Chapter 37 Bowel Elemination
Anatomy and Physiology of GI Tract
Mouth: The mouth mechanically and chemically breaks down the nutrition’s into useable size
and form.
Esophagus: Esophageal sphincter, a circular muscle that prevents air from entering the
esophagus and food from refluxing in the throat.
Peristalsis: a contraction that propels food through the length of the GI tract
The sphincter prevents reflux of stomach contents
Stomach: The stomach performs three tasks: storing swallowed food and liquid, mixing food
with digestive juices, and regulating emptying of its contents into the small intestines.
The stomach produces and secretes hydrochloric acid, mucus, the enzyme pepsin, and intrinsic
factor. Pepsin and HCI facilitate the digestion of protein. Mucus protects the stomach mucosa
from acidity and enzyme activity.
Small intestine: Movement within the small intestine facilitates both digestion and absorption.
The small intestine is separated in to three parts: duodenum, the jejunum, and the ileum. The
duodenum is about 8-11 inches long and continues to process the fluid from the stomach. The
jejunum is about 8 feet long and absorbs carbohydrates and proteins. The duodenum and the
jejunum absorb most nutrients and electrolytes in the small intestine. The ileum is about 12 feet
long and absorbs water, fats, and bile salts. The ileum absorbs certain vitamins, iron and bile
salts.
Large intestine: The large intestine is divided into the cecum, ascending colon, transverse colon,
descending colon, sigmoid colon, and rectum. It is the primary organ of bowel elimination.
The colon has three functions: absorption, secretion, and elimination. It resorbs a large volume of
water (up to 1.5 L) and significant amounts of sodium and chloride daily.
Fast movement= watery stool, Normal movement= soft, solid, Slow=constipation
The rectum is normally empty of feces until just before defecation. Each fold contains veins that
can become distended from pressure during straining.
Anus: The body expels feces and flatus from the rectum trough the anus.
The anal canal contains a rich supply of sensory nerves that allow people to sense when there is
solid, liquid, or gas that needs to be expelled and aids in maintaining continence.
Defecation: Normal defecation begins with movement in the left colon, moving stool toward the
anus.
, Straining while having a bowel movement indicates that the patient may need changes in diet or
fluid intake or that there is an underlying disorder in the GI function.
Bowel Elimination Problems:
Constipation: defines as having fewer than three bowel movements per week.
Health care providers now also define constipation as one or more of the following: (1) hard or
dry stools, (2) decreased frequency of stooling, (3) sensations of incomplete evacuation
following a bowel movement, and (4) pain or straining associated with stool elimination
Straining while pooping is not normal or good!
Impaction: Fecal impaction results from unrelieved constipation.
An obvious sign of impaction is the inability to pass a stool for several days, despite a repeated
urge to defecate. Continuous oozing of liquid stool after several days with no fecal output may
indicate an impaction. Loss of appetite, abdominal distention and cramping, nausea and/or
vomiting, and rectal pain can also occur.
Remove impaction by lubricated gloved hand.
Diarrhea: Diarrhea is an increase in the number of stools and the passage of liquid, unformed
stools.
Intestinal contents pass to quickly through the small intestine and colon to allow for the usual
absorption of fluid and nutrients.
Older adults and very young children are at the greatest risk for dehydration. Persistent diarrhea
can cause skin breakdown. You want to make sure to increase fluids when someone has
persistent diarrhea.
A common cause of diarrhea in health care facilities is from C. Difficile. The best way to prevent
the occurrence and spread of C. Diff is cautious use of antibiotics and rigorous hand hygiene
with soap and water. Clean surfaces with bleach.
Fecal incontinence: Fecal incontinence is the temporary or permanent inability to control the
passage of feces and gas from the anus.
Affects up to 20% of community-living adults and nearly 50% of nursing home residents.
Impairment of anal sphincter function or control may cause incontinence.
Flatulence: one of the most common GI disorders. It is a sensation of bloating and abdominal
distention accompanied by excess gas.
Foods that can cause flatulence: eggs, beans, broccoli
Hemorrhoids: are dilated, engorged veins in the lining of the rectum. Increased venous pressure
resulting from straining at defecation, pregnancy and chronic illnesses such as congestive heart
failure and chronic liver disease are causative factors.
