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Bowel Elimination
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State Standard
20) Understand principles of and successfully perform skills related to toileting, intake and output, and bedpan or bedside commode use. Incorporate guidelines for residents’ rights and utilize rubrics from textbooks, National HOSA guidelines, or other clinical standards of practice for the following: a. Urine characteristics, and abnormalities that should be reported to the charge nurse b. Common disorders of bladder and bowels c. Factors affecting elimination of urine or stool d. Types of urine specimens obtained e. Catheter care/emptying urinary bag f. Procedure for collecting urine and stool specimens g. Care guidelines for ostomy
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Objectives
Students will be able to…
Develop an understanding of normal bowel habits, factors affecting bowel movements, solutions to assist patients with normal bowel habits
Perform the skills of transferring a patient to a bedside commode
Perform the skills of feeding a dependent patient
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4. Normal Bowel Movements
The frequency varies from person to person.
No less than 1 every three days.
Stools are normally brown.
Bleeding in the stomach and small intestine causes black or tarry stools.
Bleeding in the lower colon and rectum causes red-colored stools.
Some foods, diseases, and infections change the color of stools.
Stools are normally soft, formed, moist, and shaped like the rectum.
They have a normal odor caused by bacterial action.
Certain foods and drugs also cause odors.
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Observations
Carefully observe stools before disposing of them.
Observe and report the following to the nurse:
Color
Amount
Consistency
Odor
Shape
Frequency of defecation
Any complaints of pain or discomfort
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6. Factors affecting bowel habits.
Bowel elimination is a basic physical need.
Factors affecting bowel elimination include:
Privacy
Habits
Age
Diet
exercise and activity
Fluids
Medications
Promoting normal bowel elimination is important.
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Common Bowel Problems
Constipation
Fecal Impaction (p. 401)
Diarrhea
Fecal Incontinence
Flatulance
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Bowel Assistance:
When all other factors have been tried:
Bowel Training – fig p. 405
Enemas
Cleansing enema
Tap water enemas
Soap suds enema
Small Volume enema figure 19–7 p. 411
Oil Retention enema
Rectal Tube p. 414
Videos: Taylor’s Video Guide:
Administering a Large volume cleansing enema
Administering a Small volume cleansing enema
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Person with an Ostomy
An ostomy is the surgical creation of an artificial opening (Stoma).
Reasons include cancer, bowel diseases, and trauma.
The person wears a pouch over the stoma to collect feces and flatus.
Stomas do not have nerve endings and are not painful.
Types
Colostomy
Ileostomy
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Colostomy
Figure 19-9 on page 415
permanent colostomy, the diseased part of the colon is removed.
temporary colostomy gives the diseased or injured bowel time to heal.
The colostomy site depends on the site of disease or injury.
Stool consistency depends on the colostomy site.
The more colon remaining, the more solid and formed the stool will be.
Feces irritate the skin.
After the skin is washed and dried, a skin barrier is applied around the stoma.
The barrier is part of the pouch or a separate device.
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Ileostomy
Figure on page 416
Part of the ileum is brought out onto the abdominal wall, and a stoma is made.
The entire colon is removed.
Liquid feces drain constantly from an ileostomy.
Feces in the small intestine contain digestive juices that are very irritating to the skin.
The ileostomy pouch must fit well.
Good skin care is required.
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Ostomy pouches
Figure on page 416
The pouch has an adhesive backing that is applied to the skin.
Sometimes pouches are secured to ostomy belts.
Many pouches have a drain at the bottom that closes with clips, clamps, or wire closures.
The pouch is emptied when feces are present.
The pouch is opened when the bag balloons or bulges with flatus.
The drain is wiped with toilet tissue before it is closed.
The pouch is changed every 3 to 7 days and when it leaks.
The person can wear normal clothes.
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Peristalsis increases after eating.
Stomas are usually quieter before breakfast.
Showers or baths are best done at this time.
Showers or baths are delayed 1 or 2 hours after applying a new pouch.
Do not flush pouches down the toilet.
Follow agency policy for disposal.
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14. Factors Affecting Bowel Elimination
Privacy
Lack of privacy can prevent defecation despite having the urge.
