Urinary Elimination

Bowel Elimination

• Bowel elimination involves the removal of solid waste from the body.

Normal Bowel Movement Patterns

• Bowel movement frequency varies among individuals.
• Most people have a bowel movement every day or every 2 to 3 days.
• It is a misconception that constipation automatically occurs if a daily bowel movement doesn't happen.

Normal Stool Characteristics

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

Observations of Stools

• Carefully observe stools before disposing of them.
• Ask the nurse to observe potentially abnormal stools.
• Ensure the nurse doesn't need to collect stools before disposal.
• Colour, amount, consistency, shape, and size of stools should be observed and recorded along with any pain or discomfort and frequency of defecation.
• The Bristol Stool Chart is a tool for describing stool types consistently.

Factors Affecting Bowel Movement

• Key factors include: privacy, personal habits, diet, fluids, activity, medications, aging, and disability.

Comfort and Safety During Defecation

• Follow standard practices during defecation.
• Assist the client to the toilet/commode, or provide a bedpan promptly.
• Promote privacy and ensure client comfort and safety.
• Ensure the client's skin does not rub or get pinched by the commode seat or toilet bowl.
• The call bell and toilet tissue need to be within reach.
• Leave room if the client is able to be left alone but ensures you stay within hearing distance.
• Provide perineal care and dispose of stools quickly.
• Assist with hand washing.
• Follow the care plan if the client has fecal incontinence.

Constipation

• Constipation involves the passage of hard, dry stool less frequently than normal.
• It occurs due to slow feces movement in the bowel, causing excessive water absorption.
• Causes include low-fibre diet, ignoring the urge to defecate, decreased fluid intake, inactivity, medications, aging, and certain diseases.
• Hemorrhoids (swollen veins in the anal canal) may result from constipation.
• Constipation it's prevented or relieved by dietary changes, fluids, activity, medications, and enemas.
• Preventing constipation is preferable to treating it.

Fecal Impaction

• Fecal impaction is the prolonged retention and buildup of feces in the rectum, resulting from unrelieved constipation.
• A digital exam can check for an impaction by a physician or a nurse.
• It is dangerous to check for and remove impactions.
• Sometimes, the fecal mass needs to be manually removed with a gloved finger which is called the digital removal of an impaction.

Signs of Fecal Impaction Requiring Nurse Notification

• Severe abdominal discomfort.
• Abdominal swelling.
• Cramping.
• A feeling of fullness or pain in the rectum.
• Nausea or vomiting (vomitus that smells like stool).
• Fever.
• Increased urge or decreased ability to urinate.
• Liquid feces seepage from the anus.

Diarrhea

• Diarrhea involves the frequent passage of liquid stools.
• Feces move too rapidly through the intestines and liquid isn't absorbed.
• Diet and drugs manage peristalsis.
• The need to assist with elimination needs promptly.
• Fluid lost through diarrhea must be replaced to prevent dehydration and death.
• Otherwise dehydration occurs.
• Skin breakdown occurs with loose stools.

Fecal Incontinence

• Fecal incontinence is the inability to control the passage of feces and gas through the anus, which affects the client emotionally.
• Follow the client's care plan.
• A common problem is resistance to care, washing, and changing the client can become difficult.

Flatulence

• Gas or air passed through the anus is called flatus.
• Flatulence is the excessive formation of gas or air in the stomach and intestines.
• If flatus isn't expelled, the intestines distend.
• Exercise, walking, moving in bed, and the left side-lying position can help expel flatus

Bowel Training

• Bowel training aims to gain control of bowel movements and develop a regular pattern of elimination.
• Factors that promote elimination are part of the care plan and bowel training program.

Enemas

• An enema is the introduction of fluid into the rectum and lower colon.
• They relieve constipation, fecal impaction, or flatulence.
• They clean the bowel of feces before certain surgeries and diagnostics.
• Commercial enemas stimulate and distend the rectum and cause defecation.
• The solution is usually administered at room temperature.

Rectal tubes

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

Ostomy

• An ostomy is a surgically created opening.
• The opening is called a stoma.
• The client wears a pouch over the stoma to collect stools and flatus.
• A colostomy involves a surgically created opening between the colon and the abdominal wall.
• With a permanent colostomy, the diseased part of the colon is removed.
• A temporary colostomy gives the diseased or injured bowel time to heal.
• The colostomy site depends on the disease or injury.
• An ileostomy is a surgically created opening between the ileum and the abdominal wall and the entire colon is removed.
• Liquid stools drain constantly from an ileostomy because very little water is absorbed.

Ostomy Pouches

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

Stool Specimen

• Stools are checked and studied for blood, fat, microbes, worms, and other abnormal contents.
• The stool specimen cannot be contaminated with urine.
• Testing 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 because it is in very small amounts is called occult blood.
• Occult blood is tested for with special equipment.

Review Points

• Each client will have different patterns and frequency of bowel.
• Report any changes in normal routine of frequency or if painful immediately.
• Follow policies when coming into contact with feces to avoid any pathogens.
• Number of items affecting the bowel include privacy, personal habits, diet, activity, aging and disability
• Constipation if untreated can lead to serious health concerns.
• Fluids if having diarrhea, vomiting, or need to be replaced to avoid dehydration.
• Accurate reporting will allow supervisor to adjust plan to replaced fluids.
• Training can assist the client with controlling bowel and allow a regular elimination pattern.
• Dealing with items can be frustrating and personal so remember the DIPPS principles. </existing_notes>