What are the implications associated with the following common bowel elimination problems: constipation, impaction, diarrhea, incontinence, flatulence, and hemorrhoids?
- Constipation: decreased peristalsis; decreased frequency of BMs and/or prolonged or difficult passage of hard stools; this is something that is highly individualized (BM frequency ranges from 3x p/d - 3x p/w); Causes: decreased amount of food intake, decreased fluid intake, decreased muscle tone, insufficient exercise, ignoring the urge to go, laxative abuse; Implementation: respond to urge, help if needed, provide time & privacy, ensure adequate fluid intakes, provide appropriate positioning, increase overall activity, get adequate fiber.
- Impaction: stool that cannot be passed, unrelieved constipation; usually seen in bed bound patients and those who havent had BM in several days; Signs: oozing diarrhea around the mass, anorexia, abdominal distention, cramping, & rectal pain; implementation: for impaction physical removal of mass by hand (must have MD order) done with enema and lube; monitor vitals during this
- Diarrhea: increased perstalsis; increase in number of stools and passage of liquid & unformed feces; can lead to F/E imbalance; Causes: improper diet, ABX, enteral nutrition, food/allergy intolerances, C. difficile, surgery, diagnostic tests; implementation: remove the cause, respond to pt urge to go, be careful giving anti-diarrheal meds, maintain F/E balance, use moist wipes, promote dairy products to return to normal flora
- Incontinence: may be secondary to diarrhea; can cause body alterations, embarrassment, & skin breakdown; Causes: SCI, CVA, infection, impaction, depression, sedatives; implementation: assist if needed, note when it will occur, provide support and understanding, provide pericare, change linens, retrain bowel, maintain their dignity, give fecal caths
- Flatulence: intestinal gas; the inability to pass this can cause abdominal distention, SOB, fullness, or cramping; Causes: diet, opiates, general anesthesia, abdominal surgery, or immobility; implementation: avoid gas producing foods, increase activity, reposition, give return flow enema, NG tube, or rectal tube
- Hemorrhoids: distended rectal veins that can be internal or external; usually due to straining during defecation or other actions; Symptoms: itching, bleeding, & burning after defecation; implementation: promote soft stools in various ways, local heat/sitz baths, be careful with thermometers & enemas, use moist wipes, administer prescribed ointments/creams