• Define the key terms and key abbreviations listed in this chapter. • Describe normal defecation and the observations to report. • Identify the factors affecting bowel elimination. • Explain how to promote comfort and safety during defecation. • Describe the common bowel elimination problems. • Explain why enemas are given. • Describe the common enema solutions. • Describe the rules for giving enemas. • Describe how to care for a person with an ostomy. • Perform the procedures described in this chapter. • Explain how to promote PRIDE in the person, the family, and yourself. Bowel elimination is a basic physical need. Wastes are excreted from the gastro-intestinal (GI) system (Chapter 7). You assist patients and residents in meeting elimination needs. See Delegation Guidelines: Assisting With Bowel Elimination. See Promoting Safety and Comfort: Assisting With Bowel Elimination. To assist with bowel elimination, you need to know these terms. • Defecation—the process of excreting feces from the rectum through the anus; a bowel movement. • Feces—the semi-solid mass of waste products in the colon that is expelled through the anus. It is also called a stool. • Privacy. Lack of privacy can prevent a BM despite the urge. Odors and sounds are embarrassing. Some people ignore the urge when others are present. • Habits. Many people have a BM after breakfast. Some drink a hot beverage, read, or take a walk. These activities are relaxing. A BM is easier when the person is relaxed, not tense. • Diet—high-fiber foods. High-fiber foods leave a residue for needed bulk and prevent constipation. Fruits, vegetables, and whole-grain cereals and breads are high in fiber. Some people cannot chew these foods. They may not have teeth. Or dentures fit poorly. Some nursing centers add bran to cereal, prunes, or prune juice. • Diet—other foods. Milk and milk products can cause constipation or diarrhea. Chocolate and other foods cause similar reactions. Spicy foods can cause frequent BMs or diarrhea. Gas-forming foods stimulate peristalsis, thus aiding BMs. Such foods include onions, beans, cabbage, cauliflower, radishes, and cucumbers. • Fluids. Feces contain water. Stool consistency depends on the amount of water absorbed in the colon. Feces harden and dry when large amounts of water are absorbed or when fluid intake is poor. Hard, dry feces move slowly through the colon. Constipation can occur. Drinking 6 to 8 glasses of water daily promotes normal bowel elimination. Warm fluids—coffee, tea, hot cider, warm water—increase peristalsis. • Activity. Exercise and activity maintain muscle tone and stimulate peristalsis. • Drugs. Drugs can prevent constipation or control diarrhea. Other drugs have diarrhea or constipation as side effects. • Disability. Some people cannot control BMs. They have a BM whenever feces enter the rectum. A bowel training program is needed (p. 298). • Aging. Aging causes changes in the GI tract. Feces pass through the intestines at a slower rate. Constipation is a risk. Some older persons lose bowel control (see “Fecal Incontinence,” p. 298). Common problems include constipation, fecal impaction, diarrhea, fecal incontinence, and flatulence. • Assist with elimination needs promptly. • Dispose of stools promptly. This prevents odors and the spread of microbes. • Give good skin care. Liquid stools irritate the skin. So does frequent wiping with toilet tissue. Skin breakdown and pressure ulcers are risks. • Follow Standard Precautions and the Bloodborne Pathogen Standard when in contact with stools. See Focus on Older Persons: Diarrhea. See Promoting Safety and Comfort: Diarrhea. • Nervous system diseases and injuries. • Fecal impaction or diarrhea. • Mental health disorders or dementia (Chapters 29 and 30). The person may not recognize the need for or act of having a BM. • Not getting to the bathroom in time. The person may have mobility problems or he or she may walk slowly. Or the bathroom may be too far away or occupied by another person. • Difficulty removing clothes. • Help with elimination after meals and every 2 to 3 hours • Incontinence products to keep garments and linens clean See Focus on Older Persons: Fecal Incontinence.
Assisting With Bowel Elimination
Normal Bowel Elimination
Factors Affecting BMs
Common Problems
Diarrhea
Fecal Incontinence
Assisting With Bowel Elimination
