Gastrointestinal Function

Surgical Construction of Stoma

*Colostomies:* 1. Single 2. Loop 3. Divided 4. Double-barreled

Implementing: Decreasing Flatulence

Avoid gas-producing foods Exercise Movement in bed Ambulation Probiotics

Older Adults

Constipation can be relieved by increasing the fiber intake to 20 to 35 grams per day. Adequate roughage in the diet, adequate exercice, and 6 to 8 glasses of fluid daily. A cup of hot water or tea at a regular time in the morning is helpful for some. Responding to the gastrocolic reflex (increased peristalsis of the colon after food has entered the stomach). For example: toileting is recommended 30 minutes after meals, especially after breakfast when gastrocolic reflex is strongest.

Antiflatulent Medications

Do not decrease the formation of flatus but they do coalesce the gas bubbles and facilitate their passage by belching through the mouth or expulsion through the anus. A comination of simethicone and loperamide (Imodium Advanced) is effective in relieving abdominal bloating and gas associated with acute diarrhea

Physical Examination

Inspection, auscultation, percussion, and palpation with specific inferences to the intestinal tract. Auscultation before palpation because palpation alters peristalsis Examination of abdomen, rectum, and anus Inspection of feces for color, consistency, shape, amount, odor, abnormal constituents Review any data obtained from relevant diagnostic tests

Assessing

Nursing history Physical examination Review of data from any diagnostic tests Client's normal pattern Description of usual feces Recent changes Past problems with elimination Presence of an ostomy Factors influencing elimination pattern

A transverse colostomy

produces a malodorous, mushy drainage because some of the liquid has been reabsorbed. For odor there is usually no control

Valsalva maneuver

Holding the breath caused by straining associated with constipation. Valsalva maneuver can present serious problems to people with heart disease, brain injuries, or respiratory disease. *Holding the breath* while bearing down increases intrathoracic pressure and vagal tone, slowing the pulse rate.

*Retention*

Introduces oil or medication into rectum and sigmoid colon. Liquid is retained 1-3 hours An oil retention enema acts to soften the feces and to lubricate the rectum and anal canal, thus facilitating passage of the feces. Antibiotic enemas are used to treat infections locally, antehlmintic enemas to kill helminths such as worms and intestinal parasites, and nutritive enemas to admin. fluids and nutrients to the rectum.

Haustral churning

(shuffling) movement of the chyme back and forth within the haustra in the large intestine

Bowel Diversion Ostomies (cont'd)

4. Ileostomy Opening into the ileum (small bowel) 5. Colostomy Opening into the colon 6. Stoma -opening created by ostomy Ostomies can be temporary or permanent Location influences character and management of fecal drainage The farther along the bowel, the more formed the stool, and the more control possible over frequency of stomal discharge

Nursing Diagnoses

Bowel Incontinence Constipation Risk for Constipation Perceived Constipation Diarrhea Dysfunctional Gastrointestinal Motility

Diagnostic Procedures

Client given cleansing enema prior to the examination

Planning

Maintain or restore normal bowel elimination pattern Maintain or regain normal stool consistency Prevent associated risks such as fluid and electrolyte imbalance, skin breakdown, abdominal distention and pain

Feces

Normal feces are made of about 75% of water and 25% solid materials. If the feces are propelled very quickly along the large intestine, there is no time for most of the water in the chyme to be absorbed and the feces will be around 95% water

Suppositories

Softens the feces, releases gases (CO2) to distend the feces. The best results can be obtained by inserting the suppository 30 min before the client's usual defecation time or when the peristaltic action is greatest, such as breakfast.

Bowel (Fecal) Incontinence (cont'd)

Two types of bowel incontinence: 1. Partial continence is the inability to control flatus or to prevent minor soiling. 2. Major incontinence is the inability to control feces or normal consistency.

Hemmorhoids

When the veins become distended, as occur with repeated pressure.

