OUR LADY OF FATIMA UNIVERSITY
FECAL ELIMINATION A.Y. 2021- 2022
FUNDAMENTALS OF NURSING PRACTICE
PHYSIOLOGY OF DEFECATION
→ Elimination of the waste products of digestion
from the body is essential to health.
LARGE INTESTINE
→ The large intestine extends from the ileocecal (ileocolic)
valve, which lies between the small and large intestines,
to the anus.
→ muscular tube lined with mucous membrane. The
muscle fibers are both circular and longitudinal,
permitting the intestine to enlarge and contract in both
width and length.
→ about 125 to 150 cm (50 to 60 in.) long. It has seven
parts: cecum; ascending, transverse, and descending
colons; sigmoid colon; rectum; and anus
→ The colon also serves a protective function in that it
secretes mucus
CHYME
→ The waste products leaving the stomach through
the small intestine and then passing through the
ileocecal valve
FLATUS
→ largely air and the by-products of the digestion of
carbohydrates.
PERISTALSIS
→ wavelike movement produced by the circular and
longitudinal muscle fibers of the intestinal walls; it propels
the intestinal contents forward
RECTUM AND ANAL CANAL
→ The rectum in the adult is usually 10 to 15 cm (4 to 6 in.)
long; the most distal portion, 2.5 to 5 cm (1 to 2 in.) long, is
the anal canal.
→ rectum has folds that extend vertically
→ The internal sphincter is involuntary while external
sphincter is voluntarily controlled
→ hemorrhoids - When the veins become distended, as can
occur with repeated pressure
DEFECATION
→ the expulsion of feces from the anus and rectum. It is also
called a bowel movement.
FECES
→ 75% water and 25% solid materials
→ Another factor that affects fecal color is the action of
bacteria such as Escherichia coli or staphylococci, which
are normally present in the large intestine.
FACTORS THAT AFFECT DEFECATION
1. DEVELOPMENT
2. DIET
→ Amount of fiber that should be taken daily:
a. Men age 50 and younger: 38 grams
b. Men age 51 and older: 30 grams
c. Women ages 50 and younger: 25 grams
d. Women ages 51 and older: 21 grams.
3. FLUID INTAKE & OUTPUT
→ The body continues to reabsorb fluid from the chyme as
it passes along the colon.
→ Healthy fecal elimination usually requires a daily fluid
intake of 2000 to 3000 ml.
FECAL ELIMINATION; ADMINISTERING ENEMA
ZAPANTA, VIA KRISTEL U.
4. ACTIVITY
→ Stimulates peristalsis, thus facilitating the movement of
chyme along the colon. Weak abdominal and pelvic
muscles are often ineffective in increasing the
intraabdominal pressure during defecation or in
controlling defecation.
5. PSYCHOLOGIC FACTORS
→ Some individuals who are anxious or angry experience
increased peristaltic activity and subsequent nausea or
diarrhea
6. DEFECATION HABITS
→ Many individuals defecate after breakfast due to the
gastrocolic reflex (increased peristalsis of the colon after
food has entered the stomach)
7. MEDICATIONS
→ Some drugs have side effects that can interfere with
normal elimination
→ Laxatives are medications that stimulate bowel activity
and so assist fecal elimination. Other medications soften
stool, facilitating defecation. Certain medications suppress
peristaltic activity and may be used to treat diarrhea
8. DIAGNOSTIC PROCEDURES
→ Before certain diagnostic procedures, such as visualization
of the colon (colonoscopy or sigmoidoscopy), the client is
restricted from ingesting food or fluid.
9. ANESTHESIA AND SURGERY
→ General anesthetics cause the normal colonic movements
to cease or slow by blocking parasympathetic stimulation
to the muscles of the colon
→ Surgery that involves direct handling of the intestines can
cause temporary stoppage of intestinal movement. This
condition, called ileus, usually lasts 24 to 48 hours
10. PATHOLOGIC CONDITIONS
→ Spinal cord injuries and head injuries can decrease the
sensory stimulation for defecation. Impaired mobility may
limit the client’s ability to respond to the urge to defecate
and the client may experience constipation
11. PAIN
→ Clients who experience discomfort when defecating
often suppress the urge to defecate to avoid the pain.
FECAL ELLIMINATION PROBLEMS
I. CONSTIPATION
→ fewer than three bowel movements per week.
→ This infers the passage of dry, hard stool or the passage of
no stool.
→ It occurs when the movement of feces through the large
intestine is slow, thus allowing time for additional
reabsorption of fluid from the large intestine
→ in children constipation is often associated with changes in
activity, diet, and toileting habits
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 OUR LADY OF FATIMA UNIVERSITY
FECAL ELIMINATION A.Y. 2021- 2022
FUNDAMENTALS OF NURSING PRACTICE ZAPANTA, VIA KRISTEL U.

