Bowel Function

kistinbee

Okay here's another good read from the State of Minnesota Office of the Ombudsman for Mental Health and Developmental Disabilities. Like I said, since I'm having some issues, I've been doind some reading. Actually pretty good to know!

Normal bowel function:


Doctors often define constipation as a stool (or bowel movement) frequency of less than 3 times a week. Normal frequency of bowel movements can range from 3 times a day to 3 times a week. The pattern of bowel movements can be considered normal if it does not represent a change in the client’s usual frequency or character of stool and if passing the stool is not associated with discomfort (pain). Discomfort may be reported or observed as straining, hard stool, or feelings that client is unable to empty the bowel.

Normal stool in an adult or child (not infant) is brown, soft and formed. White or clay-colored stool, black/tarry stool, bloody, thin ribbon-like stool, narrow/pencil-shaped stool, hard or liquid stool is usually considered abnormal.

Why be so concerned about maintaining normal bowel function?

Constipation is more than an annoying problem. People with chronic constipation report they feel that they have a lower quality of life. People who have only one or two bowel movements per week are more likely to have obesity, diabetes, diverticulosis, hemorrhoids, and colon cancer. Constipation may lead to complications including fecal impaction, ulceration, bowel obstruction, sigmoid volvulus (the bowel twisting in a loop), incontinence of stool, rectal prolapse, urinary retention, and even dizziness (and falls). Increasing intestinal distension (stretching of the intestines) may lead to loss of blood flow to the bowel, perforation, and tissue death. Untreated, a bowel obstruction can cause hypovolemic or septic shock and death.

Factors that may contribute to constipation:

Dietary factors - low residue (low fiber) diet, not drinking enough liquids
Inactivity and immobility - movement disorders, gait disturbance (difficulty with walking and balance), wheelchair use, scoliosis, cerebral palsy, quadriplegia, paraplegia
Environmental factors - lack of routine, lack of privacy, schedules that cause the client to ignore the urge to have a bowel movement (defecate)
Structural abnormalities - hemorrhoids, tumors, narrow openings
Smooth muscle or connective tissue disorders - amyloidosis, scleroderma
Depression
Neurological disorders such as stroke, Parkinson’s disease, spinal cord tumors
Metabolic/endocrine disorders - high calcium, low potassium, low or high thyroid hormones (hypothyroidism or hyperthyroidism), diabetes, Addison’s disease

Medications - This list is intended to give common examples and cannot include all current or future medications that can cause constipation.


Opioid analgesics - codeine (30 mg in Tylenol #3), fentanyl, morphine, oxycodone, hydromorphone, meperidine
Nonsteroidal antiinflammatory drugs (NSAIDS) - Motrin/ibuprofen, Celebrex, Indocin, Toradol, Vioxx
Antacids - Amphojel/aluminum hydroxide, Tums/calcium carbonate
Anticholinergic drugs - Cogentin/benztropine, scopolamine (transdermal), methscopolamine, atropine, propantheline
Antidepressants - particularly lithium and tricyclics (like Elavil, Anafranil, desipramine, Pamelor, Tofranil/imipramine)
Antipsychotics - Clozaril, Risperdal, Zyprexa, Haldol, Seroquel, Mellaril, Thorazine
Antihypertensives - Captopril, Catapres/clonidine, Altace, Accupril, Inderal/propranolol
Antiarrhythmics - calcium channel blockers especially verapamil
Diuretics - Diamox, Lasix, Hydrochlorothiazide, Zaroxolyn, torsemide
Anticonvulsants - Klonopin, Cerebyx, Neurontin, Lamictal, Dilantin/phenytoin, Topamax, Depakote, Felbatol
Antihistamines - Benadryl
Anti-ulcer medications - Aciphex
Antilipidemics - Lipitor

Maintaining Healthy Bowel Function:

Serve and eat foods high in fiber instead of refined carbohydrates and concentrated fats. Vegetables (dried beans, Brussels sprouts, corn, peas, and potatoes), fruits (apples with peels, raisins, and prunes), and cereals (bran and whole wheat and whole grain bread) are high in fiber. Some foods can act as natural laxatives: figs, prunes, pears, raisins, and rhubarb.

Added intake of liquids should accompany an increase in fiber intake. Adults need at least 8 glasses of non-caffeinated beverages per day, unless a fluid restriction is required because of a medical condition. Fruit juices and warm liquids can be helpful.

Age-appropriate exercise program. Clients restricted to bed may benefit from range of motion exercises.