Ileostomy

a colostomy that generally empties from the distal end of the small intestine

Normal Defecation is facilitated by

a. Thigh flexion which increases the pressure within the abdomen. b. Sitting position, which increases the downward pressure on the rectum

Gastrostomy

an opening through the abdominal wall into the stomach

Implementing: Stoma and Skin Care (cont'd)

Prepare and apply skin barrier Measure stoma with stoma guide Trace and cut skin barrier material to be no more than 1/8 to 1/4 inch larger than the stoma Remove barrier backing Press adhesive side onto skin, avoiding wrinkles; hold for 30 seconds For 2-piece, remove tissue and snap appliance onto the flange or skin barrier wafer Apply closed drainable pouches per instructions Document care

Implementing: Stoma and Skin Care (cont'd)

Prepare and apply skin barrier (cont'd) For 2-piece, remove tissue and snap appliance onto the flange or skin barrier wafer Apply closed drainable pouches per instructions Document care

Bowel Diversion Ostomies are classified according to:

(a) Their status as permanent or temporary (b) their anatomic location (c) the construction of the stoma

Characteristics of Abnormal feces

*1. Color is clay or white:* absence of bile pigment (bile obstruction); diagnostic study using barium. *2. Black or tarry feces color:* drug (iron); bleeding form upper GI tract (e.g., stomach, small intestine); diet high in red meat and dark green vegetables (e.g., spinach). *3. Red feces:* bleeding from lower GI tract (e.g., rectum); some foods (e.g., beets) *4. Pale feces*: malabsorption of fats; diet high in mild and milk products and low in meat. *5.Orange or green feces:* Intestinal infection

Major causes of Diarrhea

*1. Psychological stress (anxiety):* increased intestinal motility and mucous secretion *2. Medications:* Inflammation of the infection of mucosa due to overgrowth of pathogenic intestinal microorganisms *3. Antibotics:*Irritation of intestinal mucosa *4. Iron:* Irritation of intestinal mucosa *5. Cathartics:* Incomplete digestion of food or fluid *6. Allergy to food, fluid, drugs:* increased intestinal motility and mucous secretion *7. Intolerance of food or fluid:* reduced absorption of fluids *8. Diseases of the colon (e.g., malabsorption) syndrome, Chrohn's disease:* Inflammation of the mucosa often leading to ulcer formation

Nursing Diagnoses Used as Etiology

*1. Risk for Deficient Fluid Volume and or Risk for Electrolyte Imbalance related to:* a. prolonged diarrhea b. Abnormal fluid loss through ostomy *2. Risk for Impaired Skin Integrity related to:* a. Prolonged diarrhea b. Bowel incontinence c. Bowel diversion ostomy *3. Situational Low Self-esteem related to:* a. Ostomy b. Fecal Incontinence c. Need for assistance with toileting *4.Disturbed Body Image related to:* a. Ostomy b. Bowel incontinence *5.Deficient Knowledge (Bowel Training, Ostomy Management) related to:* lack of previous experience *6.Anxiety related to:* a. Lack of control of fecal elimination secondary to ostomy b. Response to others to ostomy

Characteristics of Abnormal feces (cont'd)

*10. Pus:* Bacterial infection *11. Mucous:* Inflammatory condition *12. Parasites, blood:* GI bleeding *13. Large quantities of fate:* malabsorption *14. Foreign objects:* Accidental ingestion

Characteristics of Abnormal feces (cont'd)

*6. hard, dry feces consistency: dehydration; decreased intestinal motility resulting from lack of fiber in diet, lack of exercise, emotional upset, laxative abuse. *7. Diarrhea:* Increased intestinal motility (e.g., due to irritation of the colon by bacteria). *8. Narrow, Pencil-shaped or stringlike stool:* obstructive condition of the rectum *9. Pungent odor:* Infection, blood

Fecal impaction (cont'd)

*In severe Impactions* the feces accumulate and extend well up into the sigmoid colon and beyond. *Causes:* poor defecation habits and constipation *Assessed:* by digital examination of the rectum, during the hardened mass can often be palpated. *Signs and Systems:* frequent but nonproductive desire to defecate and rectal pain A generalized feeling of illness results, client becomes anorexic, the abdomen becomes distended, and nausea vomiting may occur. *Increase Risk of fecal Impaction:* medications such as anticholinergics, antihistamines and barium. *Treatment:* Client is given an oil retention enema, a cleansing enema 2-4 hours later, and daily additional cleansing enemas, suppositories, or stool softeners. If these measures fail, manual removal is often necessary.