COMMON CHARACTERISTICS OF CONSTIPATION CLOSTRIDIUM DIFFICILE INFECTION

Decreased frequency of Abdominal pain, cramps, → Infection of the large intestine (colon) caused by the bacteria
defecation or distention Clostridium difficile.
→ Long-term use of antibiotics reduces the normal bacterial
Hard, formed stools Anorexia, nausea
population in the intestine and triggers the C. difficile
Straining at stool; painful Headache
overgrowth in the intestine.
defecation
Reports of rectal fullness or pressure or incomplete bowel IMPLEMENTATION
evacuation o Encourage oral intake of fluids and bland food
CAUSES OF CONSTIPATION o Excessively hot or cold fluids should be avoided because
Insufficient Fiber Intake Chronic Use of Laxatives they stimulate peristalsis.
or Enemas o highly spiced foods and high-fiber foods can aggravate
Insufficient Fluid Intake Irritable Bowel Syndrome diarrhea
(IBS)
Insufficient Activity or Pelvic Floor Dysfunction or IV. BOWEL INCONTINENCE
Immobility Muscle Damage → Also called fecal incontinence
Irregular Defecation Habits Poor Motility or Slow → Refers to the loss of voluntary ability to control fecal and
Transit gaseous dis charges through the anal sphincter
Change In Daily Routine Neurologic Conditions → Generally associated with impaired functioning of the anal
(E.G., Parkinson’s Disease), sphincter or its nerve supply, such as in some neuromuscular
Stroke, Or Paralysis diseases, spinal cord trauma, and tumors of the external
Lack Of Privacy Emotional Disturbances anal sphincter muscle.
Such as Depression or
Mental Confusion V. FLATULENCE
Medications Such as Habitual Denial and → The presence of excessive flatus in the intestines and leads
Opioids, Iron Supplements, Ignoring the Urge to to stretching and inflation of the intestines (intestinal
Antihistamines, Antacids, Defecate. distention)
And Antidepressants → If the gas is propelled by increased colon activity before it
IMPLEMENTATION: can be absorbed, it may be expelled through the anus. If
o Increase daily fluid intake, and instruct the client to excessive gas cannot be expelled through the anus, it may
drink hot liquids, warm water with a squirt of fresh be necessary to insert a rectal tube to remove it.
lemon, and fruit juices, especially prune juice. Include PRIMARY SOURCE OF FLATUS:
fiber in the diet, that is, foods such as raw fruit, bran o Action of bacteria on the chyme in the large intestine
products, and wholegrain cereals and bread o Swallowed air
o Gas that diffuses between the bloodstream and the
II. FECAL IMPACTION intestine.
→ a mass or collection of hardened feces in the folds of the IMPLEMENTATION
rectum. o Limit carbonated beverages, the use of drinking straws,
→ Impaction results from prolonged retention and and chewing gum—all of which increase the ingestion of
accumulation of fecal material. In severe impactions the air
feces accumulate and extend well up into the sigmoid colon o Gas-forming foods, such as cabbage, beans, onions,
and beyond and cauliflower, should also be avoided.
→ Along with fecal seepage and constipation, symptoms
include frequent but nonproductive desire to defecate and BED SIDE COMMODE
rectal pain. A generalized feeling of illness results; the client → A portable chair with a toilet seat and a receptacle
becomes anorexic, the abdomen becomes distended, and beneath that can be emptied
nausea and vomiting may occur. BED PAN
CAUSES → A receptacle for urine and feces.
o Poor defecation habits → Female clients use a bed pan for both urine and feces;
o Constipation → Male clients use a bedpan for feces and a urinal for urine
o Medication administration CATHARTICS
→ Drugs that induce defecation.
III. DIARRHEA LAXATIVES
→ the passage of liquid feces and an increased frequency → mild in comparison to a cathartic, and it produces soft
of defecation. or liquid stools that are sometimes accompanied by
→ It is the opposite of constipation and results from rapid abdominal cramps.
movement of fecal contents through the large intestine → Laxatives are contraindicated in the client who has
→ diarrhea is not present unless the stool is relatively nausea, cramps, colic, vomiting, or undiagnosed
unformed and excessively liquid abdominal pain
→ diarrhea is not present unless the stool is relatively → Some laxatives are given in the form of
unformed and excessively liquid suppositories.
→ Often, spasmodic cramps are associated with diarrhea. → The best results can be obtained by inserting the
Bowel sounds are increased. suppository 30 minutes before the client’s usual
→ When the cause of diarrhea is irritants in the intestinal defecation time or when the peristaltic action is greatest,
tract, diarrhea is thought to be a protective flushing such as after breakfast.
mechanism -

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FECAL ELIMINATION; ADMINISTERING ENEMA
 OUR LADY OF FATIMA UNIVERSITY
FECAL ELIMINATION A.Y. 2021- 2022
FUNDAMENTALS OF NURSING PRACTICE ZAPANTA, VIA KRISTEL U.