Establish a routine for bowel movements that includes a regular time and privacy. A bowel movement is most likely to occur an hour after meals. Positioning is important while attempting a bowel movement. Squatting increases pressure on the rectum and encourages use of abdominal muscles. Use of a toilet, raised toilet seat, or a bedside commode is better than the use of a bedpan whenever possible.

Treatments used for constipation include bulk laxatives (psyllium or bran), stool softeners (Colace and Surfak), stimulants (bisacodyl or senna), osmotic laxatives (lactulose, milk of magnesia, sorbitol, sodium salts), lubricants (mineral oil), and enemas. With bulk laxatives and stool softeners, enough liquids must be taken to make them work.

Frequent use of some laxatives is harmful and can be habit-forming.

Talk with your clients about healthy bowel function and the signs and symptoms that are important to report to a health professional.

Monitoring bowel function:

It is important for every facility and home health care program to have an established procedure for monitoring bowel function and responding to changes. Clients should be asked on a daily basis whether they have had a bowel movement. The information needs to be documented in order to learn what the individual’s normal routine is and to monitor for the development of problems.

Be sure to monitor the bowel function of clients who have had recent abdominal surgeries, injuries, medication changes, and changes in diet or activity level.


Since many clients are unable or unlikely to communicate verbally because of cognitive challenges, staff must also be skilled at detecting non-verbal signs of pain or discomfort.

SIGNS AND SYMPTOMS OF CONSTIPATION

• Change in bowel frequency (decrease) or consistency
• Soft, paste-like stool in rectum or hard stool with oozing liquid stool
• Feeling of rectal fullness
• Straining at stool
• Decreased or hyperactive bowel sounds
• Report of feeling abdominal fullness or pressure
• Distended (swollen) abdomen
• Indigestion
• Severe gas
• Nausea
• Other - back pain, headache, decreased appetite

SIGNS AND SYMPTOMS OF A BOWEL OBSTRUCTION

• Abdominal pain - may be described as dull, squeezing or ill-defined, constant, or "colicky" (a sharp pain that may come and go)
• Abdominal distension - swollen abdomen may push on diaphragm and affect breathing
• Nausea and vomiting • Decreased urine output (from dehydration which is possible even without vomiting)
• Constipation
• Fever, chills
• Abnormal bowel sounds


BOTTOM LINE

The symptoms of constipation and bowel obstruction can look like “the flu” and look like each other.

kistinbee

Okay here's another good read from the State of Minnesota Office of the Ombudsman for Mental Health and Developmental Disabilities. Like I said, since I'm having some issues, I've been doind some reading. Actually pretty good to know!

Normal bowel function:


Doctors often define constipation as a stool (or bowel movement) frequency of less than 3 times a week. Normal frequency of bowel movements can range from 3 times a day to 3 times a week. The pattern of bowel movements can be considered normal if it does not represent a change in the client’s usual frequency or character of stool and if passing the stool is not associated with discomfort (pain). Discomfort may be reported or observed as straining, hard stool, or feelings that client is unable to empty the bowel.

Normal stool in an adult or child (not infant) is brown, soft and formed. White or clay-colored stool, black/tarry stool, bloody, thin ribbon-like stool, narrow/pencil-shaped stool, hard or liquid stool is usually considered abnormal.

Why be so concerned about maintaining normal bowel function?

Constipation is more than an annoying problem. People with chronic constipation report they feel that they have a lower quality of life. People who have only one or two bowel movements per week are more likely to have obesity, diabetes, diverticulosis, hemorrhoids, and colon cancer. Constipation may lead to complications including fecal impaction, ulceration, bowel obstruction, sigmoid volvulus (the bowel twisting in a loop), incontinence of stool, rectal prolapse, urinary retention, and even dizziness (and falls). Increasing intestinal distension (stretching of the intestines) may lead to loss of blood flow to the bowel, perforation, and tissue death. Untreated, a bowel obstruction can cause hypovolemic or septic shock and death.

Factors that may contribute to constipation:

Dietary factors - low residue (low fiber) diet, not drinking enough liquids
Inactivity and immobility - movement disorders, gait disturbance (difficulty with walking and balance), wheelchair use, scoliosis, cerebral palsy, quadriplegia, paraplegia
Environmental factors - lack of routine, lack of privacy, schedules that cause the client to ignore the urge to have a bowel movement (defecate)
Structural abnormalities - hemorrhoids, tumors, narrow openings
Smooth muscle or connective tissue disorders - amyloidosis, scleroderma
Depression
Neurological disorders such as stroke, Parkinson’s disease, spinal cord tumors
Metabolic/endocrine disorders - high calcium, low potassium, low or high thyroid hormones (hypothyroidism or hyperthyroidism), diabetes, Addison’s disease

Medications - This list is intended to give common examples and cannot include all current or future medications that can cause constipation.