Implementing: Common Enema Solutions and Actions

*Isotonic (physiologic/normal saline)* Distends colon Stimulates peristalsis Softens feces *Soapsuds (pure soap)* Irritates mucosa Distends colon *Oil* Lubricates feces and colonic mucosa

*Cleansing*

Prevents escape of feces during surgery Prepares intestines for certain diagnostic tests Removes feces in instances of constipation or impaction Hypertonic (Fleet phosphate) - draws water into colon Hypotonic (tap water) - distends colon, stimulates, peristalsis, softens feces Isotonic - safest, exert osmotic pressure Soapsuds - only pure soap used, irritates bowel mucosa Large or small volume; high or low

Implementing: Promoting Regular Defecation

Privacy Timing Nutrition and fluids Exercise Positioning Commode; bedpan

Implementing

Promote regular defecation Teach about medications Decrease flatulence Administer enemas Digital removal of fecal impaction (if agency policy permits) Institute bowel training programs Apply fecal incontinence pouch Ostomy management

Implementing: Stoma and Skin Care (cont'd)

Protect skin, collect stool, and control odor with an ostomy appliance Skin barrier and pouch One- or two-piece Closed or drainable pouch Empty 1-2 times/day (when 1/3 to 1/2 full) Change appliance twice weekly or at least q 7 days or with leakage

Characteristics of Normal feces

1. Adult: Brown 2. Child: Yellow 3. Formed, soft, semisolid, moist consistency 4. Cylindrical shape (contour of rectum) about 2.5 cm (1in.) in diameter in adults 6. Amount varies with diet (about 100-400 g per day) 7. Has an aromatic odor: affected by ingested food and person's own bacterial flora 8. Constituents: Small amounts of undigested roughage, sloughed dead bacteria and epithelial cells, fate, protein, dried constituents of digestive juices (e.g., bile pigments, inorganic matter).

Medications that affect feces appearance

1. Aspirin (causes GI bleeding): red or black stool 2. Iron salts (oxidation of iron): black stool 3. Antibiotics: gray-green discoloration in stool 4. Antacids: whitish discoloration or white specks in stool 5. Pepto-Bismol: black stool

Enemas are classified into four groups

1. Cleansing 2. Carminative 3. retention 4. return-flow enemas

Three types of movement occurs in the large intestine

1. Haustral churning 2. Colon peristalsis 3. Mass peristalsis

Developmental

1. Newborns and Infants: Meconium is the first fecal material passed by the newborn normally up to 24 hours after birth. 2. Toddlers: some control of defecation starts at 1/2- 2 years. 3. School-age children & adolescents: have bowel habits similar to those of adults. Patterns of defecation vary in feqeuncy, quantity, and consistency. 3. Older Adults: Constipation is a significant health problem due to reduced activity levels, inadequate amounts of fluid, fiber intake, and muscle weakness.

Bowel Diversion Ostomies

1. Ostomy An opening from the gastrointestinal, urinary, or respiratory tract onto the skin 2. Gastrostomy Opening through the abdominal wall into the stomach 3. Jejunostomy Opening through the abdominal wall into the jejunum

Medications

1. Repeated administration of *morphine and codeine,* cause constipation because they decrease gastrointestinal activity through their action on the central nervous system. 2. *Iron tablets:* has an astringent effect, acts more locally on the bowel mucosa to cause constipation. 3. *Laxatives:* are medications that stimulate bowel activity and so assist fecal elimination. 4. *Narcotic analgesics:* for pain, constipation may be a side effect 5. *Opiods, iron supplements, antihistamines, antacids, and antidepressants* cause constipation

Colostomies temporary or permanent

1. Temporary colostomies are generally performed for traumatic injuries or inflammatory conditions of the bowel. Allow the distal diseases portion of the bowel to rest and heal. 2. Permanent colostomies are performed to provide a means of elimination when the rectum or anus is nonfunctional as a result of a birth defect or disease such as cancer of the bowel.