Anatomy and Physiology of GI Tract
Mouth: The mouth mechanically and chemically breaks down the nutrition’s into useable size
and form.
Esophagus: Esophageal sphincter, a circular muscle that prevents air from entering the
esophagus and food from refluxing in the throat.
Peristalsis: a contraction that propels food through the length of the GI tract
The sphincter prevents reflux of stomach contents
Stomach: The stomach performs three tasks: storing swallowed food and liquid, mixing food
with digestive juices, and regulating emptying of its contents into the small intestines.
The stomach produces and secretes hydrochloric acid, mucus, the enzyme pepsin, and intrinsic
factor. Pepsin and HCI facilitate the digestion of protein. Mucus protects the stomach mucosa
from acidity and enzyme activity.
Small intestine: Movement within the small intestine facilitates both digestion and absorption.
The small intestine is separated in to three parts: duodenum, the jejunum, and the ileum. The
duodenum is about 8-11 inches long and continues to process the fluid from the stomach. The
jejunum is about 8 feet long and absorbs carbohydrates and proteins. The duodenum and the
jejunum absorb most nutrients and electrolytes in the small intestine. The ileum is about 12 feet
long and absorbs water, fats, and bile salts. The ileum absorbs certain vitamins, iron and bile
salts.
Large intestine: The large intestine is divided into the cecum, ascending colon, transverse colon,
descending colon, sigmoid colon, and rectum. It is the primary organ of bowel elimination.
The colon has three functions: absorption, secretion, and elimination. It resorbs a large volume of
water (up to 1.5 L) and significant amounts of sodium and chloride daily.
Fast movement= watery stool, Normal movement= soft, solid, Slow=constipation
The rectum is normally empty of feces until just before defecation. Each fold contains veins that
can become distended from pressure during straining.
Anus: The body expels feces and flatus from the rectum trough the anus.
The anal canal contains a rich supply of sensory nerves that allow people to sense when there is
solid, liquid, or gas that needs to be expelled and aids in maintaining continence.
Defecation: Normal defecation begins with movement in the left colon, moving stool toward the
anus.
, Straining while having a bowel movement indicates that the patient may need changes in diet or
fluid intake or that there is an underlying disorder in the GI function.
Bowel Elimination Problems:
Constipation: defines as having fewer than three bowel movements per week.
Health care providers now also define constipation as one or more of the following: (1) hard or
dry stools, (2) decreased frequency of stooling, (3) sensations of incomplete evacuation
following a bowel movement, and (4) pain or straining associated with stool elimination
Straining while pooping is not normal or good!
Impaction: Fecal impaction results from unrelieved constipation.
An obvious sign of impaction is the inability to pass a stool for several days, despite a repeated
urge to defecate. Continuous oozing of liquid stool after several days with no fecal output may
indicate an impaction. Loss of appetite, abdominal distention and cramping, nausea and/or
vomiting, and rectal pain can also occur.
Remove impaction by lubricated gloved hand.
Diarrhea: Diarrhea is an increase in the number of stools and the passage of liquid, unformed
stools.
Intestinal contents pass to quickly through the small intestine and colon to allow for the usual
absorption of fluid and nutrients.
Older adults and very young children are at the greatest risk for dehydration. Persistent diarrhea
can cause skin breakdown. You want to make sure to increase fluids when someone has
persistent diarrhea.
A common cause of diarrhea in health care facilities is from C. Difficile. The best way to prevent
the occurrence and spread of C. Diff is cautious use of antibiotics and rigorous hand hygiene
with soap and water. Clean surfaces with bleach.
Fecal incontinence: Fecal incontinence is the temporary or permanent inability to control the
passage of feces and gas from the anus.
Affects up to 20% of community-living adults and nearly 50% of nursing home residents.
Impairment of anal sphincter function or control may cause incontinence.
Flatulence: one of the most common GI disorders. It is a sensation of bloating and abdominal
distention accompanied by excess gas.
Foods that can cause flatulence: eggs, beans, broccoli
Hemorrhoids: are dilated, engorged veins in the lining of the rectum. Increased venous pressure
resulting from straining at defecation, pregnancy and chronic illnesses such as congestive heart
failure and chronic liver disease are causative factors.
