ESTEVES, CHRISTIAN C.

BSN II-4
BOWEL ELIMINATION
Feces or Stool – the excreted waste product from the digestion from the body.
Large Intestine – it extends from the ileocecal valve to the anus
- it has a size of 125 to 150 cm. Long in a normal adult
- it has seven parts: cecum, ascending, transverse, descending, sigmoid, rectum, and
Anus
- it is a muscular tube lined with mucous membrane
- the muscle fibers are both circular and longitudinal
- HAUSTRA – formed because of longitudinal muscles are shirter than the colon
- The main functions are: absorption of water and nutrients, mucal protection of
intestinal walls, and fecal elimination
- INGESTION – the act of taking food
- CHYME – the waste products leaving the stomach through the ileocecal valve
- it also transport along its lumen the products of digestion. The products are flatus and
Feces
- FLATUS – is largely air and the by-products of the digestion and carbohydrates
- There are 3 movements of the large intestine: Haustral churning, colon peristalsis, and
mass peristalsis
- HAUSTRAL CHURNING – movement of chime back and forth within the haustra, and
also aids in the absorption of water and moves the contents to the next haustra.
- PERISTALSIS – wavelike movement produced by circular and longitudinal muscle fibers
of the intestinal walls, it propels the intestinal contents forward
- COLON PERISTALSIS – very sluggisg and is thought to move the chime very little along
The large intestines
- MASS PERISTALSIS – wave of powerful muscular contraction that moves over large
Areas of the colon. Occurs after eating, stimulated by presence of food in the stomach
And the small intestines

Rectum - usually 10 to 15 cms. long

- folds that extend vertically
- each folds has a vein and an artery
- this fold help retain feces in the rectum

Anal Canal - usually 2.5 to 5 cms. Long

- bounded by internal and external sphincter
- the internal sphincter has an involuntary control while the external sphincter has
A voluntary control

Defecation - expulsion of feces from the anus to the rectum

- it is also called bowel movement

Process of Defecation:
Peristaltic waves -> sigmoid colon-> rectum-> internal anal sphincter relax-> anal canal -> external anal
sphincter relax -> expulsion of feces

- assisted by the contraction of the abdominal muscles and diaphragm

 - facilitated by: thigh flexion – increased pressure in the abdomen
Sitting position – increased downward pressure on the rectum
FECES - composed of 75% water, 25% solid
- normally brown, due to the presence of stercobilin and urobilin
- because of bacteria: Escherichia coli, and staphylococci
- has normally 7 to 10 liters of gas for 24 hours has carbon dioxide, methane, hydrogen,
oxygen, and nitrogen
- normal characteristics:
- color – yellow or golden brown
- odor – aromatic
- consistency – soft / formed
- shape – cylindrical
- frequency – 1-2/ day to 2-3 days
- amount – 150 – 300 g/day
- alterations:
- alcoholic – gray, pale, clay-colored stool
- hematochezia – stool with bright red blood
- melena – black tarry stool
- stetorrhea – bulky, foul, smelling stools, greasy

FECAL ELIMINATION PROBLEMS

CONSTIPATION - fewer than 3 bowel movements per week
- the passage of dry, hard stool, or no stool at all
- occurs when movement of feces through the large intestine is slow, thus allowing time
for additional time for additional time for additional reabsorption of fluid from the large
intestine
- FACTORS : insufficient fiber intake, insufficient fluid intake, insufficient activity or
immobility, irregular defecation habits, change in daily routine, lack of privacy, chronic
use of laxatives, emotional disturbances, medication such as opiates
- CHARACTERISTICS: decreased frequency of defecation, hard, dry, formed stool,
straining at stool, painful defecation, reports of rectal fullness, abdominal pain, use of
laxatives, decreased appetite, and headache

FECAL IMPACTION- mass or collection of hardened feces in the folds of the rectum
- results from prolonged retention and accumulation of fecal materials
- passage of diarrhea, and no normal stool
- sometimes, it accumulate and extend well up into the sigmoid colon and beyond
- can be assessed by digital examination
- S/ Sx: fecal seepage, constipation, frequent but non productive desire to defecate,
rectal pain, anorexia, distended abdomen, nausea and vomiting
- causes: poor defecation habits, constipation, barium used in radiologic exam
- Management: give oil retention enema, cleansing enema 2 to 4 hours later, daily
additional cleansing enema, suppositories or stool softener, if these fail, manual
removal is often necessary.

DIARRHEA - passage of liquid feces and an increase frequency of defecation

- results from rapid movement of fecal contents through the large intestine, thus reduce
time to reabsorb water and electrolytes.
 - management: replace fluid and electrolytes, avoid hot or cold fluids, antidiarrheal as
Ordered
BOWEL INCONTINENCE – loss of voluntary ability to control fecal and gaseous discharge through the
anal sphincter
- Partial incontinence- inability to control flatus or to prevent minor soiling
- Major incontinence- inability to control feces of normal consistency
- Associated with impaired functioning of the anal sphincter or its nerve supply

FLATULENCE - Presence of excessive flatus in the intestines and leads to stretching and inflation of
the intestines
- Primary sources of flatus
o Action of bacteria on the chyme in large intestine
o Swallowed air
o Gas that diffuses between the bloodstream and the intestine
- Causes – foods, abdominal surgery, and narcotics
- If gas is propelled by increased colon activity before it can be absorbed, it may be
expelled through the anus.
-If excessive gas cannot be expelled through the anus, it may be necessary to insert a
rectal tube to remove it
- Management: avoid gas forming foods (beans, cabbage, brocolli, spinach, egg, chees,
milk, yogurt, alcohols, nuts), Warm fluids to drink, Early ambulation, Activity and
exercise, Limit carbonated beverages, Rectal tube insertion for 30 minutes

HEMORRHOID - occurs when there is a repeated pressure in the veins of the rectum

QUIZ:
1. All are parts of the large intestine except
a. Cecum c. Sigmoid colon
b. Vermiform appendix d. anus
2. All are characteristics of constipation except:
a. Abdominal pain c. Use of laxatives
b. Decreased frequency of defecation d. Soft, wet, and unpainful defecation
3. This is the recommended fiber intake for women:
a. Over 20 grams (BONUS) c. Less than 1 gram
b. Less than 3 grams d. Fiber should only be taken by men
4. All of which are normal characteristics of feces except:
a. The color is yellow or golden brown c. Has an amount of 400 – 500 g / day
b. Cylindrical in shape d. Has an amount of 150 – 300 g/ day
5. TRUE or FALSE. Laxatives are used to inhibit bowel movement.
6. All of which may do as a management to flatulence except:
a. Warm fluids to drink c. Early ambulation
b. Warm fluids should be avoided d. Avoid gas forming foods
7. What does sitting position do in the process of defecation:
 a. Increases pressure in abdomen c. Increases pressure in
diaphragm
b. Increases upward pressure on the rectum d. Increases downward pressure in
the rectum
8. All of which are NOT factors for constipation EXCEPT:
a. Insufficient fiber intake c. Regular defecation routine
b. Sufficient fluid intake d. Excessive intake of fibers
9. The act of taking food? Ingestion
10. Name atleast 1 common bowel elimination problem.