*

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*Undigested food particles
* gastrointestinal secretions
*Swallowed air
*Gas produce during food fermentation
*Bacteria not needed by our body

Need to be eliminated
*Among older persons
elimination problems are
likely to occur

*Common elimination problems:

…constipation
…fecal impaction
…bowel incontinence
*condition in
which there is
infrequency of
defecation

*
*Rousseau
(1990)
*Claims that
constipation occurs
when there are fewer
than 3 bowel
movements per week
*For some, they
define
constipation as
difficulty passing
hardened stools
*Presence of hardened feces in the rectum
and sigmoid colon

*Pathophysiology:
feces remains in the colon for long
periods

Increases its size and become harder

Hardened and large sized stools aren’t able

to pass through the anal canal

Aren’t able to defecate voluntarily

*
*condition
where there is
inability to
control the
passage of
stools and flatus
*
*Factors that can affect
bowel elimination among
older persons:
*1. lifestyle factors
*2. physiologic
*3. psychosocial

*
*Older persons
have lessened
thirst and
therefore do not
drink enough fluids

*
* Physiology

1.Lack of fluid 2.Not enough 3.

bulk that will Decrease
decreases the stimulate mobility
transit of contents
internal
sphincter to Poor tone LEADS TO:
Contributes to
longer stay of dilate of the IRREGULAR
feces in the large muscles BOWEL
intestines External MOVEMENT
(enhances further
absorption of sphincter will Decrease
fluids) not dilate capacity
to
Making feces No urge to defecate
harder defecate
*1. Physiologic
factors
* Inability to chew food due to poor
dentition
* Decrease amounts of digestive
enzymes and gastric acids
(inability to breakdown food)
* Slowing of nerve impulses (slow
peristalsis/metabolism)
* Common drugs taken (e.g. antacids,
sedatives, pain relievers *
2.Psychosocial Factors

Nervousness
Agitation more
mobile  bowel
elimination
Depression decreases
activity and contributes
to constipation
*HARKREADER (2000)

*ALTERED BOWEL
MOVEMENTS can
interfere with person
ADL and sense of
wellbeing

*
*1. Valsalva maneuver – cardiac problems

*2. anal bleeding- hemorrhoids

*3. Malnutrition - due to altered bowel

elimination (feeling of
fullness)
fecal incontinence (decrease
absorption nutrients)

Dehydration
Electrolyte imbalance cause by
frequent passage
of stools

*
*SKIN irritation/skin
breakdown

* fecal incontinence
due to acidic nature of
the feces and constant
moisture
*Due to fecal
incontinence
- Uncontrolled Time and
energy
defecation can consuming
caused task
embarrassment and
social isolation

*
* BESTS MANAGEMENT: PREVENTION

* 1. Give adequate fluid and fiber

FIBER( vegetables and fruits)
-facilitates absorption of water to
improve intestinal motility
ex. Papaya-locally available
raisins
prunes
beans
cabbage gas forming foods
onions

*
* Apple
* Banana Pectin and
* Guava casein
hardened
* Star apple stools

*
*Warm drinks
*Fruits juices

* EFFECTIVE when taken with food

during the early morning
intestinal motility is greatest
immediately after post-absorptive
state ( OVERNIGHT FASTING)
* 2.
promote training and
habit formation

*MORNING is the bests

time to train people
(gastro-colic reflex is
strongest in the morning)
*3. suggest squatting position

*Ex. Sitting in a toilet bowl To

assume
* bed pain or low chair normal
squatting
position

*SAFETY,PRIVACY AND LONGER

TIME SHOULD BE PROVIDED
*4. exercise

*Resende, et al (1993),have
proven that exercise and
abdominal massage are
effective for preventing
and relieving constipation
in immobile patients
*5. consider
pharmacologic
management

*Bulk-forming agents-
constipation
*Stool softeners
*laxatives
*1. Interventions for bowel
elimination can also
helped
*2. but suppositories and
laxatives are
ineffective if it is
blocked by large stools
*3. MANUAL contraindicated:
DISEMPACTION is bests cardiac/hypertensive
clients
way to relieve in older
person *
* 1. Provide privacy-do not expose

* 2.position the client on the left side and flex

his/her knees to allow easier access to the sigmoid
colon and rectum
* Done double hand glove
* Moisten fingers with KY jelly or any water soluble
lubricant
* Insert finger and ask patient to deep breathly while
inserting
* Gently rotate finger to dislodged stool breaking
into smaller pieces to avoid injury of the rectal
lining

* 3. before removing finger gently stimulate the anal

spinchter with circular motion 2-3 times to
increase peristalsis and encourage defecation

*
*30-60 ml of mineral oil is
introduced to the rectum to soften
the hardened stool

*If nausea, pain, rectal bleeding is

experience stop the procedure

*Do it gradually in several sessions

*Causes of incontinence fecal
impaction
*Management for fecal impaction is
useful

*Target 2 goals:
*1. restoring normal bowel function
*2. maintaining skin integrity

*
*Bowel training Bowel training could

*Diet alterations fiber rich include:

.Daily enemas
.administering
diet suppository every

*Environmental manipulation morning and evening

(toilet training,
low chair,
bedpan)

*NOTE: Safety, privacy and

time
*