BOWEL ELIMINATION

I. EMPTYING THE COLON OF FECES

A. ENEMAS – introduction of a solution into the large intestine, usually to remove

feces

1. Types
a. Cleansing Enemas – given to remove feces from the colon
- to relieve constipation or fecal impaction
- to prevent involuntary escape of fecal material during
surgical procedures
- to promote visualization of the intestinal tract by
radiographic or instrument exam
- to help establish regular bowel function during bowel
training
- solutions used for cleansing are tap water, normal saline
solution, soap solution and
hypertonic solution

i. Hypertonic (tap water) and Isotonic (normal saline) solution

enemas – large volume
enemas that result in rapid colonic emptying
- hypertonic solutions draw water into the colon,
stimulating the
defecation reflex

b. Retention Enemas –retained in the bowel for a prolonged period

i. Oil- Retention Enemas – lubricate stool and intestinal
mucosa, making defecation
easier
ii. Carminative Enemas – help to expel flatus from the rectum
and provide relief from
gaseous distention
- common solutions include milk-and-molasses (equal
parts) and
magnesium sulfate-glycerin water (MGW = 30
mL magnesium
sulfate, 60 mL glycerin, 90 mL warm water)
iii. Medicated Enemas – provide medications that are absorbed
through the rectal
mucosa
iv. Anthelmintic Enemas – destroy intestinal parasites
v. Nutritive Enemas – administer fluids and nutrition rectally

c. Return-Flow Enemas – (Harris Flush) enemas are occasionally

prescribed to expel flatus
- for adults, 100 to 200 mL of solution is instilled into the
rectum and sigmoid colon
 - solution container is lowered so that the solution
flows back into the
container
- procedure is repeated 5 or 6 times
- terminated when abdominal distention is relieved
- if solution return solution becomes thick with feces, it
is replaced by fresh
solution

2. Equipment – include flexible bottle containing hypertonic solution with

an attached prelubricated firm
tip about 5 to 7.5 cm (2 to 3 in.) long
- for tap water, saline solution, or soap solution enemas, a
container, rubber or plastic tubing
with side openings near its distal end, a tubing clamp,
lubricant, and the solution are needed

B. RECTAL SUPPOSITORIES – conical or oval solid substance shaped for easy insertion
into a body cavity and
designed to melt at body temperature
- types include fecal softeners (useful when stool is hard); some direct
action on the nerve endings in
the rectal mucosa (useful for weak muscle tone or poor
innervation); some liberate carbon
dioxide when moistened, which causes distention, stimulating
elimination impulses

C. ORAL INTESTINAL LAVAGE

- used to cleanse the intestine of feces
- prescribed by physician and can be administered before diagnostic
tests that require a clear bowel
for visualization purposes or as a “bowel prep” before intestinal
surgery

D. DIGITAL REMOVAL OF STOOL

fecal impaction – prolonged retention or an accumulation of fecal material
that forms a hardened mass in
the rectum
- prevents passage of normal stools
- liquid fecal seepage with no passage of feces is an indication of
impaction

- if other interventions fail, impaction must be broken up manually

- physician’s order is required
- may cause great discomfort as well as irritation of rectal mucosa
and bleeding
- digital removal can stimulate the vagus nerve, resulting in
slowed heart rate

E. MANAGING BOWEL INCONTINENCE

 bowel incontinence – inability of the anal sphincter to control the discharge
of fecal and gaseous material
- cause is usually an organic disease, resulting either in a mechanical
condition that hinders the
proper functioning or an impairment in the nerve supply to the
anal sphincter

1. Rectal Indwelling Catheter – used for patients with uncontrollable

diarrhea, relatively little research
supports the safety of this procedure
- some concerns include the possibility of worsening the diarrhea
due to stimulating of the
sensory nerve fibers in the rectum or the possibility of rectal
perforation and
development of necrosis
- most experts agree that indwelling rectal catheters should not be
used to manage large
volumes of diarrhea

2. Fecal Incontinence Pouch – an alternative measure to protect

perianal skin from repeated
episodes of fecal incontinence
- nursing responsibilities include careful regular assessment and
documentation of the
perianal skin condition and attentive management of the
drainage system

3. Designing and Implementing Bowel Training Program

- purpose is to manipulate factors within the person’s control (food
and fluid, intake,
exercise, time for defecation) to produce the elimination of a
soft, formed stool at
regular intervals without a laxative

4. Meeting the Needs of Patients with Bowel Diversions

stoma – intestinal mucosa is brought out to the abdominal wall,
structure formed by suturing the
mucosa to the skin

ostomy – general term for an opening into the body, used to refer to
an opening created for the
excretion of body wastes
- if surgery is not emergent, patients meet with a specially trained
registered nurse called a
wound, ostomy, and continence nurse (WOCN) and together
they determine the
ideal location for the stoma

ileostomy – allows liquid fecal content from the ileum of the small
intestine to be eliminated through
 the stoma
- continent ileostomy is an alternative to the traditional surgical
procedure
- internal pouch created that the patient accesses through a
nipple like
valve constructed from the ileum on the abdominal
wall
- no need for an external device
- ileoanal reservoir is another alternative
- terminal ileum is sutured directly to the anus, a pouch is
created and the patient is
able to control expulsion through the intact anal
sphincter
- may be temporary (for repair after inflammatory disease, some
types of intestinal surgery
or injury) or permanent (for debilitating intestinal diseases
or caner of the colon or
rectum

colostomy – permits formed feces from the colon to exit through the
stoma
- may be temporary (for repair after inflammatory disease, some
types of intestinal surgery
or injury) or permanent (for debilitating intestinal diseases
or caner of the colon or
rectum