BOWEL / FECAL ELIMINATION and Common Problems

1. Constipation
< 3 x bowel movements / week
the passage of small, hard, and dry stools or
absence of stools related to:
o inadequate fluid intake
o inadequate fiber intake
o irregular defecation or bowel habits
o immobility
o lack of privacy

Nursing Interventions for Constipation
Increase fluid between 1,500 2,000 ml or 2-3L
Increase fiber intake or roughage to provide bulk in
stool (fresh or cooked vegetables with skin, whole
wheat grains and cereals)
Establish regular bowel habits or pattern
Do not avoid the urge to defection
Regular activity and exercise to promote muscle
tone and increase peristalsis
Minimize stress (SNS stimulation w/c decreases
peristalsis)
Assume a sitting or squatting position (gravity
assists elimination and easier to contract
abdominal and pelvic muscles)
Administer laxatives as ordered. To stimulate
peristalsis. DO NOT ABUSE can cause rebound
constipation!

Types of Laxatives
1. Chemical Irritants
o irritates colon to increase peristalsis
o Dulcolax (Bisacodyl), Castor Oil, Senakot
(Senna)
2. Stool Lubricants
o Lubricates stool to promote defecation
o Mineral Oil
3. Stool Softeners
o Softens stool to promote defecation
o Colace (Na Ducconate)
4. Bulk Formers
o increases bulk causes distension and
pressure to promote defecation
o METAMUCIL (Psyllium Hydrophilic Mucilloid)
5. Osmotic Agents
o Attract fluids to the stool
o Milk of Magnesia (Magnesium Hydroxide)
o Duphalac (Lactulose)

2. Fecal Impaction
Mass or collection of hardened feces which
are lodged or stuck in the rectum and person
is unable to voluntarily evacuate stool r/t
o prolonged retention and accumulation
of feces
o poor bowel habits and constipation
Assessment
o Most common manifestation: LIQUID
FECAL SEEPAGE
o Absence of BM for 3-5days
o hardened fecal mass upon palpation in
digital rectal examination
o no desire to defecate, rectal pain
o subjective: abdominal fullness, bloating,
dstention
o nausea and vomiting

Nursing Intervention for Fecal Impaction
Oil retention enema as ordered
Cleaning enema 2 4 hours after oil retention and
daily additional cleaning enemas as ordered
Suppository and stool softeners
Manual extraction or fecal disimpaction if above
mentioned failed

3. Diarrhea
>3x BM daily; frequent passage of
liquid/watery stools related to:
o rapid passage of chyme which reduces
time of colon to reabsorb water and
electrolytes
o increase peristalsis and GIT motility
treated as INFECTIOUS (CONTACT
PRECAUTION) client is placed in a private
room
Potassium electrolytes usually lost in stool

Nursing Interventions for Diarrhea
Replace fluid &electrolyte losses (ex. IV as ordered)
Promote rest to decrease peristalsis
DIET:
o Small amounts of bland food
o Low fiber diet
o BRAT DIET (banana, rice am, apple, toast)
o Potassium rich foods (banana, cantaloupe,
Gatorade)
o AVOID too hot and cold foods and fluids
(stimulants)
Antidiarrheal meds as ordered
o Delumcents coats irritated bowel
o Absorbents absorbs gas and toxic subs.
o Astringents

Note: do not administer antidiarrheal meds at the start
of diarrhea. It is the bodys protective mechanism to rid
of bacteria and toxins.

2. Flatulence
Presence of excess gas or flatus leading to
stretching and inflation of intestines
Causes
o constipation
o abdominal surgery bowel relaxation
o excessive intake of gas forming foods
o excessive intake of carbonated drinks
o swallowed air
o improper use of drinking straw
o gum chewing, candy sucking, smoking

Nursing Interventions
Avoid gas forming foods
o cabbage, camote, cauliflower, onions,
mayonnaise, egg, chocolate drinks, rootcrops,
legumes
Avoid carbonated drinks, limit use of drinking
straws, chewing gum, smoking
Provide warm fluids to drink (increases peristalsis)
Early ambulation of post op clients
Rectal tube insertion
o position in sims left lateral or left side lying
with right knee flexed
o insert lubricated tube 3-4 inches gently in
rotating motion
o retain tube for 30 mins
Carminative enema to expel flatus as ordered
Administer Cholinergics as ordered

4. Fecal Incontinence
involuntary elimination of feces
loss of voluntary ability to control anal
sphincter leading to excessive fecal and
gaseous discharge d/t impaired function of
anal sphincter or nerve supply
o cerebral cortex injury (cannot perceive
distended rectum)
o disoriented and confused clients
o sacral spinal cord injury
surgical procedure may correct problem