BULK Increases the fluid, gaseous, or

FORMING solid bulk in the intestines.
OSMOTIC Draws water into the intestine by
osmosis, and works by holding
water in the stool to soften the
stool. The active ingredient is
polyethylene glycol (PEG).
TYPES OF LAXATIVES
ENEMA SOLUTIONS
1. HYPERTONIC SOLUTION
→ It draws water in the colon
→ Exerts osmotic pressure, which draws fluid from the
interstitial space into the colon
→ 90–120 mL of solution (e.g., sodium phosphate); takes 5-10

SALINE The active ingredients are usually mins to effect

magnesium, sulfate, citrate, and → ADVERSE EFFECT: Retention of sodium
phosphate ions, which draw
2. HYPOTONIC SOLUTION
water into the intestines. The
additional water softens the stool → Distends colon, stimulates peristalsis, and softens feces.
and stimulates peristalsis → 500–1000 mL of tap water ; takes 15-20 mins to effect
STIMULANT/ Irritates the intestinal mucosa or → ADVERSE EFFECT: Fluid and electrolyte imbalance; water
IRRITANT stimulates nerve endings in the intoxication
wall of the intestine, causing rapid 3. ISOTONIC SOLUTION
propulsion of the contents. → Distends colon, stimulates peristalsis, and softens feces.
STOOL Softens and delays the drying of → Safest solution to use because there is no fluid movement
SOFTENER/ the stool; causes more water and into or out of the colon
SURFACTANT fat to be absorbed into the stool. → 500–1000 ml of normal saline: takes 15-20 mins to effect
LUBRICANT Lubricates the stool and colon → ADVERSE EFFECT: Possible Sodium retention
mucosa.
4. SOAPSUDS
CARMINATIVES → Irritates mucosa, distends colon
→ Herbal oils known to act as agents that help expel gas from → stimulate peristal sis by increasing the volume in the colon
the stomach and intestines. and irritating the mucosa.
ADMINESTERING ENEMA → 500–1000 mL (3–5 mL soap to 1000 mL water) takes 10-
15 mins to effect
ENEMA → ADVERSE EFFECT: Irritates and may damage mucosa
→ a solution introduced into the rectum and large intestine
in order to distend the intestine and sometimes to irritate 5. OIL
the intestinal mucosa, thereby increasing peristalsis and → Either mineral, olive or cottonseed
the excretion of feces and flatus → Lubricates the feces and the colonic mucosa.
→ should be at 37.7°C (100°F) because too hot or too cold → 90–120 mL ; Takes .5 to 3 hours to effect
enema would promote discomfort and cause cramping
TYPES OF ENEMA II. RETENTION ENEMA
→ Introduces oil or medication into the rectum
I. CLEANSINGE ENEMA
and sigmoid colon
→ It is commonly used for:
OIL RETENTION ENEMA
o Prevent the escape of feces during surgery.
→ Acts to soften the feces and to lubricate the rectum and
o Prepare the intestine for certain diagnostic tests such
anal canal
as x-ray or visualization tests (e.g., colonoscopy).
ANTIBIOTIC ENEMA
o Remove feces in instances of constipation or
impaction. → Treat infections locally, anthelmintic enemas to kill
HIGH CLEANSING ENEMA helminths
NUTRITIVE ENEMA
→ Cleanse as much as the colon as possible
→ POSITION: Left Lateral to Dorsal Recumbent to Right → To administer fluids and nutrients to the rectum.
lateral III. CARMINATIVE ENEMA
→ Solution container is held: 12-18 inches → given primarily to expel flatus.
LOW ENEMA → Two ounces of glycerin, one ounce of magnesium sulfate
→ Used to cleanse rectum and sigmoid colon part only (epom salts) and three ounces of water
→ POSITION: Left Lateral position during administration → For an adult, 60 to 80 mL of fluid is instilled.
→ When using this kind of enema, instruct the client to try
THE FORCE OF FLOW IS GOVERN BY:
to retain it for 5-10 minutes before expelling
a. Height of the solution container
b. Size of tubing
c. Viscosity of fluid IV. RETURN-FLOW ENEMA
d. Resistance of rectum – the higher the solution container → Harris Flush
is held, the faster the flow → To remove intestinal gas and stimulate peristalsis
→ A large volume fluid is used but the fluid is instilled in
o Most adult enemas should not be higher than 30 cm (12 100-200 ml increments. Then the fluid is drawn out by
inches) above rectum the container the level of the bowel. This brings the flatus
o During a high cleansing enema, the solution container is out with the fluid
usually held 30 to 48 cm (12 to 18 in.) above the rectum
because the fluid is instilled farther to clean the entire ADULT Fr. 22-30
RECTAL TUBE
bowel. CHILDREN Fr. 14-18
SIZES
INFANT Fr. 12

