Learning Materials with Tasks - Bowel Elimination

BOWEL ELIMINATION
Elimination is the process of removing waste products from the body. They are essential to
maintain health. The urinary and gastrointestinal systems together provide for the elimination
of wastes. The urinary system filters and excretes urine from the body, thereby maintaining
fluid, electrolyte, and acid-base balance. Normal bowel function provides for the regular
elimination of solid wastes.
Ø The urinary system is composed of the kidneys, ureters, bladder, and urethra. The kidneys
form the urine, the ureters carry the urine to the bladder, and the bladder acts as a reservoir
for the urine, and the urethra is the passageway for the urine to exit the body.
Ø The gastrointestinal tract is composed of the stomach, small intestine, large intestine, and
the rectum. The stomach digests the food, the small intestine absorbs nutrients, the large
intestine absorbs fluids and the remaining nutrients, and the distal portion of the large intestine
collects and stores the remaining solid wastes until elimination occurs.
Bowel elimination may affect the following aspects:
1. Fluid and electrolyte balance
2. Hydration
3. Nutritional status
4. Skin integrity
5. Comfort
6. Self-concept
Characteristics of Normal and Abnormal Feces

Characteristic
Normal
Abnormal

Possible cause
1. Color
Adult: Brown

Clay or white
Absence of bile

Infant: Yellow

Black or tarry
Drug (iron)
UGIT bleeding
Diet high in red meat

Red
LGIT bleeding
Pale
Malabsorption of fats
Diet high in milk and milk products
Low in meat

Orange, green
Intestinal infection

2. Consistency
Formed, soft, semi-solid, moist
Hard, dry, constipated stools

Dehydration
Decreased intestinal motility
Lack of exercise
Emotional upset
Laxative abuse
Diarrhea
Increased intestinal motility

3. Shape
Cylindrical about 2.5 cm in diameter
Narrow, pencil-shaped, or string-like stools

Obstructive condition of the rectum

4. Amount
Varies with diet about 100-400 g/day

5. Odor
Aromatic, affected by ingested food and person’s own bacterial flora
Pungent

Infection and blood

6. Constituents
Small amount of undigested roughage sloughed dead cells inorganic matter

Pus
Bacterial infection
Mucus
Inflammation
Parasites
Blood
GIT bleeding
Fats
Malabsorption
Foreign body and Accidental ingestion

Factors affecting elimination:

