Fundamental of Nursing II: Fecal Elimination

Fecal Elimination

• Fecal elimination is the process of eliminating waste products from the body through the anus and rectum, also known as bowel movement.
• The frequency of defecation is highly individual, varying from several times a day to 2-3 times a week.
• The amount of defecation also varies from person to person.

Physiology of Defecation

• The rectum and anus are the most distal parts of the large intestine.
• The rectum is usually 10-15 cm long in adults.
• The internal anal sphincter is innervated by the autonomic nervous system, and the external anal sphincter is innervated by the somatic nervous system.
• Defecation is a process that involves both involuntary and voluntary control.
• The colon's main functions are:
  • Absorption of water and nutrients
  • Mucoid protection of the intestinal wall
  • Fecal elimination

Characteristics of Normal and Abnormal Feces

• Normal feces are:
  • 75% water and 25% solid materials
  • Soft, but formed
  • Brown due to the presence of sterocobilin and urobilin
  • Has a characteristic odor due to the action of bacteria
  • Contains 7-10 liters of gas in the large intestine every 24 hours
• Abnormal feces may be:
  • Clay or white (absence of bile pigment)
  • Black or tarry (bleeding from upper GIT)
  • Red (bleeding from lower GIT)
  • Pale or orange/green (malabsorption of fats or diet-related)

Factors that Influence Fecal Elimination

• Age and development
• Diet
• Fluid intake
• Activity
• Psychologic factors
• Defecation habits
• Medications
• Diagnostic procedures
• Anesthesia and surgery
• Pathologic conditions
• Pain

Fecal Elimination Problems

• Constipation
  • Defined as fewer than 3 bowel movements a week
  • Characteristics: decreased frequency of defecation, hard, dry, formed stools, straining at stool, painful defecation
  • Causes: irregular defecation habits, insufficient activity, insufficient fluid or fiber intake, chronic use of laxatives, change in daily routine
• Fecal impaction
  • A mass or collection of hardened feces in the folds of the rectum
  • Causes: poor defecation habits, constipation, certain medications
  • Treatment: oil retention enema, cleansing enema, daily additional cleansing enemas, suppositories or stool softeners, manual removal
• Diarrhea
  • Passage of liquid feces and an increase in frequency of defecation
  • Causes: rapid movement of fecal contents through the large intestine, infection, inflammation, irritation of the intestinal mucosa
  • Treatment: client teaching (managing diarrhea), fluids, electrolytes, and medications as needed
• Fecal incontinence
  • Loss of voluntary control of fecal and gaseous discharges through the anal sphincter
  • Types: partial incontinence, major incontinence
  • Causes: nerve damage, muscle weakness, rectal surgery
  • Treatment: bowel training program, fecal incontinence pouch

Nursing Management

• Assessment of fecal elimination includes:
  • Nursing history
  • Physical examination of the abdomen, rectum, and anus
  • Inspecting the feces
  • Reviewing diagnostic test data
• Nursing diagnosis:
  • Altered bowel movement
  • Risk for fluid volume deficit
  • Self-esteem disturbance
  • Anxiety
  • Risk for impaired skin integrity
• Planning:
  • Maintain or restore normal bowel elimination pattern
  • Maintain or regain normal stool consistency
  • Prevent associated risks
• Implementing:
  • Promoting regular defecation
  • Client teaching for healthy habits related to bowel elimination
  • Administering prescribed medications
  • Administering enemas
  • Digital removal of a fecal impaction
  • Decreasing flatulence
  • Bowel training program
  • Fecal incontinence pouch