Fecal Elimination

Problems
 CONSTIPATION
oFewer than three bowel movements per week
oThe passage of dry, hard stool, or no stool at
all
o Occurs when movement of feces through the
large intestine is slow, thus allowing time for
additional reabsorption of fluid from the large
intestine
 Factors
o Insufficient fiber intake
o Insufficient fluid intake
o Insufficient activity or immobility
o Irregular defecation habits
o Change in daily routine
o Lack of privacy
o Chronic use of laxatives or enemas
o Emotional disturbances
o Medication such as opiates or iron salts
Characteristics of Constipation
oDecreased frequency of defecation
oHard, dry, formed stool, straining at stool,
painful defecation
o Reports of rectal fullness
o Abdominal pain
o Use of laxatives
o Decreased appetite
o Headache
 Fecal Impaction
o Mass or collection of hardened feces in the
folds of the rectum
o Results from prolonged retention and
accumulation of fecal materials
o Passage of liquid fecal seepage and no normal
stool
o Sometimes, it accumulate and extend well up
into the sigmoid colon and beyond
o Can be assessed by digital examination
 Symptoms
oFecal seepage
oConstipation
oFrequent but nonproductive desire to defecate
oRectal pain
oAnorexia
oAbdomen becomes distended
oNausea and vomiting
 Causes
oPoor defecation habits
oConstipation
oBarium used in radiologic exam
 Management
oGive oil retention enema
oA cleansing enema 2 to 4 hours later
oDaily additional cleansing enema,
suppositories or stool softener
o If these fail, manual removal is often
necessary
 DIARRHEA
oPassage o f liquid feces and an increase
frequency of defecation
o Results from rapid movement of fecal contents
through the large intestine, thus reduce time to
reabsorb water and electrolytes
Causes Physiologic effect

Physiologic stress Increased intestinal motility

and mucus secretion

Medications
antibiotics infection of mucosa
iron Irritation of intestinal mucosa
cathartics Irritation of intestinal mucosa

Allergy to food, fluid, drugs Incomplete digestion of fluids

Intolerance of food and fluid Increase intestinal motility

Disease of the colon Reduce absorption of fluid

 Bowel Incontinence
oLoss of voluntary ability to control fecal and
gaseous discharge through the anal sphincter
o Partial incontinence- inability to control flatus
or to prevent minor soiling
o Major incontinence- inability to control feces
of normal consistency
o Associated with impaired functioning of the
anal sphincter or its nerve supply
 FLATULENCE
oPresence of excessive flatus in the intestines
and leads to stretching and inflation of the
intestines
o 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
oFoods
oAbdominal surgery
oNarcotics
oIf gas is propelled by increased colon activity
before it can be absorbed, it may be expelled
through the anus.
o If excessive gas cannot be expelled through
the anus, it may be necessary to insert a rectal
tube to remove it