1. Age
Infants initially lack a pattern to their elimination. Control over bladder and bowel movements
can begin as early as 18 months but is typically not mastered until age 4. Nightmare control
usually takes longer to achieve, and boys typically take longer to develop control over
elimination than girls. With increasing age comes loss of muscle tone and therefore bladder
control, this is accompanied by the urge to void more frequently.
2. Diet
Adequate fluid and fiber intake are critical factors to a client’s urinary and bowel health.
Inadequate fluid intake is a primary cause of constipation, as in ingestion of constipating foods
such as certain dairy products. Diarrhea and flatulence (discharge of gas from rectum) are a
direct result of food ingested.
3. Exercise
Exercise enhances muscle tone, which leads to better bladder and sphincter control. Peristalsis
is also aided by activity, thus promoting healthy bowel elimination patterns.
4. Medication
Medications can have an impact on client’s elimination health and pattern.
5. Psychologic factors
People wo are anxious or angry experience increased peristaltic activity with subsequent
diarrhea.
6. Life-style
Early training creates a regular bowel habit of defecating at regular time.
7. Diagnostic procedures
Before certain diagnostic procedures (visualization of the sigmoid colon), the client is not
allowed no food or liquid after midnight preceding the examination.
8. Anesthesia or surgery
General anesthesia causes the normal colonic movements to cease or slow down. Surgery that
involves direct handling of the intestines can cause temporary cessation of intestinal
movements.
9. 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 when the
client is unable to reach the toilet resulting to constipation.
10. Irritants
Spicy foods, bacteria toxins, and poisons can irritate the intestinal tract and produce diarrhea or
large amounts of flatulence.
11. Pain
Pain upon defecation often suppresses the urge to defecate to avoid the pain.
Common alterations in bowel elimination:
1. Constipation- is the infrequent and difficult passage of hardened stool.
Possible causes:
a. Decrease fiber in the diet
b. Decrease intake of fluids
An insufficient fluid intake reduces the amount of fluid in the chime which results in dryer and
harder feces.
c. Decreased mobility
Prolonged bed rest creates a generalized muscle weakness that extends to the abdomen,
diaphragm, and pelvic floor, which are used n defecation.
d. Disease conditions
e. Medications
f. Increase psychologic stress
Strong emotion is thought to cause constipation. Stress can also cause spastic bowel.
g. Irregular defecation traits
When the normal defecation reflexes are inhibited or ignored, these conditioned reflexes tend
to be progressively weakened, ultimately the urge to defecate is lost.
h. Overuse of laxatives
The habitual use of laxatives will eventually require larger or stronger does because they have
progressively reduced effect with continual use.
2. Diarrhea- is the passage of liquified stool that, because of its increased frequency and
consistency represents a change in a person’s bowel habit.
Possible causes:
a. Pathogenic microorganisms
b. Malabsorption/lactose intolerance
c. Drugs- cholinergics
d. Misuse of laxatives and enemas
3. Fecal incontinence- is the involuntary loss of stool of sufficient magnitude to create a
social or hygienic problem.
Possible causes:
a. Dysfunction of the anal sphincter
b. Disorders of the delivery of the stool to the rectum
c. Disorders or rectal storage
d. Anatomic defects
4. Fecal impaction- a mass or collection of hardened, putty like feces in the folds of the
rectum. It results from prolonged retention and accumulation of fecal material.
Causes:
a. Poor defecation habits and constipation
b. Medications- Barium enema
c. Poor fluid intake, insufficient bulk in diet, lack of activity and weakened muscle tone in the
elderly.
5. Flatulence- refers to the air or gas in the GIT
Causes:
a. Action of bacteria on the chyme
b. Swallowed air
c. Gas that diffuse from the blood stream into the intestine
6. Helminths- intestinal infestation with worms.
Managing altered fecal elimination:
a. Understand the relationship between dietary and fluid intake and stool consistency
b. Understand the relationship between altered stool consistency and altered patterns of
bowel elimination, including incontinence.
c. Ensure adequate daily fluid intake (15 ml/lb body weight)
d. Ensure adequate intake of dietary fiber
e. Establish a regular schedule of defecation
f. Heed the urge to defecate
Promoting regular defecation:
1. Privacy
2. Timing
Encourage clients to defecate when the urge is recognized to establish a routine.
3. Nutrition and fluids
For constipated client- increase daily fluid intake, and increase fiber in the diet such as prunes,
bran products and whole-grain cereals and bread, chocolates and alcohol.
For a client with diarrhea- encourage oral intake of fluid and foods, eating small amount of
bland foods because they are more easily digested, avoid highly spicy foods; take cheese, pasta,
eggs, and lean meat.
For client who has flatulence- limit carbonated beverages, use of drinking straw, and chewing
gums, avoid gas-forming foods like cabbage, beans, onions, cauliflower.
4. Exercise
Regular exercise helps client develop a regular defecation pattern and normal feces.
Postsurgical clients are encouraged to ambulate to regain normal intestinal motility. Kegel’s
exercise.
5. Positioning
Select a position that promotes defecation

Promoting regular defecation:

1. Provide privacy
2. Timing
A client should be encouraged to defecate when the urge to defecate is recognized to establish
a regular elimination pattern.
3. Manage with foods and fluids
4. Regular exercise
Artificial elimination
1. Enemas- is a solution introduced into the rectum and sigmoid colon to remove feces
and/or flatus.
2. Rectal catheters
3. Digital removal- involves breaking up the fecal mass using the fingers and removing it in
portions.
4. Suppositories- are conical or oval-shaped drugs inserted into the rectum to soften feces.
5. Bowel diversion ostomies
An ostomy is an opening on the abdominal wall for the elimination of feces or urine. Ex.
Gastrostomy, Jejunostomy, Ileostomy, Colostomy.