Colorectal Cancer

A serious malignant disorder that causes constipation. Risk Factors: 1. Nonmodifiable: Age, race, family history 2. Modifiable: cigarette smoking, poor diet (e.g., low in fiber and high in fat), lack of physical activity, regular consumption of alcohol. Symptoms: Inform clients to see their primary care provider if they have any of the following: 1. A change in bowel habits such as diarrhea, constipation, or narrowing of the stool that last for more than a few days. 2. A feeling of needing to have a bowel movement that not relieved by doing so 3. Rectal bleeding or blood in the stool (often, though, the stool will look normal) 4. Cramping or steady abdominal pain 5. Weakness and fatigue 6. Unexpected weight loss

Implementing: Bowel Training Program

Based on factors within client's control Goal of establishing normal defecation pattern Major phases: Determine client's usual habits and factors that help or hinder defecation Design plan with client (fluid, fiber, hot drinks, exercise)

Implementing: Digital Removal of Fecal Impaction

Break up fecal mass with fingers and remove it in portions Restrictions on who may perform this intervention in some facilities Can injure bowel mucosa *Vagal response can trigger cardiac arrhythmia* Usually preceded by 30-minute oil retention enema

Implementing:

Care of Client Receiving Enema Enema violates personal space Maintain cultural awareness and sensitivity Gender of nurse may be an issue Monitor emotional response to procedure May trigger memory of past abuse or trauma Ask client to describe and provide referral as needed

Implementing: Teaching about Medications

Cathartics Laxatives Suppositories Antidiarrheal medications Antiflatulence medications Carminatives

Constipation (cont'd)

Causes include: Insufficient fiber and fluid intake Insufficient activity Irregular bowel habits (ignoring urge to defecate) Changes in routine, lack of privacy Chronic laxative or enema use Irritable bowel syndrome (IBS) Functional or neurologic conditions Emotional disturbances Medications

Implementing: Care for Client with Ostomy

Client will need emotional support as well as physical care Wound ostomy continence nurse (WOCN) often assists these clients Refer client to national support group for quality of life issues Drainage coming out of a bowel ostomy is called effluent

Fecal Elimination Problems

Constipation Fecal impaction Diarrhea Bowel incontinence Flatulence

Chyme

Contents of the colon. When the waste products leaving the stomach through the small intestine and then passing through the ileocecal valve.

Defining Characteristics for Constipation

Decreased frequency of defecation Hard, dry, form stools Straining at stool; painful defecation Reports of rectal fullness or pressure or incomplete bowel evacuation Abdominal pain, cramps, or distention Anorexia, nausea Headache

Constipation

Decreased frequency of defecation Hard, dry, formed stools Straining at stool; painful defecation Feeling of fullness, discomfort (in rectum, abdomen) Anorexia or nausea Headache

Factors that Affect Defecation

Developmental (meconium, gastrocolic reflex). Diet Fluid Activity Psychological factors Defecation habits

Physiology of Defecation

Elimination of waste products is essential *Excreted waste products:* feces or stool Small intestines, ileocecal valve, large intestines *Main function of the small intestines:* absorption of nutrients *Main function of colon:* absorption of water and some electrolytes/nutrients, storage *Chyme:* term that refers to waste products leaving the small intestine

Implementing: Common Enema Solutions

Enema Cleansing enema Hypertonic (Fleet phosphate) Hypotonic (tap water) Isotonic (physiologic/normal saline) Soapsuds (pure soap) Oil

