GI/GU: Assisting with bowel elimination

Defecation refers to the excretion of feces, commonly referred to as “poop” or “stool,” which are semi-solid waste products that result from the intestinal digestion of nutrients.

Feces form in the colon, and they are stored in the rectum until they can be released through the anus during defecation.

The process is also often called a “bowel movement.” And usually, bowel movements are also accompanied by “flatus” which is the fancy way of saying gas, or air, passing through the anus.

This is not to be confused with flatulence, or excessive gas formation in the stomach and intestines. Bowel movements are a physiological way for the body to eliminate waste and prevent us from getting sick, so normal bowel habits and stools are super important to our overall health.Normal bowel habits vary from person to person.

Some people pass a bowel movement once a day, some only every 2 or 3 days, while some people can have 2 or 3 bowel movements per day; and that’s normal if there’s no change in stool quality.

Normal stool is usually brown, but color varies depending on diet and fluid intake. Stool can be red after eating tomato juice, tomato soup, or foods with red food coloring, like ketchup.

Pathologically, red stool can also mean there’s intestinal bleeding. Green foods, on the other hand, can make stool greener.

Pathologically, green stools as well as clay-colored, white, yellow, or orange stools can signal a disease or infection.

Regarding shape and consistency, there’s a useful tool called the Bristol stool chart that can help orient us. According to this chart, there are 7 types of stool, numbered from 1 to 7, which go from hard to soft.

So, type 1 stools are represented by hard, separate lumps. Type 2 is when the stool is formed, with lumps, and has a “sausage like'' aspect.

Types 1 and 2 usually indicate severe and mild constipation, respectively, which means the passage of a hard, dry stool.

Prolonged constipation can also cause fecal impaction which is when feces stay in the rectum so long that they form a hard, solid mass.

Type 3 is when the stool is formed, with cracks, while type 4 is when the stool is smooth and soft. Types 3 and 4 are considered normal stools.

Type 5 is when stool is organized as small blobs with clear-cut edges and that may be because of a low fiber diet. Type 6 is when the stool is loose and unformed and has a mushy consistency, and finally, type 7 is when the stool is entirely liquid, and there are no solid pieces.

The last two types indicate mild and severe diarrhea or they can be signs of inflammation in the GI tract. Diarrhea is technically defined as the frequent passage of liquid stools.

Now, before we go into each procedure, some common care tips include: Make sure the path to the toilet is lit before the client goes to the bathroom.

Answer call lights promptly, especially if the client is elderly or has a history of fecal incontinence. Keep note of the client’s normal bowel habits, so you can recognize any changes.

Warm bedpans are more comfortable and close the door and bed curtains for privacy when using them. A person might be too embarrassed to defecate when you’re there, so leaving the room or looking away might help but stay nearby in case they need assistance.

You might be asked to provide perineal care, or “peri-care,” where you clean the anal region. Use disposable cloths and wipe from the front to the back to keep bacteria away from the genital region.

Finally, when you finish assisting, check their clothing, gown, and bedsheet to ensure they’re dry and not soiled. It’s also important for you to know a couple of strategies that can prevent constipation.

These include encouraging clients to eat a high fiber diet, to drink lots of liquids, and to exercise regularly. If constipation occurs, suppositories or an enema can be used.

Suppositories are drugs that can be inserted in the rectum to help relieve constipation. In some states, nursing assistants can insert suppositories themselves, while in others, the nurses do that.

An enema is when fluid is inserted into the rectum and lower colon, and this can be done to relieve both constipation and fecal impaction.

For people who can’t use the toilet, a bedside commode or a bedpan can be used. A bedside commode looks like a chair with a toilet seat and a removable waste container.

A bedside commode is used for people who can get out of bed but can’t get to the bathroom. A bedpan, on the other hand, is a container that can be placed underneath the buttocks while the person’s still in bed, so it’s mainly used for bedridden people.

There are two types of bedpans: regular bedpans, which are the same thickness all the way through, and fracture bedpans, which are wedge-shaped with a thin end and a thick end.

Fracture pans are not as tall as normal bed pans, so they are safer to use for people with back or hip fractures or other injuries.

To use a bedpan for bowel elimination, put on gloves and lower the bed to a comfortable working height. Roll the client onto their side, so they’re in the lateral position and place down the bed protector.

Move the gown, so the buttocks are exposed. Ask them to bend their knees and place the bedpan firmly against their buttocks.

Place a standard bedpan like a regular toilet seat. A fracture bedpan is placed with the thin end towards the person’s back.

Roll them back into the supine position and make sure the bedpan is under them securely. Tell them it’s ready and give them time to defecate.

For some clients, you can leave the room until they finish if they can hold the bedpan themselves. Remember to remove gloves when you leave and put on a new pair when you come back.

Provide tissue paper or a moist cloth or pre-moistened sheets if they are able to clean themselves. Otherwise, you might be asked to assist in perineal care.

To remove the bedpan, ask them to push against the bed with their feet to lift their hips off the bed, so you can take the bedpan.

Put on the bedpan cover and remove the bed protector. Cover the client back up with the gown.

Take the pan to the bathroom and empty the contents into a toilet. You might be asked to take a sample, check the stool color, amount and consistency, or leave it for a nurse to look at.

Take off your gloves, dispose of them safely, and wash your hands. Put on new gloves, return, and help the clients wash their hands and make sure they’re dry and comfortable.

There are a couple things you should report to the nurse right away, like if the client reports abdominal pain with bowel movement, excessive flatus or bloating, fecal incontinence between bowel movements, or any other change in their bowel habits, like constipation or diarrhea.

Any abnormalities in the stool, like blood or mucus, should also be reported. These findings need to be documented after reporting.

If there are no abnormalities, document the date and time you’ve assisted with the bowel movement, what assistive device was used, the general quality of the stool, and frequency of the bowel movements.

All right, as a quick recap… Defecation is the process of excreting feces from the body, also called a “bowel movement.” Understanding normal and abnormal bowel habits is important in order to recognize signs of possible illness in individuals.

Any changes in bowel habits or stool quality, like diarrhea, constipation, fecal impaction, or flatulence, should be reported to the nurse.

Suppositories or an enema can be used to help relieve constipation. For clients with limited mobility that are not bed bound, a commode is used.

For those who can not get out of bed, a bedpan is used instead.