Understanding Bowel Movements

Normal Bowel Movement Patterns

• Normal bowel movement frequency varies among individuals.
• Most people go every day, or every 2 to 3 days.
• Constipation is not defined by not having a bowel movement every day.

Normal Stool Characteristics

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

Observations Regarding Bowel Movements

• Carefully observe stools before disposing of them.
• Report abnormal-looking stools to the nurse.
• The nurse may need to collect stool samples.
• Use the Bristol Stool Chart as a way to describe stools.
• Important observations to note are color, amount, pain or discomfort, frequency of defecation, consistency, shape, and size.

Factors Affecting Bowel Movement

• Privacy
• Personal habits
• Diet
• Fluids
• Activity
• Medications
• Aging
• Disability

Comfort and Safety During Defecation

• Follow standard practices.
• Assist the client to the toilet or commode, or provide a bedpan when requested.
• Promote privacy by assisting the client to the bathroom.
• Position the commode over the toilet.
• Ensure the client's skin doesn’t rub or get pinched between the commode seat and the 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 close if the client is weak or unsteady.
• Leave the room if the client can be left alone but 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

• Defined as the passage of a hard, dry stool with less frequency than normal.
• Occurs when feces move too slowly through the bowel, leading to excessive water absorption which hardens the stool.
• Causes include a low-fibre diet, ignoring the urge to defecate, decreased fluid intake, inactivity, medications, aging, and certain diseases.
• Hemorrhoids are swollen veins in the anal canal that often result from constipation and straining during bowel movements.
• Prevented or relieved by dietary changes, fluids, activity, medications, and enemas.
• Prevention is easier than treating it.

Fecal Impaction

• Prolonged retention and build-up of feces in the rectum.
• Results if constipation is not relieved.
• Checked with a digital (finger) exam by a physician or nurse.
• Sometimes, the fecal mass is removed manually using a gloved finger, known as digital removal of impaction.
• Checking for and removing fecal impactions is dangerous.
• Possible signs 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

• Defined as the frequent passage of liquid stools.
• Occurs when feces move through the intestines too rapidly for liquid to be absorbed.
• Diet and drugs are ordered to reduce peristalsis.
• Key steps include assisting with elimination needs promptly, dispose of stools promptly and giving very good skin care due to the high risk of skin breakdown with loose stools.
• Fluid lost is replaced to avoid dehydration, which can quickly cause death in elderly or very sick patients.

Fecal Incontinence

• Inability to control the passage of feces and gas through the anus.
• Affects the client emotionally.
• Resistance to care is a common problem, making washing and changing the client difficult.
• Follow the client’s care plan.

Flatulence

• Gas or air passed through the anus is called flatus.
• Excessive formation of gas/air in the stomach and intestines; if not expelled, the intestines distend.
• Expelled through exercise, walking, moving in bed, and the left side-lying position.

Bowel Training

• Bowel training has two goals which are 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.

Enemas

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

Commercial Enemas

• Stimulate and distend the rectum and cause defecation.
• The solution is typically administered at room temperature.
• This is a delegated act.

Rectal Tubes

• Inserted into the rectum to relieve flatulence and intestinal distension.
• Usually inserted about 10 cm and left in place for 20 to 30 minutes.
• Can be re-inserted every 2 to 3 hours

Client With an Ostomy

• An ostomy is a surgically created opening.
• The opening is called a stoma.
• A pouch is worn over the stoma to collect stools and flatus.
• A colostomy involves a surgically created opening between the colon and the abdominal wall.
• A permanent colostomy involves removing the diseased part of the colon.
• A temporary colostomy is used to allow the diseased or injured bowel time to heal.
• The location of the colostomy depends on the site of disease or injury.
• After healing, surgery is done to reconnect the bowel.
• An ileostomy is a surgically created opening between the ileum and the abdominal wall.
• The entire colon is removed.
• The body absorbs very little water.
• Liquid stools drain constantly from an ileostomy.

Ostomy pouches

• The pouch has an adhesive backing that is applied to the skin.
• Pouches are sometimes secured to ostomy belts.
• Some pouches have a drain at the bottom that opens and closes.
• Pouches are emptied when stools are present.
• The pouch is changed every 3 to 7 days, or when it leaks.
• Do not flush pouches down the toilet.

Stool Specimens

• Stools are checked and studied for blood, fat, microbes, worms, and other abnormal contents.
• The stool specimen 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 gastro-intestinal tract.
• Blood that is present but cannot be seen (occult blood) is tested for with special equipment.

Review

• Each client has different patterns and frequency of bowel movements.
• Report any changes in the client's normal routine (colour, amount, odour, shape, size, frequency of stools).
• Follow Standard Practices when in contact with feces, which may contain pathogens.
• A number of factors can affect bowel movements, including lack of privacy, personal habits, diet, fluids, activity, medications, aging, and disability.
• Untreated constipation can lead to fecal impaction, which, if untreated, can lead to a bowel obstruction which can be very serious.
• Fluids lost through diarrhea, vomiting, or both must be replaced, or dehydration can result.
• Accurate reporting and recording is important so the supervisor can adjust the care plan.
• Closely note how much fluid the client is losing.
• Bowel training can help the client control bowel movements and develop a regular pattern of elimination, preventing fecal impaction, constipation, and fecal incontinence.
• Administering enemas is delegated and must be taught by a nurse.
• Remember DIPPS principles when dealing with aspects of bowel elimination, as they may be embarrassing.