Elimination - let's talk about poop

constipation is a ____________ not a disease

symptom

Common causes of fecal incontinence

weak anal sphincter, functional, inflammatory, neurological disease, pelvic floor dysfunction, chronic constipation, diarrhea, fecal impaction

diagnostic tests to find the cause of constipation

•Abdominal x-rays •Barium enema •Colonoscopy or sigmoidoscopy •Anorectal manometry •GI transit studies •Balloon expulsion •Defecography

interprofessional care for fecal incontinence

•Bowel management program—regular defecation, high-fiber diet, increased fluids •Fiber supplements; bulk-forming laxatives •Reduce irritating, diarrhea-producing foods •Caffeine, artificial sweeteners, dairy products, gas-producing vegetables, and vegetables with insoluble fiber •Remove fecal impaction •Antidiarrheal agents •Physical therapy and biofeedback training •Mild electrical stimulation •Dextranomer/hyaluronic acid gel—narrows anal canal •Surgery—sphincter repair or colostomy

nursing implementation for fecal incontinence

•Bowel training program •Best time to schedule elimination is 30 minutes after breakfast •If ineffective: •Administer bisacodyl, glycerin suppository, or small enema to stimulate anorectal reflex until pattern established •Digital stimulation •Tap water irrigation maintain skin integrity

How is impaction diagnosed?

•Digital examination, abdominal x-ray

diagnostic tests for fecal incontinence

•H&P •Rectal examination •Anorectal: manometry, ultrasound or electromyography

complications of constipation

•Obstipation, fecal impaction, perforation

what are 3 different drug induced constipation?

•Opioids •Cathartic colon syndrome •Chronic laxative use results in dilated, atonic colon

nursing assessment of fecal incontinence

•Previous and current bowel patterns •Stool consistency (Bristol Stool Scale), volume, frequency, and symptoms •Sensation of urgency to defecate or pass flatus •Interference with daily activities, diet, and family and social activities •Perineal irritation or breakdown •Incontinence-associated dermatitis (IAD)

nursing patient education fecal incontinence

•Reduce episodes •Coping strategies •Identify triggers skin integrity + hygiene

nursing implementation of impaction

•Regular defecation time •Don't ignore urge •Record elimination pattern •Avoid laxatives and enemas •Defecation position •Provide privacy

interprofessional care for constipation

bulk forming?? •Increase dietary fiber, fluids, and exercise •Laxatives •Enemas •Peripherally acting opioid receptor antagonists •Biofeedback •Colostomy, ileostomy, continent fecal diversion

how is impaction treated?

enema or may need to be manually removed.

Involuntary passage of stool related to motor and/or sensory dysfunction.

fecal incontinence

Chronic constipation lasts

greater than 3 months

black stool

higher GI bleed

acute constipation lasts

less than 1 week

manifestations of impaction

liquid, foul-smelling, material with no formed stool, feeling ill, abdominal distention and possible nausea/vomiting

bright red bleeding / stool

lower GI bleed - hasn't come into contact with stool

impaction

A mass of hardened stool in the folds of the rectum or colon.

nursing implementation dietary for impaction

- patient / caregiver education - adequate fluid intake - 2L/day - fiber - veggies, fruits, & grains - probiotics

why does impaction happen?

Prolonged retention and accumulation of fecal material. •Caused by poor habits, laxative dependence, barium