILITATING BOWEL ELIMINATION
•1. soluble and insoluble fiber contain
diet
•Adequate fluid
•Bowel habbits- time
•Regular food habits

40. LAXATIVES
• LAXATIVES Drugs that promote evacuation of bowels/relieve
constipation.
• Based on intensity of action-short term agent
• MECHANISM OF ACTION : All laxatives increase the water
content of the faeces by: a) An osmotic action, retaining water
and electrolytes in the intestinal lumen—increase volume of
colonic content and make it easily propelled. (b) Acting on
intestinal mucosa, decrease net absorption of water and
electrolyte; intestinal transit is enhanced indirectly by the fluid
bulk. (c) Increasing propulsive activity as primary action —
allowing less time for absorption of salt and water as a
secondary effect.

41. CLASSIFICATION OF LAXATIVES
1 . Bulk PRODUCING laxatives/forming Dietary fibre:
 Bran, Psyllium (Plantago), Ispaghula, Methylcellulose
 It absorb water since it contain soluble fibre.it help to bulk up the stool which causes
peristalsis.
Contraindication : bowel obstruction
Ensure good fluid intake to prevent fecal impaction , Onset of action 2-3 days ,
 Side Effects may include bloating, flatulence, distension
2. Stool softener :
work as a surfactant.This allows water and fat are
incorporated into the stool cause softening of stool
 Docusates (DOSS), Liquid paraffin

42. 3. Stimulant laxatives/ purgatives:
Stimulating the nerves in the wall of the bowels. It
increase the peristalsis.
(a) Diphenylmethanes : Phenolphthalein,
Bisacodyl , Sodium picosulfate
(b) Anthraquinones : Senna, Cascara sagrada
(c) Fixed oil: Castor oil

43. • 4. Osmotic purgatives/laxatives :
It contain substances that draw out fluid into the bowels
and limit water reabsorption in the colon.
COMPLICATION: DEHYDRATION
Ex: glycerin ,milk of magnesia
sodium phosphate ,magnesium citrate
5. Saline laxatives:
same like osmotic laxatives.it help to retain fluids
which bulk up the stool.
•Ex: sodium acid phosphate , magnesium citrate.

44. • Lubricant laxatives :
• It provide lubrication for the stool to move
through the bowels with greater ease .These
lubricant cannot be absorbed and remain in the
bowels .
• It prevent the absorption of water.
•Ex: mineral oil ,
• magnesium hydroxide.

45. Colostomy
• An ostomy is a surgically created opening form the urinary tract or intestines.
• Effluent ( feces ,urine ,mucus ) is rerouted to the outside of the body using an
artificially created OPENING CALLED A STOMA.
• Stoma protrude above the skin ,is pink to red in color , moist and round with no
nerve sensation.

46. • Colostomy is a surgical procedure that brings one end
of the large intestine out through an opening (stoma)
made in the abdominal wall and attached to the skin ,
diverting normal intestinal fecal matter through the
stoma instead of anus.
• ILLEOSTOMY : surgical operation in which a damaged
part is removed from the ileum and the cut end diverted
to an artificial opening in the abdominal wall.

47. CLASSIFICATIONACCORDINGTOTIME
• 1.Temporary Colostomy 2. Permanent Colostomy
• In a temporary "loop colostomy, maybe for 3 to 6 months " a hole is cut in the
side of the colon and stitched to a corresponding hole in the abdominal wall
. A temporary colostomy may be used when a part of the colon needs time to rest
and heal from a problem or disease . A pouch can be placed over the stoma to
collect poo (stools).

48. • PERMENANT COLOSTOMY :
• A permanent transverse colostomy is made when the lower portion of the
colon must be removed or permanently rested.
ACCORDING TO STOMA SITE
• 1.Ascending Colostomy
• 2. Descending Colostomy
• 3.Transverse Colostomy

49. ACCORDINGTO STOMA NUMBER &TYPE
1. Single-Barrel Colostomy
2. Double –Barrel Colostomy
3. Loop Colostomy
A single-barrel colostomy removes the colon below the colostomy, including the
rectum and anal opening.This type of colostomy is permanent.
A double-barrel colostomy divides the colon into 2 ends that form separate stomas.
Stool exits from one of the stomas.

51. In a loop colostomy, a loop of colon is pulled out through a cut in abdomen

52. INDICATIONS
1. COLON CANCER
2.HIRSCHSPRUNG’S DISEASE: where nerves called the ganglion nerves are
missing in muscles of colon and waste matter cannot easily pass.
3. INFLAMMATORY BOWEL DISEASE:This includes Crohns Disease( swelling of
tissue in digestive tract) and Ulcerative Colitis, both inflammatory diseases of the
intestines.
4. POLYPS IN INTESTINE
5. Imperforate anus:
6. Neonatal necrotizing enterocolitis:

53. Pouch:
Pouches are lightweight and odor-proof. Pouches have a
special covering that prevents the pouch from sticking to
the body. Some pouches also have charcoal filters which
release gas slowly and help to decrease gas odor.
Types of colostomy pouches:
Open-ended pouch:This type of pouch allows you to
open the bottom of the pouch to drain the output.The
open end is usually closed with a clamp.The open-ended
pouch is usually used by people with ascending or
transverse colostomies.