Opioid analgesics - codeine (30 mg in Tylenol #3), fentanyl, morphine, oxycodone, hydromorphone, meperidine
Nonsteroidal antiinflammatory drugs (NSAIDS) - Motrin/ibuprofen, Celebrex, Indocin, Toradol, Vioxx
Antacids - Amphojel/aluminum hydroxide, Tums/calcium carbonate
Anticholinergic drugs - Cogentin/benztropine, scopolamine (transdermal), methscopolamine, atropine, propantheline
Antidepressants - particularly lithium and tricyclics (like Elavil, Anafranil, desipramine, Pamelor, Tofranil/imipramine)
Antipsychotics - Clozaril, Risperdal, Zyprexa, Haldol, Seroquel, Mellaril, Thorazine
Antihypertensives - Captopril, Catapres/clonidine, Altace, Accupril, Inderal/propranolol
Antiarrhythmics - calcium channel blockers especially verapamil
Diuretics - Diamox, Lasix, Hydrochlorothiazide, Zaroxolyn, torsemide
Anticonvulsants - Klonopin, Cerebyx, Neurontin, Lamictal, Dilantin/phenytoin, Topamax, Depakote, Felbatol
Antihistamines - Benadryl
Anti-ulcer medications - Aciphex
Antilipidemics - Lipitor

Maintaining Healthy Bowel Function:

Serve and eat foods high in fiber instead of refined carbohydrates and concentrated fats. Vegetables (dried beans, Brussels sprouts, corn, peas, and potatoes), fruits (apples with peels, raisins, and prunes), and cereals (bran and whole wheat and whole grain bread) are high in fiber. Some foods can act as natural laxatives: figs, prunes, pears, raisins, and rhubarb.

Added intake of liquids should accompany an increase in fiber intake. Adults need at least 8 glasses of non-caffeinated beverages per day, unless a fluid restriction is required because of a medical condition. Fruit juices and warm liquids can be helpful.

Age-appropriate exercise program. Clients restricted to bed may benefit from range of motion exercises.

Establish a routine for bowel movements that includes a regular time and privacy. A bowel movement is most likely to occur an hour after meals. Positioning is important while attempting a bowel movement. Squatting increases pressure on the rectum and encourages use of abdominal muscles. Use of a toilet, raised toilet seat, or a bedside commode is better than the use of a bedpan whenever possible.

Treatments used for constipation include bulk laxatives (psyllium or bran), stool softeners (Colace and Surfak), stimulants (bisacodyl or senna), osmotic laxatives (lactulose, milk of magnesia, sorbitol, sodium salts), lubricants (mineral oil), and enemas. With bulk laxatives and stool softeners, enough liquids must be taken to make them work.

Frequent use of some laxatives is harmful and can be habit-forming.

Talk with your clients about healthy bowel function and the signs and symptoms that are important to report to a health professional.

Monitoring bowel function:

It is important for every facility and home health care program to have an established procedure for monitoring bowel function and responding to changes. Clients should be asked on a daily basis whether they have had a bowel movement. The information needs to be documented in order to learn what the individual’s normal routine is and to monitor for the development of problems.

Be sure to monitor the bowel function of clients who have had recent abdominal surgeries, injuries, medication changes, and changes in diet or activity level.


Since many clients are unable or unlikely to communicate verbally because of cognitive challenges, staff must also be skilled at detecting non-verbal signs of pain or discomfort.

SIGNS AND SYMPTOMS OF CONSTIPATION

• Change in bowel frequency (decrease) or consistency
• Soft, paste-like stool in rectum or hard stool with oozing liquid stool
• Feeling of rectal fullness
• Straining at stool
• Decreased or hyperactive bowel sounds
• Report of feeling abdominal fullness or pressure
• Distended (swollen) abdomen
• Indigestion
• Severe gas
• Nausea
• Other - back pain, headache, decreased appetite

SIGNS AND SYMPTOMS OF A BOWEL OBSTRUCTION

• Abdominal pain - may be described as dull, squeezing or ill-defined, constant, or "colicky" (a sharp pain that may come and go)
• Abdominal distension - swollen abdomen may push on diaphragm and affect breathing
• Nausea and vomiting • Decreased urine output (from dehydration which is possible even without vomiting)
• Constipation
• Fever, chills
• Abnormal bowel sounds


BOTTOM LINE

The symptoms of constipation and bowel obstruction can look like “the flu” and look like each other.

kistinbee

BUMP