Odors and sounds are embarrassing.
Some people ignore the urge to defecate when others are present.
Habits
Diet
Certain foods cause constipation in some people and diarrhea in others.
Fluids
Stool consistency depends on the amount of water absorbed in the colon.
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15. Factors Affecting Bowel Elimination
Activity
Exercise and activity maintain muscle tone and stimulate peristalsis.
Drugs
Drugs can prevent constipation or control diarrhea.
Some drugs have diarrhea or constipation as side effects.
Disability
Some persons cannot control bowel movements.
Age
Focus on older persons
Peristalsis slows down – constipation
Incontinence
risk for intestinal tumors and disorders
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16. Constipation Constipation is the passage of a hard, dry stool.
Common causes of include:
A low-fiber diet
Ignoring the urge to defecate
Decreased fluid intake
Inactivity
Drugs
Aging
Certain diseases
Dietary changes, fluids, activity, enemas, and drugs prevent or relieve constipation
Fecal impaction
Checking for a fecal impaction
Removing a fecal impaction
Diarrhea
Focus on children
Focus on older persons

17. Fecal impaction
Fecal impaction is the prolonged retention and buildup of feces in the rectum.
The person cannot defecate.
Liquid feces pass around the hardened fecal mass in the rectum and seep from the anus.
Abdominal discomfort, nausea, cramping, and rectal pain are common.
Report these signs and symptoms to the nurse.
A digital exam is done to check for an impaction.
A lubricated, gloved finger is inserted into the rectum. (p. 401)
Sometimes the fecal mass is removed with a gloved finger.
Checking for and removing impactions are very dangerous.
The vagus nerve in the rectum can be stimulated.
Stimulation of the vagus nerve slows the heart rate.
The heart rate can slow to dangerous levels in some persons.

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Diarrhea
Diarrhea is the frequent passage of liquid stools.
Feces move through the intestines rapidly.
The need to defecate is urgent.
Abdominal cramping, nausea, and vomiting may occur.
Causes of diarrhea include:
Infections
Some drugs
Irritating foods
Microbes in food and water
Diet and drugs reduce peristalsis.
You need to:
Assist with elimination needs promptly.
Dispose of stools promptly.
Give good skin care.
Skin breakdown and pressure ulcers are risks.
Replace fluid lost through diarrhea.
Otherwise, dehydration (the excessive loss of water from tissues) occurs.
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Fecal incontinence
Fecal incontinence is the inability to control the passage of feces and gas through the anus.
Causes include:
Intestinal diseases
Nervous system diseases and injuries
Fecal impaction
Diarrhea
Some drugs
Mental health problems or dementia
Unanswered signal lights
Not finding the bathroom when the person is in a new setting
The person may need:
Bowel training
Help with elimination after meals and every 2 to 3 hours
Incontinent products to keep garments and linens clean
Good skin care
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Flatulence
Gas and air in the stomach and intestines are expelled through the mouth and anus.
Gas and air passed through the anus is called flatus.
Flatulence is the excessive formation of gas or air in the stomach and intestines.
Common causes include:
Swallowing air while eating and drinking
Bacterial action in the intestines
Gas-forming foods
Constipation
Bowel and abdominal surgeries
Drugs that decrease peristalsis
If flatus is not expelled, the intestines distend.
Abdominal cramping or pain, shortness of breath, and a swollen abdomen occur.
Bloating is a common complaint.
Walking, moving in bed, and the left side-lying position often produce flatus.
Doctors may order enemas, drugs, or rectal tubes.
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Enemas
An enema is the introduction of fluid into the rectum and lower colon.
Enemas are ordered:
To remove feces
To relieve constipation, fecal impaction, and flatulence
To clean the bowel of feces before certain surgeries and diagnostic procedures
Comfort and safety measures are practiced when giving an enema.
Follow the rules in Box 19-3 on page 405 in the textbook. Enema solutions
Numerous enema solutions are available
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Activity
We will now watch the following skills videos
Feeding client
You will demonstrate the following skills using your skill rubrics
Feeding the dependent resident
Transfer to a bedside commode
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