Bowel Elimination Stool Characteristics:

Characteri Normal Abnormal Possible causes

stic
ANATOMY AND PHYSIOLOGY OF GIT Color Adult: Yellow Black or tarry
to brown
Infant: Clay
depends if
breastfed or
formula fed Red

Pale
Functions of the Colon:

orange/green

Consisten Formed; soft; Hard/dry

cy semisolid;
moist Diarrhea

Shape Cylindrical
(contour of
the rectum)

Physiology of Defecation

Amount Varies with

the diet (about
100-400 g per
day
Odor Aromatic Pungent Infection, blood
(affected by
ingested food
and person’s

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 own bacterial  Rapid peristalsis
flora)  Infants with persistent constipation should be evaluated for structural defects.
Constitue Waste Pus  Loose stools ,ay be related to overfeeding or too much corn syrup may be
nts residues of mistaken as diarrhea by the parents.
digestion Mucus  Meconium should pass for the first 24 hours. Stool characteristics depend on
whether the infant is being fed breast milk (briht yellow to golden) or formula
Parasites (dark yellow/tan)
 The number of stools infants pass varies greatly
Blood Toddler
 18-24 months – nerves innervating the internal and external sphincters of the anus
Large are fully developed.
quantities of  Bowel training
fat Adult
 Decreased peristalsis
Foreign  Slowed esophageal emptying
objects  Systemic changes in the function of digestion and absorption due to changes in
cardio and neuro status
PHYSICAL ASSESSMENT Older adult
Abdomen – IAPP  Changes in the GI system that impair digestion and elimination
 Loose muscle tone in the perineal floor and anal sphincter (incontinence)
 Slowed impulses to the anal region (constipation)

2. Daily patterns
 Most people benefit from using their own toilet facilities at times most effective
and convenient for them. A person should learn the best time for elimination.
 The gastrocolic reflex is most easily stimulated to cause defecation after meals.
Anus and Rectum- IP
 Hospitalization may distupr patient’s elimination habit.
3. Diet
 Sufficient bulk in the diet is necessary to provide fecal volume. Bulk forming foods
absorb fluid, thereby increasing stool mass. Bowel walls are stretched, initiating
persitalsis and initiating the defecation reflex. Ex of foods that contain high
FACTORS AFFECTING BOWEL ELIMINATION
amount of fiber: raw fruits (apple, banana, oranges), vegetables such as spinach,
1. Developmental stage
cabbage, celery, green beans and whole grains such as cereal and bran flakes.
Infant
 Lactose intolerance may result to diarrhea, cramping and gaseous retention.
 Small stomach capacity
 Less secretion of digestive enzymes
 Unable to control defecation (2-3 y/o)

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4. Fluid intake 11. Pregnancy
 Fluid liquefies intestinal content easing its passage through the colon.  As fetus increases in size, pressure is exerted in the rectum. A temporary
 Reduced fluid intake slows passage of food trough the intestine and can result to obstruction created by the fetus impairs passage of feces.
hardening of stool. 12. Pain
 8-10 glasses or 1400-2000 ml should be taken daily  Hemorrhoids, rectal surgery, rectal fistula and abdominal surgery can lead to pain
 Fruit juices can soften stool while in other people milk and milk products can cause during defecation. Constipation is a common problem for clients experiencing pain
constipation. during defecation.
5. Physical Activity
 Activity promotes peristalsis whereas immobilization depresses peristalsis. COMMON BOWEL ELIMINATION PROBLEMS
6. Psychological factor 1. Constipation –
 When a person is anxious, afraid or angry, stressed response is initiated, digestive Causes:
process is accelerated resulting to diarrhea and gaseous formation. - Insufficient fiber intake -Insufficient fluid intake
 If person is depressed, autonomic nervous system slows impulses, peristalsis - Insufficient activity or immobility -Irregular defecation habit
decrease leading to constipation. - Change in the daily routine -Lack of privacy
7. Pathologic conditions - Emotional disturbances such as depression or mental confusion
 Spinal cord injuries and head injuries can decrease the sensory stimulation for - Medications such as opiates and iron salts
defecation. - Chronic use of laxative or enema
 Impaired mobility can impede the client’s urge to defecate.
 Client may experience fecal incontinence because of poor anal sphincter. 2. Fecal impaction –
8. Medications S/S:
 Laxatives and cathartics soften the stool and promote peristalsis
3. Diarrhea –.
 Medications that can cause constipation:
a. Anticholinergics (AtSO4)
4. Fecal Incontinence –
b. Narcotic analgesic
c. Dicyclomine Hcl (Bentyl)  Two types:
Partial – inability to control flatus and to prevent minor soiling
 Aspirin
Major – inability to control feces of normal inconsistency
9. Diagnostic tests
 Test involving the visualization of the colon often requires the bowel to be
5. Flatulence –
emptied of its content. In endoscopy, the client usually receives cathartics and
 Common sources of flatus include: 1) action of bacteria on the chyme in the LI;
enema. Such emptying of the bowel can interfere with normal elimination.
2)swallowed air c)gas that diffuses between the bloodstream and the intestine
10. Surgery
 Anesthetics given during surgery can cause cessation of peristalsis by blocking
6. Hemorrhoids –
parasymphatetic stimulation the muscles of the colon.
 Surgery that involves manipulation of bowel temporarily stops peristalsis (Paralytic
ileus) for 24-48 hours.

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