ABNORMALITIES OF FECAL ELIMINATION

Constipation  Patients who recently had surgery

 It is defined as fewer than three bowel
movements weekly or bowel movements that
are hard, dry, small, or difficult to pass
 It is a symptom, not a disease
4 CLASSES OF CONSTIPATION
Based upon their underlying pathophysiologic
mechanisms
 Older adults
 Non-Caucasians
 People with a history of irritable bowel syndrome
MEDICAL MANAGEMENT
“Treatment targets the underlying cause of
constipation and prevention of recurrence.” JIBE

1. Functional constipation  Judicious use of laxatives. [If laxative use is

 Involves normal transit mechanisms of mucosal
transport.  prescribed: bulk-forming agents (fiber laxatives),
 Most common and can be successfully treated
by increasing intake of fiber and fluids.
2. Slow-transit constipation
 Caused by inherent disorders of the motor
function of the colon (e.g., Hirschsprung
disease),
 Characterized by infrequent bowel movements.
3. Defecatory disorders
 Caused by dysfunctional motor coordination
between the pelvic floor and anal sphincter.  abdominal muscles is encouraged.]
 Dyssynergic constipation is a common cause of
chronic constipation and is caused by an
inability to coordinate the abdominal, pelvic floor,
and rectoanal muscles to defecate.
Anismus is a term used to describe pelvic floor
dysfunction and constipation.
4. Opioid-induced constipation
 Includes new or worsening symptoms that occur
when opioid therapy is initiated, changed, or
increased and must include two or more
symptoms of functional constipation
CLINICAL MANIFESTATION
 Fewer than three bowel movements per week
 Abdominal distention
 Abdominal pain and bloating
 A sensation of incomplete evacuation
 Straining at stool
 Elimination of small-volume, lumpy, hard, dry
stools. 
The patient may report tenesmus
necessary, one of the following may be
saline and osmotic agents, lubricants,
stimulants, or emollient stool softeners]
 Increased fiber and fluid intake [Daily dietary
intake of 25 to 30 g/day of fiber is
recommended. Add fiber to the diet slowly in
order to avoid adverse effects such as
abdominal cramping and bloating. Fiber is
increased daily in 5g increments, along with
encouraging fluid intake]
 Bowel habit training 
 Exercise [Routine exercise to strengthen
To prevent constipation:
 Ensure proper dietary habits, such as eating
high-residue, high-fiber foods (e.g., fruits,
vegetables); adding fiber to the diet slowly with
adequate fluid intake; choosing dietary sources
of fiber, which are preferred over fiber
supplements; adding bran daily (must be
introduced gradually); and increasing fluid intake
(unless contraindicated) to help prevent
constipation.

 Avoid overuse or long-term use of stimulant
laxatives.

RISK FACTORS
People more likely to become constipated are:
 Women, particularly pregnant women

Page 1 of 4 – EXCLUSIVELY FOR BSN-3A

 Diarrhea
 An increased frequency of bowel movements
(more than 3 per day) with altered consistency
of stool.
 Can be associated with urgency, perianal
discomfort, incontinence, nausea.
DIARRHEA CAN BE CLASSIFIED AS ACUTE, PERSISTENT
OR CHRONIC
1. Acute diarrhea is self-limiting, lasting 1 or 2 days
2. Persistent diarrhea typically lasts between 2 and
4 weeks
3. Chronic diarrhea persists for more than 4 weeks
and may return sporadically. This includes
secretory, osmotic, malabsorptive, infectious,
and exudative.
 Secretory diarrhea is usually high-volume
diarrhea
- associated with bacterial toxins and
chemotherapeutic agents used to treat
neoplasms
- caused by increased production and
secretion of water and electrolytes   One of the most socially and psychologically
 Osmotic diarrhea occurs when water is pulled
into the intestines by the osmotic pressure of
unabsorbed particles, slowing the reabsorption
of water
- can be caused by lactase deficiency,
pancreatic dysfunction, or intestinal
hemorrhage.
 Malabsorptive diarrhea combines mechanical
and biochemical actions, inhibiting effective
absorption of nutrients.   minor soiling
- Low serum albumin levels lead to
intestinal mucosa swelling and liquid
stool.   experience poor control of flatus
- Infectious diarrhea results from
infectious agents invading the intestinal
mucosa. 
 Exudative diarrhea is caused by changes in
mucosal integrity, epithelial loss, or tissue
destruction by radiation or chemotherapy.
Note: Acute and Persistent diarrheas are frequently
caused by viral infections and sometimes drugs such as;
some antibiotics (e.g., erythromycin) and magnesium-
containing antacids  (e.g., magnesium hydroxide). 
Note: Chronic diarrhea may be caused by adverse
effects of chemotherapy, antihypertensive agents,
metabolic and endocrine disorders.
ASSESSMENT AND DIAGNOSTIC FINDINGS
When the cause of the diarrhea is not obvious, the
following diagnostic tests may be performed:
 Complete blood cell count (CBC)
 Serum chemistries
 Urinalysis
 Routine stool examination
 Stool examinations for infectious or parasitic
organisms, bacterial toxins, blood, fat,
electrolytes, and white blood cells.
 Endoscopy or barium enema may assist in
identifying the cause.
FECAL INCONTINENCE
 AKA Bowel Incontinence
 Inability to control bowel movements resulting in
involuntary fecal elimination.
MUST KNOW ------
 Can range in severity; from involuntary leakage
of small of stool while passing gas to total loss of
bowel control
 It is treatable and not life threatening 
debilitating 
 It is a widespread problem, affecting at least 7
out of 100 non hospitalized adults and at least
half of adults who reside in long-term care
facilities
CLINICAL MANIFESTATION
Patients may have—
 occasional urgency and loss of control, or
complete incontinence.
 diarrhea
 constipation.
Passive incontinence occurs without warning; whereas,
patients with urge incontinence have the sensation of
the urge to defecate but cannot reach the toilet in time
Fecal incontinence has many causes and risk factors
and may be a symptom of an underlying condition
RISK FACTORS
  It is less commonly a long-term consequence of
vaginal childbirth injuries than in years past,
most likely because of improved delivery
methods,
 It is more common with advancing age (i.e.,
weakness or loss of anal or rectal muscle tone)
Page 2 of 4 – EXCLUSIVELY FOR BSN-3A
CAUSES
1. Damage to the anal sphincters - Abdominal pain related to defecation
2. Diarrhea - Abdominal pain associated with a change in
3. Inflammatory Bowel Disease  frequency of stool
4. Nerve damage - Abdominal pain associated with a change in
form/appearance of stool.
-
MEDICAL MANAGEMENT