Physiology of Defecation: Rectum and Anal Canal (cont'd)

Expulsion of feces assisted by contraction of the abdominal muscles and diaphragm Feces move through anal canal and are expelled through anus

Artificial Sphincter

For post-stroke, post-trauma, or paraplegic clients Surgical repair; follow manufacturer's instructions for use Cuff inflated to maintain continence Cuff deflated for bowel movement Cuff automatically reinflates in 10 min

Diet: Foods that influence bowel Elimination

Gas-producing foods, such as cabbage, onions, cauliflower, bananas, and apples. Laxative-producing foods, such as bran, prunes, figs, chocolate, and alcohol Constipation-producing foods, such as cheese, pasta, eggs, and lean meats.

Anesthesia and Surgery

General anesthetics cause the normal colonic movements to cease or slow by blocking parasympathetic stimulation to the muscles of the colon. Surgery that involves direct handling of the intestines can cause temporary cessation of intestinal movement(*ileus* which lasts 24-48 hrs).

Stroma

Generally red in color and moist. Initially, slight bleeding may occur when the stroma is touched and this is considered normal A person does not feel the stoma because there is no nerve endings in the stroma.

Fluid

Healthy fecal elimination usually requires a daily fluid intake of 2,000 to 3,000 mL.

Bowel (Fecal) Incontinence

Loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter. *Generally associated with:* Impaired functioning of anal sphincter or nerve supply Neuromuscular diseases Spinal trauma Tumor

Implementing: Bowel Training Program (cont'd)

Major phases (cont'd): Maintain routine for 2-3 weeks: cathartic suppositories, prompt response to urges, privacy, and effective physical positioning Provide positive feedback for successful defecation Offer support; encourage client to have patience with the process

Factors that Affect Defecation (cont'd)

Medications Diagnostic procedures Anesthesia and surgery Pathologic conditions Pain

Physiology of Defecation (Cont'd)

Mucus in colon protects lining from acid in feces and from bacterial activity Products excreted: flatus and feces Rectum (4-6 in) and anal canal (1-2 in) Vertical folds with vein and artery If veins distended:hemorrhoids Internal sphincter under involuntary control External sphincter under voluntary control

Implementing: Stoma and Skin Care

Normal stoma should appear pink to red and may bleed slightly when touched Assess the peristomal skin for irritation each time the appliance is changed Treat any irritation or skin breakdown immediately Keep skin clean by washing off any excretion and drying skin thoroughly

Diarrhea

Passage of liquid feces and increased frequency of defecation Spasmodic cramps, increased bowel sounds Fatigue, weakness, malaise, emaciation Major causes Stress, medications, allergies, intolerance of food or fluids, disease of colon

Psychological factors

People who are anxious or angry experience increased peristaltic activity and subsequent nausea or diarrhea. People depressed may experience slowed intestinal motility, resulting in constipation. How a person responds to these emotional states is the result of individual differences in the response of the enteric nervous system to vagal stimulation from the brain.

Older Adults (cont'd)

Should be warned that consist use laxatives inhibits natural defecation reflexes and is thought to cause rather then cure constipation. Laxatives may interfere with the body's electrolyte balance and decrease the absorption of certain vitamins

Implementing: Colostomy Irrigation

Similar to enema Only for sigmoid or descending colostomy Used to stimulate evacuation, control time of elimination so pouch will not need to be worn Fluid varies from 300 mL to 1 L Cone may be used to retain fluid in bowel before evacuation Long-term irrigation puts client at risk for peristomal hernias, bowel perforation, electrolyte imbalance

Antidiarrheal Medications

Slow the motility of the intestine or absorb excess fluid in the intestine.

