Bowel Elimination

Question 1

Gastrointestinal Overview

Answer 1

• Gastrointestinal tract is a series of hollow, mucous-membrane liquid mucosal organs
• Purpose of these organs are to absorb fluid and nutrients, prepare for food absorption and use by the body cells and provide for temporary storage of feces
• The volume of fluids absorbed by the GI tract is high, making fluid balance a key function of the GI system
• In addition to ingested foods and fluids, GI tract receives secretions from organs such as the gallbladder and the pancreas
• Any condition that seriously impairs normal absorption or secretion of GI fluids could cause fluid imbalance

Question 2

GI tract consists of

Answer 2

Mouth, 
Oesophagus
Stomach 
Small intestine 
Large intestine

Question 3

Factors influencing bowel elimination

Answer 3

Age
Diet
Fluid intake
Physical activity 
Personal habits; position during defecation 
Pain 
Pregnancy 
Surgery and anaesthesia 
Infection 
Medications 
Diagnostic tests

Question 4

Common Bowel Elimination Problems: Constipation

Answer 4

Abnormal frequency of defecation and abnormal hardening of stools
Impaction→ Accumulated mass of dry feces that cannot be expelled from the rectum

Question 5

Common Bowel Elimination Problems: Haemorrhoids

Answer 5

Dilated portions of veins in the anal canal causing itching and pain and bright red bleeding upon defecation

Question 6

Common Bowel Elimination Problems: Flatulence

Answer 6

Expulsion of gas from the rectum

Question 7

Common Bowel Elimination Problems: Incontinence

Answer 7

Involuntary elimination of feces

Question 8

Common Bowel Elimination Problems: Diarrhoea

Answer 8

Increased frequency of bowel movements (more than 3 times a day) as well as liquid consistency and increased amount, accompanied by urgency, discomfort and possibly incontinence

Question 9

Common Bowel Elimination Problems: Impaction

Answer 9

Accumulated mass of dry feces that cannot be expelled from the rectum

Question 10

BULK FORMING LAXATIVE

Answer 10

Can relieve constipation by absorbing water and swelling, thereby forming a bulky mass in the bowel which stimulates peristalsis

Question 11

STOOL SOFTENER OR EMOLLIENT

Answer 11

Acting as a detergent which breaks the surface tension of the stool, allowing intestinal fluid to be absorbed into the stool, thereby softening it and making it easier to pass

Question 12

OSMOTIC

Answer 12

Forming a concentrated solution and acting a an osmotic agent in the bowel which prevents absorption of fluid from the bowel, resulting in a rapid semi fluid evacuation of feces

Question 13

STIMULANT

Answer 13

Irritating intestinal mucosa and causing an accumulation of fluid and electrolytes in the bowel, thereby stimulating bowel motility

Question 14

Bowel: Health Promotion

Answer 14

• Bowel elimination is an important aspect of a person’s health and wellbeing
• Patients may feel embarrassed or self conscious
• Promotion of normal defecation
• Promotion of regular exercise
• Promotion of comfort
• Maintenance of skin integrity
• Promotion of self concept

Question 15

Enema

Answer 15

• Laxatives can be administered orally, by suppository or as an enema
• A suppository is a solid bullet shaped mass inserted into the rectum that melts easily to soften the feces and stimulates the rectal mucosa to trigger a bowel action
• An enema is a liquid preparation given rectally to cause bowel motion (suppositories and enemas can be given for other reasons such as administration of treatments or medications

Question 16

Laxatives to reduce acute constipation

Answer 16

• Laxatives are classified according to their mode of action
• Relieve constipation absorbing water and swelling, thereby forming a bulky mass in the bowel which stimulates peristalsis- Bulk forming laxative (psyllium)
• Acting as a detergent which breaks the surface tension of the stool, allowing interstitial fluid to be absorbed into the stool, thereby softening it and making it easier to pass- Stool softener or emollient- lactulose
• Forming a concentrated solution and acting as an osmotic agent in the bowel which prevents absorption of fluid from the bowel, resulting in rapid semi fluid evacuation of feces- osmotic (movicol sachets)
• Irritating intestinal mucosa and causing an accumulation of fluid and electrolytes in the bowel, thereby stimulating bowel motility- stimulant (coloxyl, senokot)

Question 17

Physical Assessment of the Abdomen: Bowels

Answer 17

Inspection
Observe contour, any masses, scars or distension

Auscultation
Listen for bowel sounds in all quadrants
Note frequency and character, audible clicks and flatus
Describe bowel sounds as audible, hyperactive, hypoactive or inaudible

Percussion
Expect resonant sound or tympany
Areas of increased dullness may be caused by a mass or tumor

Palpation
Note any muscular resistance, tenderness, enlargement of organs, masses