Medical management of fecal incontinence is

directed at correcting the underlying cause.

1. If fecal incontinence is related to diarrhea, the

incontinence may disappear when diarrhea is
successfully treated.
2. If the fecal incontinence is related to the use of
contributory drugs (e.g., laxatives, antacids
containing magnesium), the incontinence may
improve or cease when the drug regimen is
altered.  The Bristol Stool Form Scale (BSFS) is used to evaluate
3. When fecal incontinence is related to other bowel movement (BM) habit
disorders, treatments targeted at correcting the
underlying disorder are initiated. Some patients
benefit from the addition of psyllium as a fiber
supplement.

Note: Administering loperamide 30 minutes prior to

meals can be an effective intervention in some patients.

IRRITABLE BOWEL SYNDROME

 A chronic functional disorder characterized by
recurrent abdominal pain associated with
disordered bowel movements, which may
include diarrhea, constipation, or both, without
an identifiable cause  syndrome (IBS), where IBS-C (constipation), IBS-D
 It is typically diagnosed in adults younger than
45 years of age
[Women are affected more often than men, with twice as
many women diagnosed with IBS in the United States
than men.]
Characteristics of stools as recorded on the BSFS are
then used to determine category of irritable bowel
(diarrhea), IBS-M (mixed), and IBS-U (unclassified)
Note: Recording the quality and quantity of bowel
movements in a stool diary such as the Bristol Stool
Form Scale can be useful in determining the category of
IBS

MEDICAL MANAGEMENT
CLINICAL MANIFESTATION
Symptoms can vary widely, ranging in intensity and
duration from mild and infrequent to severe and The goals of treatment are to relieve abdominal pain and
continuous. control diarrhea or constipation
The main symptom is an alteration in bowel patterns: 
1. constipation (classified as IBS-C),
2. diarrhea (classified as IBS-D)
3. And a combination of both (classified as IBS-M
for “mixed”). 1.Lifestyle modification
- Stress reduction
ASSESSMENT AND DIAGNOSTIC FINDINGS
- Esuring adequate sleep
 
- Instituting an exercise regimen
The Rome IV criteria define IBS as recurrent abdominal
Can result in symptom improvement. 
pain occurring at least once daily during the last 3
months, associated with:

Page 3 of 4 – EXCLUSIVELY FOR BSN-3A

2. The introduction of soluble fiber (e.g., psyllium) to the
diet is important to IBS management.

3.Restriction and then gradual reintroduction of foods

that are possibly irritating may help determine what
types of food are acting as irritants. 

4. Low-FODMAP diets, which restrict intake of the

following types of foods, might improve symptoms for
some patients

Fermentable Oligosaccharides (e.g., wheat, rye,

asparagus, legumes, garlic, onions), 

Disaccharides (lactose-containing foods such as milk,

yogurt), 

Monosaccharides (fructose-containing foods such as

honey, agave nectar, figs, mangoes), 

And Polyols (e.g., blackberries, lychee, and low-calorie

sweeteners) 

BYE.

Page 4 of 4 – EXCLUSIVELY FOR BSN-3A