Diet: Fiber

Sufficient bulk (cellulose fiber) in the diet is necessary to provide fecal volume. *Insoluble fiber* promotes the movement of material through the digestive system and increases stool bulk, helps lower blood cholesterol and glucose levels. Insoluble fiber: Whole-wheat flour, wheat bran, nuts and many vegetables. Soluble fiber: oats peas, beans, apples, citrus, fruits, carrots, barley, and psyllium. Important to drink plenty of water because fiber works best when it absorbs water

Ingestion

The contents of the colon normally represents food ingested over the previous 4 days, although most of the waste products are excreted within 48 hours of ingestion (the act of taking in food or medication).

Ascending colostomy

The drainage is liquid, cannot be regulated and digestive enzymes is present. Odor however is a problem requiring control

Evaluating

The goals established during planning phase are evaluated according to specific desired outcomes If outcomes are not achieved, nurse should explore the reasons Review fluid and diet, activity level, prescription medications, and other factors Do client and family understand instructions? Was sufficient support provided?

Anatomic Location

The location of the ostomy influences the character and management of the fecal drainage. The farther along the bowel, the more formed the stool and the more control over the frequency of stomal discharge.

Mass peristalsis

The third type of colonic movement, involves a wave of type *powerful muscular contractions* that *moves over large areas of the colon*. Usually mass peristalsis occurs after eating, stimulated by the presence of food in the stomach and small intestine. In adults, waves occur only a few times a day.

Flatulence

The three primary sources of flatus: (a) action of bacteria on the chyme in the large intestine (b) swallowed air (c) gas that diffuses between the bloodstream and the intestine. The presence of excessive flatus in the intestines and leads to the stretching and inflation of the intestines (intestinal distention). Eructation (belching, burping) *Causes* foods (cabbage, onions), abdominal surgery, or narcotics. If gas cannot be expelled by through the anus, it may be necessary to insert a rectal tube to remove it.

Implementing: Fecal Incontinence Pouch(Bowel Management System)

To collect and contain large amounts of liquid feces To prevent skin breakdown and frequent linen changes To prevent damage to internal mucosa and rectal sphincter from insertion of large Foley catheter in rectum

*Carminative*

Used primarily to expel flatus. The solution instilled into the rectum releases gas, which in turn distends the rectum and the colon, thus stimulating peristalsis Adult 60-80 mL of fluid is instilled

Return-flow (Harris or Colon flush)

Used to expel flatus. Alternating flow of 100 to 200 mL of fluid into and out of the rectum and sigmoid colon stimulates peristalsis. This process is repeated with alternating flow into/out of rectum 5-6 times until flatus is expelled and abdominal distention is relieved.

Implementing: Stoma and Skin Care (cont'd)

Wash hands and use gloves Client sitting or lying in bed; sitting or standing in bathroom Unfasten belt, empty pouch Remove skin barrier; clean and dry skin Assess stoma and peristomal skin Place tissue or gauze over stoma and change as needed until new appliance is in place

Loop colostomy

a loop of bowel is brought out onto the abdominal wall and supported by a plastic bridge, or a piece of rubber tubing. A loop stoma has two openings: the aproximal or afferent end, which is active, and the distal or efferent end, which is inactive. Usually performed in an emergency procedure and is often situated on the right transverse colon. It is a bulky stoma that is more difficult to manage than a single stoma.

Fecal impaction

a mass or collection of hardened, putty-like feces in the folds of the rectum

Commode

a portable chair with a toilet seat and a receptacle underneath that can be emptied; often used for the adult client who is able to get out of bed but is unable to walk to the bathroom

Colostomy

a temporary or permanent opening into the colon (large bowel) to divert and drain fecal material

Jejunostomy

a tube that is placed surgically or by laparoscopy through the abdominal wall into the jejunum for long-term nutritional support

Carminative

an agent that promotes the passage of flatus from the colon

Stoma

an opening created in the abdominal wall by an ostomy

Ostomy

an opening on the abdominal wall for the elimination of feces or urine

Carminatives

are herbal oils known to act as agents that help expel gas from the stomach and intestines.

Divided colostomy

consists of two edges of bowel brought out into the abdomen but separated from each other. The opening from the digestive or proximal end is the colostomy. the distal end in this situation is often referred to as mucous fistula, since this section of bowel continues to secrete mucus. The divided colostomy is often used in situations where spillage of feces into the distal end of the bowel needs to be avoided.