54. •Close-ended pouch:This type of pouch is removed and
thrown away when the pouch is filled. Close-ended
pouches are usually used by people with a descending or
sigmoid colostomy.
• One-piece:A one-piece pouch contains the pouch and
adhesive skin barrier together as one unit.
• Two-piece:The two-piece pouch has two parts: an
adhesive flange and pouch.The adhesive flange stays in
place while the pouch is removed and new pouch is
attached to the flange.The pouch does not need to be
reattached to the skin each

56. PURPOSEOF COLOSTOMYCARE SKIN PROTECTIONAND CARE
6. RECEPTACLE FOR DRAINAGE
7. MECHANISM FOR CLEANINGAND REGULATING BOWEL
8. PATIENT ACCEPTANCEAND SELF CARE
EQUIPMENTS
A CLEANTRAY CONTAINING:
• 1.TISSUESOR GAUZE
• 2.NEW COLOSTOMYAPPLIANCES
• 3.COLOSTOMY BAG
• 4. ACCESSORIES • FLATUS FILTERS •TAPE • SOAP
• 5. BED PAN
• 6.GLOVES
• 7.WASH CLOTHES

57. • ostomy care: •Pouching system should be changed every 4 to 7 days,
depending on the patient and type of pouch.
• Patients should participate in the care of their ostomy,
and health care providers should promote patient and
family involvement.
•Encourage the patient to empty the pouch when it is one-
quarter to one-half full of urine, gas, or feces.
•Follow all post-operative assessments for new ostomies .
•Medications and diet may need adjusting for new
ileostomies/ colostomies.
•An ostomy belt may be used to help hold the ostomy
pouch in place.
•Factors that affect the pouching system include sweating,
high heat, moist or oily skin, and physical exercise.
•Always treat minor skin irritations right away. Skin that
is sore, wet, or red is difficult to seal with a flange

58. STEPS ADDITIONAL INFORMATION
1. Perform hand hygiene. This prevents the spread of microorganisms.
2. Gather supplies. Supplies include flange, ostomy bag and clip,
scissors, stoma measuring guide, waterproof
pad, pencil, adhesive remover for skin/warm
water, skin prep, wet cloth, non-sterile gloves,
and additional cloths.
Ostomy supplies
3. Identify the patient and review the procedure.
Encourage the patient to participate as much as
possible or observe/assist patient as they complete
the procedure.
Proper identification complies with agency
policy.
Encouraging patients to participate helps them
adjust to having an ostomy.
4. Create privacy. Place waterproof pad under
pouch.
The pad prevents the spilling of effluent on
patient and bedsheets.
5. Apply gloves. Remove ostomy bag, and measure
and empty contents. Place old pouching system in
garbage bag.
Remove ostomy bag from flange

59. • 6. Remove flange by gently pulling it toward the stoma. Support the skin with your other
hand.An adhesive remover may be used.
Rational:Gentle removal helps prevent skin tears. An adhesive remover may be used to
decrease skin and hair stripping.
• 7. Clean stoma gently by wiping with warm water. Do not use soap.
• Aggressive cleaning can cause bleeding.
• Clean stoma and peristomal skin

60. • 8. Assess stoma and peristomal skin.
Rational :A stoma should be pink to red in colour,
raised above skin level, and moist.
•Assess stomaSkin ,surrounding the stoma should
be intact and free from wounds, rashes, or skin
breakdown.

61. • 9. Measure the stoma diameter using the measuring
guide (tracing template) and cut out stoma hole.
•Trace diameter of the measuring guide onto the flange,
and cut on the outside of the pen marking.
•The opening should be 2 mm larger than the stoma size.

62. 10. Prepare skin and apply
accessory products as required
or according to agency policy.
Accessory products may include
stomahesive paste,
stomahesive powder, or
products used to create a skin
sealant to adhere pouching
system to skin to prevent
leaking.
Wet skin will prevent the flange
from adhering to the skin.
Peristomal skin
prepStomahesive paste

63. 11. Remove inner backing on flange and
apply flange over stoma. Leave the
border tape on.Apply pressure. Hold in
place for 1 minute to warm the flange to
meld to patient’s body.Then remove
outer border backing and press gently to
create seal.
The warmth of the hand can help the
appliance adhere to the skin and prevent
leakage.
Remove backing from flange. Apply flange
around stoma. Press gently to create seal

64. 2
. Apply the ostomy bag. Attach
the clip to the bottom of the bag.
This step prevents the effluent from soiling
the patient or bed.
Apply ostomy pouch.Attach clip to bottom of
bag
13. Hold palm of hand over ostomy pouch for 2
minutes to assist with appliance adhering to
skin.
The flange is heat activated.
14. Clean up supplies, and place patient in a
comfortable position. Remove garbage from
patient’s room.
Removing garbage helps decrease odour.
15. Perform hand hygiene. This minimizes the transmission of
microorganisms.
16. Document procedure. Document appearance of stoma and
peristomal skin, products used, and
patient’s ability to tolerate procedure
and assistance with procedure.