Chapter 30

Bowel Elimination

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 Bowel Elimination
 Bowel elimination is a basic physical need.
 You assist clients and residents in meeting
their elimination needs.
 Client may have difficulty with bowel
elimination.
 May experience discomfort, frustration, and this
may be humiliating for the client.
 Practice sensitivity and offer emotional
support.
 Follow Standard practices.
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 Normal Bowel Movements
(1 of 3)
 Time and frequency of bowel movements varies.
 Most people go every day, or every 2 to 3 days.
 Stools are normally brown; they are soft, formed,
moist, and shaped like the rectum.
 Stools have a normal odour caused by bacterial
action in the intestines.
 Your observations are used for the care-planning
process:
 Carefully observe stools before disposing of them.
 Ask the nurse to observe abnormal stools.

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Normal Bowel Movements
(2 of 3)

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Slide 4
 Normal Bowel Movements
(3 of 3)
 Observations:
 Observe and report the following to the nurse. If you
are allowed to chart, also record the following:
• Colour
• Amount
• Consistency
• Odour
• Shape and size
• Frequency of defecation
• Complaints of pain or discomfort

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 Factors Affecting Bowel
Movement
 Privacy
 Personal habits
 Diet
 Fluids
 Activity
 Medications
 Aging
 Disability

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Slide 6
 Common Challenges Affecting
Bowel Movement (1 of 6)
 Constipation is the passage of a hard, dry
stool with less frequency than normal.
 Constipation occurs when feces move slowly
through the bowel.
 Stool is hard, dry, and difficult to pass.
 Client may complain of abdominal discomfort.
 Constipation is prevented or relieved by:
• Dietary changes, fluids, and activity
• Drugs and enemas
 See textbook box: Think about Safety: Preventing
Constipation
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 Common Challenges Affecting
Bowel Movement (2 of 6)
 Fecal impaction is the prolonged retention and
build-up of feces in the rectum.
 Fecal impaction results if constipation is not
relieved.
 A digital (finger) exam is done to check for an
impaction by a physician or a nurse.
 Sometimes the fecal mass is removed with a gloved
finger.
• This is called digital removal of an impaction.
 Checking for and removing impactions is very
dangerous.
• This is never done by a support worker.
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 Common Challenges Affecting
Bowel Movement (3 of 6)
 Diarrhea is the frequent passage of liquid
stools.
 Feces move through the intestines rapidly.
 Diet and drugs are ordered to reduce peristalsis.
 You need to:
• Assist with elimination needs promptly
• Dispose of stools promptly
• Give good skin care
 Fluid lost through diarrhea is replaced.
• Otherwise, dehydration occurs.
 Always follow Standard Practices when you come
in contact with stools.
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 Common Challenges Affecting
Bowel Movement (4 of 6)
 Fecal incontinence (anal incontinence) is the
inability to control the passage of feces and
gas through the anus.
 Fecal incontinence affects the client emotionally.
 Can occur because of delayed requests for help to
use bathroom, commode, or bedpan.
 A common problem support workers encounter is
resistance to care, making washing and changing
the client difficult.
 Follow the client’s care plan.

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 Common Challenges Affecting
Bowel Movement (5 of 6)
 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 is not expelled, the intestines distend.
• Common causes of flatulence:
 Bacterial action in intestines
 Constipation
 Bowel and abdominal surgeries
 Medications that decrease peristalsis

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 Common Challenges Affecting
Bowel Movement (6 of 6)
 The following help produce flatus:
 Exercise
 Walking
 Moving in bed
 The left side-lying position
 Doctors may order enemas, rectal tubes, or
drugs to relieve flatulence.

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 Bowel Training
 Bowel training has two goals:
 To gain control of bowel movements
 To develop a regular pattern of elimination
 Factors that promote elimination are part of
the care plan and the bowel training program.

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 Enemas (1 of 3)
 An enema is the introduction of fluid into the
rectum and lower colon.
 Doctors order enemas for the following reasons:
• To remove feces
• To relieve constipation, fecal impaction, or flatulence
• To clean the bowel of feces before certain surgeries and
diagnostic procedures
 Most enemas are commercial enemas; they are pre-
packaged and ready to administer.
 Saline enema: must be prepared prior to
administration.

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 Enemas (2 of 3)
 Delegation to Perform an Enema
 Questions you need to answer before you do this
task:
• Do your provincial or territorial laws and employer’s
policies allow you to do this?
• Do you have the necessary education and training?
• Have you reviewed the procedure with a nurse?
• Is a nurse available to answer questions and supervise
you?

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 Enemas (3 of 3)
 Commercial Enemas
 Commercial enemas stimulate and distend the
rectum and cause defecation.
 The solution is usually administered at room
temperature.
 To give enema, squeeze and roll up the plastic
bottle from the bottom; do NOT release pressure,
as that would cause the solution to be drawn back
into the bottle,
 Encourage client to hold the solution for 5 to 10
minutes before expelling.
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 Rectal Tubes
 A rectal tube is a flexible tube that is inserted
into rectum to relieve flatulence and intestinal
distension.
 It is usually inserted about 10 cm into adult
rectum and left in place for 20 to 30 minutes.
 Can be re-inserted every 2 to 3 hours.
 Procedure is performed by a nurse.

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 The Client With an Ostomy
(1 of 3)
 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.
 Colostomy
 A colostomy is a surgically created opening between the
colon and 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.
• After healing, surgery is done to reconnect the bowel.
 The colostomy site depends on the site of disease or injury.

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 The Client With an Ostomy
(2 of 3)
 Ileostomy
 An ileostomy is a surgically created opening
between the ileum (ileo) and the abdominal wall
(stomy).
 Liquid stools drain constantly from an ileostomy.
 A portion or entire section of the colon is removed.
 Ileostomy pouch must fit well to avoid feces
touching and irritating the skin.
 Good skin care is essential.

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 The Client With an Ostomy
(3 of 3)
 Ostomy pouches
 The pouch has an adhesive backing that is applied
to the skin.
 Sometimes pouches are secured to ostomy belts.
 Many pouches have a drain at the bottom that
closes with a clip, clamp, or wire closure.
• The drain is opened to empty the pouch.
 The pouch is emptied when stools are present.
 The pouch is changed every 3 to 7 days, and
when it leaks.
 Do not flush pouches down the toilet.
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 Stool Specimens
 Stools are checked and studied for blood, fat,
microbes, worms, and other abnormal
contents.
 The stool specimen must not be
contaminated with urine.
 Some tests require a warm stool.

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 Testing Stools for Blood
 Stools may contain blood for many reasons.
 Often, blood is seen if there is bleeding low in the
bowels.
 Stools are black and tarry (melena) if there is
bleeding in the stomach or upper gastro-intestinal
tract.
 Sometimes bleeding occurs in very small amounts
and cannot be seen (occult blood).
• When using occult blood test kits, follow the
manufacturer’s instructions.

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