Bowel Elimination and Types of

Ostomies
• Fundamental of Nursing
• Prepared by: A.L AMANI
FADHIL ABBAS
• BASIC SCIENCE
• FIRST STAGE
Contents
Bowel elimination

Physiology of Bowel Elimination

Common Alterations in Bowel Elimination

Methods for bowel elimination

Enema

Rectal Suppositories

Colostomies
 BOWEL ELIMINATION
It is also known as defecation. Bowel
elimination is a natural process critical
to human functioning in which body
excretes waste products of digestion. It
is a essential component of the healthy
body functioning.
Defecation (bowel elimination) is the
act of expelling feces (stool) from the
body.
 Physiology & Anatomy
of Bowel Elimination
Gastrointestinal (GI )tract also known as
alimentary canal. It is a hollow muscular
tube that extend from the mouth to the
anus.
 Food is broken down in the stomach in to
a semiliquid mass called chyme. Chyme
leaves the stomach and enter in to the
small intestine which is divided in to three
part i.e. Duodenum (10 inches long.
Receive bile and pancreatic enzyme),
Jejunum (it mixes with digestive enzyme
and most nutrients are absorbed) and
ileum (unabsorbed chyme enters in to the
intestine through ileum).
Through large intestine and colon chyme
expel out from the body through anus.
Physiology & Anatomy
of Bowel Elimination
• Peristalsis means the rhythmic contractions of
intestinal smooth muscle that facilitate defecation
(movement of bowel).
• Peristalsis moves fiber, water, and nutritional wastes
along the ascending, transverse, descending, and
sigmoid colon toward the rectum.
• Peristalsis becomes even more active during eating.
Auscultation of the abdomen as it relates to the GI
system is performed to assess for intestinal function.
Bowel sounds are produced by the movement of fluid,
gas, and contents through the intestines.
Auscultating for bowel sounds with the stethoscope’s
diaphragm . Bowel sounds are sometimes loud enough
to hear without a stethoscope.
The abdomen should be exposed when conducting
auscultation, begin in the right lower quadrant and
progress clockwise to the right upper quadrant, left
upper quadrant, and the left lower quadrant.
Always begin in the right lower quadrant because this is
the location of the ileocecal valve, which is a muscular
sphincter that allows contents to move from the ileum
of the small intestine to the cecum of the large
intestine.
Bowel sounds
Assess the presence, frequency, and quality of bowel
sounds.
1. Presence :
Normally, bowel sounds are present in all four
quadrants. This means that peristalsis is occurring and
contents are moving through the intestines.
 listening for bowel sounds in each quadrant for five
minutes.
 Absent bowel sounds are a cue that suggest there
may be a problem with the movement of contents
through the intestines.
 Common causes of absent bowel sounds include:.
1. Peritonitis.
2. Complete bowel obstruction.
3. Perforation of the small or large intestine.
Bowel sounds
2-Frequency:
The rate of occurrence or how often do the nurse hear bowel sound.
Counting the number of bowel sounds and estimate if bowel sound are
considered normoactive, hypoactive, or hyperactive.
1. Normoactive : 5–30 bowel sounds per minute (about 2 sounds every 5
seconds).
 listening for a few seconds to estimate the frequency of bowel sound.

2. Hypoactive :less than 5 bowel sounds per minute.

Listening a bit longer in order to assess bowel sound is required.
These sounds indicate that intestinal activity has slowed.
Hypoactive bowel sound is when:.
1. During sleep.
2. Post-surgery due to anesthetic use and using certain medications (e.g.,
narcotics).
3. Constipation is also a common cause of hypoactive bowel sounds
Bowel sounds
3. Hyperactive: more than 30 bowel sounds per minute.
1. After a person has just eaten
2. Diarrhea
3. Early/partial intestinal obstruction.