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FECAL ELIMINATION; ADMINISTERING ENEMA
 OUR LADY OF FATIMA UNIVERSITY
FECAL ELIMINATION A.Y. 2021- 2022
FUNDAMENTALS OF NURSING PRACTICE ZAPANTA, VIA KRISTEL U.

MATERIALS INDICATIONS
1.Waterproof Pad 1. Relieve Constipation
2.IV Pole 2. Colon Cleansing
3.Enema Can/Bag 3. Lower Gi X-Ray
4.Rectal Tube 4. Inflammatory Bowel Disease
5.Water Soluble Lubricant CONTRAINDICATIONS
6.Bed Pan 1. High amount of phosphate in the blood
7.Towel 2. Low amount of calcium in the blood
8.Clean Gloves 3. An increased sodium level in the blood
PURPOSE 4. Dehydration
→ To achieve one or more of the following actions: 5. Method of removing waste/poison from
cleansing, retention, carminative, or return-flow blood with dialysis
6. Sudden and serious symptoms of heart
ASSESS failure called acute decompensated heart
→ When was the client’s last bowel movement, the failure
amount, color and consistency of feces 7. Appendicitis
→ Presence of abdominal Distention 8. Inflammation of the large intestine
→ If the client’s sphincter control 9. Blockage of the stomach or intestine
→ If the client is able to move and use toilet or 10. Acute kidney failure
commode

IMPLEMENTATION
PREPARATION:
→ Lubricate about 5 cm (2 inches) of the rectal
Tube
→ Prime the tubing of a large volume enema to
avoid inserting air because it will cause cramps
POSITION
→ Left lateral position with leg acutely flexed
o This position facilitates the flow of solution by
gravity into the sigmoid and descending colon,
which are on the left side. Having the right leg
acutely flexed provides for adequate exposure
of the anus
INSERTION
→ Slowly directing towards the umbilicus
→ Length: 3-4 inches
If (+) Resistance:
- Instruct the patient to take a deep breath
- Run small amount of solution
If Resistance persists:
→ Withdraw the tube
→ Check for any stool that may have blocked the
tube
→ (+) flush and retry
→ Perform Deep Rectum Exam to ascertain fecal
impaction
→ Stop and report to physician if resistance
persists

DOCUMENT
→ Document the type and volume,
→ enema given.
→ Describe the results

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FECAL ELIMINATION; ADMINISTERING ENEMA
 OUR LADY OF FATIMA UNIVERSITY
FECAL ELIMINATION A.Y. 2021- 2022
FUNDAMENTALS OF NURSING PRACTICE ZAPANTA, VIA KRISTEL U.

CHARACTERISTICS NORMAL ABNORMAL POSSIBLE CAUSE

ADULT: BROWN Clay or white Absence of bile pigment (bile obstruction);
diagnostic study using barium
Infant: Yellow Black or Drug; bleeding from upper GI tract; diet
tarry high in red meat and dark green
vegetables
COLOR
Red Bleeding from lower GI Tract
Pale Malabsorption of fats; diet high in milk and
milk products and low in meat
Orange or Intestinal Infection
green
Formed, soft, semisolid, Hard, dry Dehydration; decreased intestinal motility
CONSISTENCY moist resulting from lack of fiber in diet, lack of
exercise, emotional upset, laxative abuse
Diarrhea Increased intestinal motility (e.g., due to
irritation of the colon by bacteria
Cylindrical (contour of Narrow, Obstructive condition of the rectum
rectum) about 2.5 cm (1 pencil-
SHAPE in.) in diameter in adults shaped, or
stringlike
stool
Varies with diet (about Pungent Infection, blood
AMOUNT
100–400 g/day)
Aromatic: affected by
ingested food and
ODOR
individual’s own bacterial
flora
Small amounts of Pus Mucus Bacterial infection Inflammatory
undigested roughage, Parasites condition Gastrointestinal bleeding
sloughed dead bacteria Blood Large Malabsorption Accidental ingestion
CONSTITUENTS
and epithelial cells, fat, quantities of
protein, dried constituents fat foreign
of digestive juices objects

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FECAL ELIMINATION; ADMINISTERING ENEMA