Single Stoma

created when one end of bowel is brought out through an opening into the anterior abdominal wall. This is referred to as an end or terminal colostomy; the stroma is permanent.

Diarrhea

defecation of liquid feces and increased frequency of defecation

Cathartics

drugs that induce defecation

Cathartics

drugs that induce defecation. They can have a strong, purgative effect. Examples are castor oil, cascara, phenophthalein, and bisacodyl.

Defecation

expulsion of feces from the anus and rectum. Its also called bowel movement. When peristaltic waves move the feces into the sigmoid colon and the rectum, the sensory nerves in the rectum are stimulated and the individual becomes aware of the need to defecate.

Flatus

gas or air normally present in the stomach or intestines

Gastrocolic reflex

increased peristalsis of the colon after food has entered the stomach

Mass peristalsis

involves a wave of powerful muscular contraction that moves over large areas of the colon; usually occurs after eating

Haustral churning:

involves movement of the chyme back and forth within the haustra. In addition to *mixing the contents*, this action* aids in the absorption of water* and moves the contents forward to the next haustra.

Fecal impaction

is a mass or collection of hardened feces in the folds of the rectum. Impaction results from prolonged retention and accumulation of fecal material. Client will experience the passage of liquid fecal seepage (diarrhea) and no normal stool. The liquid portion of the feces seeps out around the impacted mass.

Colon peristalsis

is a wavelike movement produced by the circular and longitudinal muscle fibers of the intestinal walls; *it propels the intestinal contents forward*. Colon peristalsis is very sluggish and is thought to move the chyme very little along the large intestine.

Bowel (fecal) incontinence

loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter

Laxatives

medications that stimulate bowel activity and assist fecal elimination

Fecal incontinence

or bowel incontinence, refers to the loss of voluntary ability to control fecal and gaseous discharges through the anal sphincter. Two types of bowel incontinence: partial and major. Partial incontinence is the inability to control flatus or to prevent minor soiling Major incontinence is the inability to control feces or normal consistency.

Constipation

passage of small, dry, hard stool or passage of no stool for a period of time. Fewer then three bowel movements per week.

Haustra

pouches that form in the large intestine when the longitudinal muscles are shorter than the colon

Descending colostomy

produces increasingly solid fecal drainage. Stools from a sigmoidostomy are of normal or formed consistency, and frequency of discharge can be regulated. People with a sigmoidostomy may not have to wear an appliance at all times, and odors can usually be controlled.

Ileostomy

produces liquid fecal drainage. Drainage is constant and cannot be regulated. Ileostomy drainage contains some digestive enzymes, which are damaging to the skin. For this reason, ileostomy clients must wear an appliance continuously and take special precautions to prevent skin breakdown. Odor is minimal because fewer bacteria is present.

Suppositories

solid, cone-shaped, medicated substances inserted into the rectum, vagina, or urethra

Enema

solution introduced into the rectum and large intestine. The action of an enema is to distend the intestine and sometimes to irritate the intestinal mucosa, thereby increasing peristalsis and the excretion of feces and flatus. The enema solution should be 37.7 C (100F) because a solution that is too cold or too hot is uncomfortable and causes cramping.

Meconium

the first fecal material passed by the newborn, normally up to 24 hours after birth. It is black, tarry, orderless and sticky.

Flatulence

the presence of excessive amounts of gas in the stomach or intestines

Double-barreled colostomy

the proximal and distal loops of bowel are sutured together for about 10cm (4in.) and both ends are brought up onto the abdominal wall.

Enema

used most often as a treatment for constipation, it distends the intestine and sometimes irritates the intestinal mucosa, thereby increasing peristalsis and the excretion of feces and flatus

Peristalsis

wavelike movements produced by circular and longitudinal muscle fibers of the intestinal walls; the movement propels the intestinal contents onward