Bowl Elimination

By
Rubina Yasmin
Nursing Instructor
College Of Nursing & Midwifery
FJMU. Lahore
Learning outcomes
After completing this chapter, students will be able to:
1. Describe the physiology of defecation.
2. Identify factors that influence fecal elimination and patterns
of defecation.
3. Identify common causes and effects of selected fecal
elimination problems and describe methods used to assess
fecal elimination.
4. Identify examples of nursing diagnoses, outcomes, and
Interventions for clients with elimination problems.
5. Identify measures that maintain normal fecal elimination
patterns.
Introduction
• Elimination of waste products
of digestion from the body is essential
to health.

• The excreted waste products are

referred to as feces or stool.
Points to remember
• Large intestine (colon)
include the cecum; ascending,
transverse, and ascending colon;
sigmoid colon; rectum and anus.
• Product of digestion
flatus ( largely air, by product of digestion of CHO) and
feces
• Rectum
contains folds that extend
vertically containing a vain and
an artery
folds helps retain feces within the rectum
Elimination pattern

• Elimination patterns describe the regulation, control, and

removal of by-products and wastes in the body. The term
usually refers to the movement of feces or urine from the
body.
Main focus of elimination

• Bowel elimination.
• Urinary elimination.
Digestive system
Peristalsis

Is wavelike movement produced

by the circular and longitudinal
muscle fibers of the intestinal
walls; it propels the intestinal
contents forward.
Peristaltic movements
Defecation

• Defecation is the expulsion of feces from the anus and

rectum. It is also called a bowel movement.

• Feces
Made up of 75% water and 25% solid
normally brown in color
Escherichia coli or staphylococci
Physiology of defecation
• Peristaltic waves move the feces into the sigmoid colon
and the rectum
• Sensory nerves in rectum are stimulated
• Individual becomes aware of need to defecate
• Feces move into the anal canal when the internal and
external sphincter relax
Cont….

• External anal sphincter is relaxed voluntarily if

timing is appropriate
• Expulsion of the feces assisted by contraction of the
abdominal muscles and the diaphragm
• Moves the feces through the anal canal and expelled
through anus
• Facilitated by thigh flexion and a sitting position
Cont.
2. Diet:
Sufficient bulk (cellulose, fiber)
Insoluble fiber promotes the
movement of material through
the digestive system and increases stool bulk
Soluble helps lower blood cholesterol and glucose levels.
3. Fluid Intake and Output:
• Daily fluid intake of 2,000 to 3,000 ml.
4. Activity:
• Activity stimulates peristalsis.
Cont.

5. Psychological Factors:
Emotional instability increases
peristaltic activity and subsequent
nausea or diarrhea.
6. Defecation Habits:
Ignores urge to defecate
Weakened conditioned reflexes
Habitually ignored
Cont.

7. Diagnostic Procedures
The client is restricted in taking meals
Prior thus normal defecation is placed
in halt until eating resumes.
8. Medications:
Side effects of drugs can interfere with
normal elimination.
9. Pathologic Conditions:
• Spinal cord injuries and head injuries can decrease the
sensory stimulation for defecation.
Cont.

10. Pain:
Clients who experience discomfort
when defecating (e.g., following hemorrhoid surgery)
 Problems of elimination
• Constipation
• Diarrhea
• Bowel incontinence
• Flatulence
 Constipation

It may be defined as fewer than

3 bowel movements per week.
This infers the passage of dry,
hard stool or the passage of no
stool.
Characteristics of constipation

• Decreased frequency of defecation.

• Hard , dry stool.
• Painful defecation.
• Abdominal pain, cramps, or distension.
• Anorexia , nausea
• Headache
• Reports of rectal fullness, or pressure, or incomplete bowel
evacuation.
Causes and factors

• Insufficient fiber intake

• Insufficient fluid intake
• Insufficient activity
• Irregular defecation habits
• Chronic use of laxative or enemas
• Pelvic floor dysfunction or muscle damage
• Poor motility
Causes….

• Neurological conditions e.g. stroke , paralysis

• Emotional disturbance
• Medications e.g. opioids, iron supplements, etc
Fecal impaction

Mass or collection of hardened feces in folds of rectum that

cannot be expelled or Fecal impaction is a
severe bowel condition in which a hard, dry mass
of stool becomes stuck in the colon or rectum. This immobile
mass will block the passage and cause a buildup of waste,
which a person will be unable to pass. Causes usually:
• Poor defecation habits
• Results from unrelieved constipation Treatment
• Removed manually
• Must have physician order
Fecal impaction
 DIARRHEA

• Passage of liquid feces and increased frequency of defecation

Characteristics:
•Spasmodic cramps,
•increased bowel sounds
•Fatigue,
•weakness,
•Malaise and emaciation
• A symptom of disorders affecting digestion, absorption, and
secretion of the GI tract
Causes

• Stress,
• Medications,( laxatives, cathartics)
• Antibiotics
• Allergies,
• Intolerance of food or fluids,
• Disease of colon e.g. malabsorption syndrome
FECAL INCONTINENCE

• Loss of voluntary ability to control fecal and gaseous

discharges
• Generally associated with: Impaired functioning of anal
sphincter or nerve supply
• Neuromuscular diseases
• Spinal trauma
• Tumor of external anal sphincter muscle.
•Nursing Considerations
• Incontinence can harm a clients body image
• Incontinence predisposes the skin to breakdown
FLATUENCE

• It is the presence of excessive flatus in the intestines leads to

stretching and inflation of intestines.
• Flatulence can occur from variety of causes
• Foods
• Abdominal surgery
• Narcotics
NANDA Nursing diagnosis for fecal
elimination problems
•Bowel Incontinence
•Constipation
•Risk for Constipation
•Perceived Constipation
•Diarrhea
Related nursing diagnosis

Risk for Deficient Fluid Volume

Risk for Impaired Skin Integrity
Low Self-esteem
Disturbed Body Image
Deficient Knowledge
Bowel Training
Ostomy Management
Anxiety
Outcomes

• Maintain or restore normal bowel elimination pattern

• Maintain or regain normal stool consistency
• Prevent associated risks such as fluid and electrolyte
imbalance, skin breakdown, abdominal distention and pain
Nursing considerations

•Promoting regular defecations by the provision of privacy

Timing
Nutrition and fluid
Exercise
Positioning
•Teaching about medications
•Decreasing flatulence
•Administering enemas
•Applying a fecal incontinence pouch
•Ostomy management
Ostomy
• An ostomy is an opening for the gastrointestinal, urinary, or
respiratory tract onto the skin.
• Gastrostomy: (is an opening through the abdominal wall
into the stomach)
• Jejunostomy: (opens through the abdominal wall into the
jejunum)
• Ileostomy: (opens into the ileum (small bowel)
• Colostomy: opens into the colon (large bowel).
Ostomy cont.

• Gastrostomies and jejunostomies are generally performed to

provide an alternate feeding route.
• The purpose of bowel ostomies is to divert and drain fecal
material
• Stoma:
• The opening created in the abdominal wall by the ostomy.
Ostomies
• Ostomies can be temporary or permanent.
• Temporary colostomies performed for traumatic injury or
inflammatory conditions of the bowel. They allow the
diseased portions of the bowel to rest and heal.
• Permanent colostomies are performed to provide means of
elimination when the rectum or anus is nonfunctional as a
result of a birth defect or a disease such as cancer of bowel
Ostomies
References
• Kozier& Erb‘s. Fundamentals of Nursing: concepts,
process and practice, 11th Edition.
• Potter & Perry's, Fundamentals of Nursing,2nd Edition