3-Quality :.
The quality of bowel sounds is typically less important than the presence
and frequency, but an extremely high-pitched bowel sound can be a cue
suggestive of an early bowel obstruction.
Describe the quality of the bowel sounds as a;.
No specific/constant rhythm).
High-pitched bowel sound .
Mixture of sounds (e.g., gurgling or bubbling).
 COMMON ALTERATIONS IN BOWEL ELIMINATION
There are five common alterations in bowel elimination:-

1. Constipation
2. Fecal Impaction
3. Flatulence
4. Diarrhea
5. Fecal Incontinence
 COMMON ALTERATIONS IN BOWEL ELIMINATION

1- Constipation is an elimination problem characterized by

dry, hard stool that is difficult to pass. Various
accompanying signs and symptoms include the following:

1. Complaints of abdominal fullness or bloating.

2. Abdominal distention.
3. Complaints of rectal fullness or pressure.
4. Pain on defecation .
5. Decreased frequency of bowel movements .
6. Inability to pass stool .
7. Changes in stool characteristics such as hard small
stool.
Classification of Constipation
Constipation classify into four distinct types:
1. Primary
2. Secondary
3. Iatrogenic
4. Pseudo constipation

Primary or simple constipation : It results from

lifestyle factors such as inactivity, inadequate intake
of fiber, insufficient fluid intake, or ignoring the urge
to defecate
 Classification of Constipation
Secondary constipation is a consequence of a pathologic
disorder such as a partial bowel obstruction.
Iatrogenic constipation occurs as a consequence of other
medical treatments. For example, prolonged use of
narcotic analgesia tends to cause constipation. These and
other drugs slow peristalsis, delaying transit time. The
longer the stool remains in the colon, the drier it becomes,
making it more difficult to pass.
Pseudo constipation is a rare condition that causes the
symptoms of bowel obstruction without the presence of a
blockage. It occurs when there is muscle or nerve problem
prevent the normal movement of food, liquids, and gas
through the
 COMMON ALTERATIONS IN BOWEL ELIMINATION

2- FECAL IMPACTION Hardened stool

that is stuck in the rectum or lower
colon due to chronic constipation. It
occurs in people who have been
constipated for a long time.
3-Flatulence or flatus (excessive
accumulation of intestinal gas)
results from some types of foods and
swallowing air while eating.
COMMON ALTERATIONS IN BOWEL ELIMINATION

4-Diarrhea is the urgent passage of watery

stool and commonly is accompanied by
abdominal cramping. Simple diarrhea
usually begins suddenly and lasts for a short
period.
Usually diarrhea is caused by :.
Tainted food or intestinal pathogens.
COMMON ALTERATIONS IN BOWEL ELIMINATION
5- Fecal incontinence is the inability
to control the elimination of stool.

Bowel incontinence is an inability

to control bowel movements,
resulting in involuntary soiling. It's
also sometimes known as fecal
incontinence. The experience of
bowel incontinence can vary from
person to person. In some people
stool leaks from the rectum without
warning, or feel a sudden need to go
to the toilet ,but are unable to reach
the toilet in time.
Methods for bowel elimination

1. ENEMAS
2. RECTAL SUPPOSITORIES
3. COLOSTOMIES
Methods for bowel elimination
• Enema procedure in which liquid is injected in to the rectum, to expel its
contents or to introduce drugs like Anti- helminthic. OR An enema is the
injection of fluid into the lower bowel by way of the rectum.
Uses Of Enema

1. To relieve constipation.

2. For bowel cleansing before a medical examination or

procedure. (doctor may order an enema prior to an X-ray of
the colon to detect polyps so that they can get a clearer
picture.) This procedure may also be done prior to a
colonoscopy.
3. To administer drugs.

4. To relieve the gaseous distension of abdomen.

5. Cold cleansing enema It is used to reduce the body
temperature during high fever.
Types Of Enema

1. Cleansing Enema
2. Retained Enema
 Types of enema
A-Cleansing enema
Administered to remove feces from the colon.
1. Hot – cause injury to the bowel mucous
2. Cold – uncomfortable and may trigger a spasm of the sphincter
muscles
 High enema is given to clean as much of the colon as possible. up to
1000 ml of fluid for adult
Low enema is administered to clean the rectum and sigmoid colon only.
Approximately 150ml of fluid is used.
Types of solutions used for cleansing enema are :
Tap water( most time) , Normal saline solution, Soap solution, and
Hypertonic solutions.
The large volume of solution for adult is 500-1000ml and for infant is
150-250ml.
 The procedure should not take > 2 hours.
 Should be finished 1 hour before x-ray – to give time for the large
intestine to absorb the fluid.
 Differences between Evacuant enema and Retention
enema

Cleansing enema Retention enema

1. Evacuant enema is used to eliminate 1. Retention enema is used to soften the

different gaseous distension stool.

