Bowel Elimination & Standard Practices

Bowel Elimination & Standard Practices

• Standard practices should be followed when in contact with feces, as it may contain pathogens.

Normal Bowel Movement Patterns

• Most people have bowel movements every day or every 2 to 3 days.
• Bowel movement time and frequency can vary from person to person.
• Having a bowel movement less than once a day is not necessarily constipation.
• Clients can have different bowel movement patterns and frequencies.

Normal Stool Characteristics

• Normal stools are usually brown, soft, formed, moist, and shaped like the rectum.

Observations of Stool

• Observations of stools are important and should be made before disposal.
• If a stool appears abnormal, a nurse should also observe it.
• Make sure the stool is not being collected for a test if observed.
• Observe, report, and record stool color, amount, consistency, shape and size, frequency of defecation, and any pain or discomfort.
• Changes in a client's normal routine, color, amount, odour, shape, size, or frequency of stools must be reported.
• The Bristol Stool Chart describes types of stools in a consistent way.

Factors Affecting Bowel Movement

• Factors that affect bowel movement include lack of privacy, personal habits, diet, fluids, activity, medications, aging, and disability.

Comfort and Safety During Defecation

• Assist the client to the toilet or commode, or provide a bedpan as soon as requested.
• Promote privacy when assisting clients.
• Position the commode over the toilet.
• Ensure the client's skin isn’t rubbed or pinched by the commode seat or toilet bowl.
• Close doors, privacy curtains, and shades.
• Make sure the bedpan is warm
• Position the client in a normal sitting position.
• Cover the client for warmth and privacy.
• Allow enough time for defecation.
• Place the call bell and toilet tissue within reach.
• Stay around if the client is weak and unsteady.
• Leave the room if the client can be left alone.
• Stay within hearing distance.
• Provide perineal care and dispose of stools promptly.
• Assist the client with hand washing.
• Follow the care plan if the client has fecal incontinence.

Constipation

• Constipation is the passage of hard, dry stool with less frequency than normal.
• Untreated constipation can lead to fecal impaction, which can lead to a bowel obstruction, which is a very serious condition.
• Constipation occurs when feces moves slowly through the bowel causing more water than usual to be absorbed, making the stool harder.
• Causes of constipation include a low-fiber diet, ignoring the urge to defecate, decreased fluid intake, inactivity, medications, aging, and certain diseases.

Hemorrhoids

• Hemorrhoids are swollen veins in the anal canal caused by constipation and straining during bowel movements.
• Low fiber diet can cause hemorrhoids
• Ignoring the urge to defecate can cause hemorrhoids
• Decreased fluid intake can cause hemorrhoids
• Inactivity can cause hemorrhoids
• Medications can cause hemorrhoids
• Aging can cause hemorrhoids
• Certain diseases can cause hemorrhoids
• Constipation is prevented or relieved by dietary changes, fluids, activity, medication, and enemas.
• Prevention of constipation is more manageable than treating it.

Fecal Impaction

• Fecal impaction is the prolonged retention and buildup of feces in the rectum, resulting from unrelieved constipation.
• A digital exam is done by a physician or nurse to check for impaction.
• Digital removal of an impaction may be required
• Checking for and removing impactions is very dangerous.
• Signs of fecal impaction include severe abdominal discomfort, abdominal swelling, cramping, a feeling of fullness or pain in the rectum, nausea or vomiting, fever, increased urge or decreased ability to urinate, and liquid feces seeping from the anus.

Diarrhea

• Diarrhea is the frequent passage of liquid stools.
• With diarrhea, feces move quickly through the intestines resulting in a lack of liquid absorption.
• Diet and drugs are ordered to reduce peristalsis.
• Assist with elimination promptly.
• Dispose of stools promptly.
• Provide good skin care due to increased risk of skin breakdown with loose stools.
• Fluids lost through diarrhea must be replaced to avoid dehydration, which can quickly cause death, particularly in elderly or very sick patients.

Fecal Incontinence

• Fecal incontinence is the inability to control the passage of feces and gas through the anus.
• Emotional distress can occur with fecal incontinence
• A common problem is when support workers encounter resistance to care, making washing and changing the client difficult.
• Follow the client’s care plan.

Flatulence

• Flatulence is gas or air passed through the anus and the excessive formation of gas or air in the stomach and intestines.
• If flatus is not expelled, the intestines distend
• Methods to help expel flatus include exercise, walking, moving in bed, the left side-lying position, and encouraging mobility.

Bowel Training

• Bowel training has two goals: to gain control of bowel movements and to develop a regular pattern of elimination.
• Factors that promote elimination are part of the care plan and the bowel training program.
• Bowel training can help your client gain control of bowel movements and develop a regular pattern of elimination to prevent fecal impaction, constipation and fecal incontinence.

Enemas

• An enema is the introduction of fluid into the rectum and lower colon.
• Doctors order enemas to remove feces, relieve constipation, fecal impaction, or flatulence, and clean the bowel of feces before certain surgeries and diagnostic procedures.

Commercial Enemas

• Commercial enemas stimulate and distend the rectum and cause defecation.
• The solution is usually administered at room temperature.
• Administering a commercial enema is a delegated act and requires training from a nurse.

Rectal Tubes

• A rectal tube is inserted into the rectum to relieve flatulence and intestinal distension.
• Rectal tubes are usually inserted about 10 cm and left in place for 20 to 30 minutes.
• The tube can be re-inserted every 2 to 3 hours.

Clients With An Ostomy

• An ostomy is a surgically created opening (there are different types of ostomies).
• The opening is called a stoma.
• The client wears a pouch over the stoma to collect stools and flatus.
• A colostomy is a surgically created opening between the colon and abdominal wall.
• In a permanent colostomy, the diseased part of the colon is removed.
• A temporary colostomy gives the diseased or injured bowel time to heal; after healing, surgery is done to reconnect the bowel.
• The colostomy site (where it is located on the abdomen) depends on the site of disease or injury.
• An ileostomy is a surgically created opening between the ileum and the abdominal wall.
• The entire colon is removed during an ileostomy
• Very little water is absorbed during an ileostomy
• Liquid stools constantly drain from the ileostomy

Ostomy Pouches

• Ostomy pouches have an adhesive backing that is applied to the skin.
• Sometimes, pouches are secured to ostomy belts.
• Some pouches have a drain at the bottom that opens and closes.
• Pouches are emptied when stools are present.
• Ostomy pouches are changed every 3 to 7 days or when they leak.
• Pouches should not be flushed down the toilet.

Stool Specimen Collection

• Stools are checked and studied for blood, fat, microbes, worms, and other abnormal contents.
• Stool specimens must not be contaminated with urine.
• Some tests require a warm stool.

Testing Stools For Blood

• Stools may contain blood for many reasons.
• Red bloody stools indicate bleeding in the lower bowels.
• Black, tarry stools (melena) indicate bleeding in the stomach or upper gastrointestinal tract.
• Blood that is present but cannot be seen due to small amounts is called occult blood; special equipment is required to test for occult blood.