Fecal Elimination Problems

CONSTIPATIONoFewer than three bowel movements

per week

oThe passage of dry, hard stool, or no stool at all

oOccurs when movement of feces through the large intestine is slow, thus allowing time for additional reabsorption of fluid from the large intestine

Factors

oInsufficient fiber intake

oInsufficient fluid intake

oInsufficient activity or immobility

oIrregular defecation habits

oChange in daily routine

oLack of privacy

oChronic use of laxatives or enemas

oEmotional disturbances

oMedication such as opiates or iron salts

Characteristics of Constipation

oDecreased frequency of defecation

oHard, dry, formed stool, straining at stool, painful defecation

oReports of rectal fullness

oAbdominal pain

oUse of laxatives

oDecreased appetite

oHeadache

Fecal Impaction

oMass or collection of hardened feces in the folds of the rectum

oResults from prolonged retention and accumulation of fecal materials

oPassage of liquid fecal seepage and no normal stool

oSometimes, it accumulate and extend well up into the sigmoid colon and beyond

oCan 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

oIf these fail, manual removal is often necessary

DIARRHEA

oPassage o f liquid feces and an increase frequency of defecation

oResults 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 iron cathartics

infection of mucosaIrritation of intestinal mucosaIrritation 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

oPartial incontinence- inability to control flatus or to prevent minor soiling

oMajor incontinence- inability to control feces of normal consistency

oAssociated 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

oPrimary sources of flatus

oAction of bacteria on the chyme in large intestine

oSwallowed air

oGas 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.

oIf excessive gas cannot be expelled through the anus, it may be necessary to insert a rectal tube to remove it