2.A water-based formulation is used 2. A oil-based formulation is used.

3. Evacuant enema are intended to 3. Retained enemas are intended to be

returned. retained.

4. Used to increase the water content of 4. Used in shock, collapse and some
the stool. poisoning cases.
2. RETAINED ENEMA
 It means injecting a solution into the rectum specially
in sigmoid colon and holding for a specific period of
time.

This enema type is for people whose stool has

hardened. The oil-retention enema softens the stool.
The enemas used in this process usually contain 90-
120 ml solution.
General instructions about Enema
The appropriate size catheter or rectal tube need to
be used. the rectal tube needs to be smooth and
flexible. The rectal tube is lubricated with water
soluble lubricant. The temperature of the solutions
needs to be adjusted according to the purpose of
enema.
The amount of the solution to be administered
depends upon the type of the enema and the age &
size of the person. When enema is administered, the
client usually assumes a left lateral position .The
distance to which the tube is inserted depends upon
the age and the size of the client. The height of the
can should be adjusted to regulate the flow of the
solution according to the type of the enema
Contraindications of Bowel Enema
1. Acute renal failure.
2. Acute myocardial infarction and cardiac problems.
3. Appendicitis.
4. Obstetrical contraindications like antepartum
hemorrhage, and leaking membranes.
5. Recent surgical procedures involving the lower
intestinal tract.
6. Intestinal obstruction.
7. Inflammation and infection of the abdomen.
Complications / Risks of Enema

1. Irritation of the rectal mucosa by too much soap

or an irritating soap
2. Osmosis (fluid drawn into colon from
surrounding tissues) if hypertonic solution is used.
3. Water intoxication if hypotonic solution is used.
4. Electrolyte imbalances.
5. Tear and bleeding .
Position of the patient during
Bowel Enema
Adult 7-10 cm
Child 3-5 cm
Infant 1.5-2.5 cm
10/1/2022 , 1:00 pm
Methods for bowel elimination
RECTAL SUPPOSITORIES
It is a solid dosage that is inserted into the rectum, where it dissolved or
melts and exerts local or systemic effects.
The effect usually results in a bowel movement with in 15-60 minutes.
Glycerin belongs to a class of drugs known as hyperosonate laxatives. It is
used to relief constipation.
3. COLOSTOMIES
A colostomy is a surgical procedure in which an opening (stoma) is formed
by drawing the healthy end of the large intestine or colon through an incision
in the anterior abdominal wall.
During this procedure, one end of the colon is diverted through an incision
in the abdominal wall to create a stoma. A stoma is the opening in the skin
where a pouch for collecting feces attached.
Colostomy
Colostomy bag
PURPOSE OF COLOSTOMY
1. Blockage
2. Injury
3. Colorectal cancer
4. Colonic polyps
TYPES OF COLOSTOMY

1.Sigmoid colostomy
2.Descending colostomy
3.Transverse colostomy
4.Ascending colostomy
5. Ileostomy
An ileostomy is where a small part of the ileum, or small bowel has been
diverted on to the surface of the abdomen. An ileostomy will work more
regularly and the waste will be more fluid. This type of stoma is less common in
neuropathic conditions such as spina bifida.

A urostomy is where the ureters, the two small tubes that drain urine from the
kidneys to the bladder, are diverted onto the surface of the abdomen. These
tubes are so tiny that they have to be transplanted into a small piece of bowel
which forms the stoma. The urine drains continuously into a special bag
(appliance) which is then emptied regularly.

A vesicostomy is where the bladder is diverted through a small opening

directly onto the surface of the abdomen. This operation is only carried out in
babies where the kidneys are under pressure and at risk of damage. A bag is
not necessary because the urine drains straight into the nappy. This is always a
temporary stoma
Providing Peristomal Care
Preventing skin breakdown is a major challenge in
ostomy care. Enzymes in stool can quickly cause
excoriation (chemical injury of skin).
Washing the stoma and surrounding skin with mild
soap and water and patting it dry can preserve skin
integrity.
Dressing .