Bowel Elimination

Question 1

When peristaltic waves move the feces into the sigmoid colon and the rectum, the sensory nerves in the rectum are stimulated and the individual becomes aware of the need to defecate.

Answer 1

Defecation

Question 2

Normal defecation is facilitated by:
a. Thigh flexion, which increases the pressure within the abdomen
b. A sitting position, which increases the downward pressure on the rectum.

Question 3

Normal feces are made of about 75% water and 25% solid materials. They are soft but formed.

Normal feces require a normal fluid intake; feces that contain less water may be hard and difficult to expel.

Question 4

Factors That Affect Defecation

1. Developmental
2. Diet and Fluid Intake
3. Activity
4. Psychological Factors
5. Medications
6. Diagnostic Procedures
7. Anesthesia and Surgery
8. Pathologic Conditions
9. Pain

Question 5

Factors That Affect Defecation

Developmental Factors

NEWBORNS AND INFANTS: Pass frequent, soft, liquid stools due to immature intestines. Breastfed infants have LOGHT YELLOW to GOLDEN FECES, while formula-fed infants have darker yellow or tan, more formed stool. MECONIUM, the first stool, is black, tarry, odorless, and sticky, passed normally within 24 hours of birth.

TODDLERS: Bowel control begins between 1 1/2 and 2 years, with daytime control usually achieved by 2 1/2 years after toilet training.

SCHOOL-AGE CHILDREN AND ADOLESCENTS : Have adult-like bowel habits with varying frequency, quantity, and consistency. Some may delay defecation due to activities like play.

OLDER ADULTS: Constipation is common due to reduced activity, inadequate fluid and fiber intake, and muscle weakness. Preventing constipation involves adequate roughage (fiber), exercise, and 6-8 GLASSES OF FLUID DAILY. Any change in bowel habits over several weeks, especially with weight loss, pain, or fever, should be medically evaluated.

Question 6

Diet and Fluid Intake Affecting Defecation

FIBER (BULK): Sufficient dietary fiber (cellulose) is needed for fecal volume. Inadequate fiber increases risks for obesity, type 2 diabetes, coronary artery disease, and colon cancer. Bland and low-fiber diets lack bulk, reducing residue needed to stimulate defecation. Low-residue foods (rice, eggs, lean meats) move slowly through the intestines.

FLUID INTAKE: Increasing fluid intake with foods speeds their movement. Healthy fecal elimination generally requires 2,000 to 3,000 mL of fluid daily.

EATING HABITS: Irregular eating can disrupt regular defecation. Consistent meal times usually lead to regular physiological responses and peristaltic activity.

Specific Foods:
- Spicy foods and excessive sugar can cause diarrhea and flatus (gas).
- Gas-producing foods: Cabbage, onions, cauliflower, bananas, apples.
- Laxative-producing foods: Bran, prunes, figs, chocolate, alcohol.
- Constipation-producing foods: Cheese, pasta, eggs, lean meat.

Question 7

_____ are medications that stimulate bowel activity and so assist fecal elimination.

Answer 7

Laxatives

Question 8

Fecal Elimination Problems

_____ fewer than three bowel movements per week. This infers the passage of dry, hard stool or the passage of no stool.

_____ a mass or collection of hardened feces in the folds of the rectum. Impaction results from prolonged retention and accumulation of fecal material.

_____ the passage of liquid feces and an increased frequency of defecation.

_____ also called fecal incontinence, refers to the loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter.

_____ the presence of excessive flatus in the intestines and leads to stretching and inflation of the intestines (intestinal distention).

Answer 8

1. Constipation
2. Fecal impaction
3. Diarrhea
4. Bowel incontinence
5. Flatulence

Question 9

• Fecal elimination problems may affect many other areas of human functioning and as a consequence may be the etiology of other NANDA diagnoses. Examples follow:
• Risk for Deficient Fluid Volume and/or Risk for Electrolyte Imbalance related to
  a. Prolonged diarrhea
  b. Abnormal fluid loss through ostomy
• Risk for Impaired Skin Integrity related to
  a. Prolonged diarrhea
  b. Bowel incontinence
  c. Bowel diversion ostomy
• Situational Low Self-Esteem related to
  a. Ostomy
  b. Fecal incontinence
  c. Need for assistance with toileting
• Disturbed Body Image related to
  a. Ostomy
  b. Bowel incontinence
• Deficient Knowledge (Bowel Training, Ostomy Management) related to lack of previous experience
• Anxiety related to
  a. Lack of control of fecal elimination secondary to ostomy
  b. Response of others to ostomy.