Bowel elimination: constipation, enemas and faecal impaction
- Fundamental
Nurses check the bowel pattern every day, prevent constipation and give enemas as ordered, alert to impaction and ileus.
What it is
Each person has their own bowel pattern; in general a soft or formed stool every one to three days is expected. Constipation is usually defined as fewer than three bowel movements a week, with hard stools and straining. Faecal impaction is hard stool collecting in the rectum, usually because the person does not feel the stool or does not use the toilet when the urge comes. Nurses assess the pattern, carry out the ordered bowel plan and give enemas or suppositories with safe technique.
Key points
- Risk factors for constipation: immobility, dehydration, low fibre, opioids, depression and abdominal surgery.
- Signs: rectal pressure, cramps, bloating, straining and hard, dry stools.
- The Bristol stool scale helps describe consistency.
- Impaction is treated by digital removal or oil-retention enemas, as ordered.
- After barium studies or abdominal surgery there is a risk of hardened stool or paralytic ileus.
Components
- Assessment: usual pattern, last bowel movement, stool characteristics and recent changes.
- Habits: fibre, fluids, activity, toileting routine and opioid use.
- Examination: bowel sounds in all four quadrants and light palpation of the abdomen.
- The ordered bowel plan: stool softener, laxative, suppository or enema.
What it is for
- Preventing constipation and impaction.
- Detecting obstruction or ileus early.
- Giving enemas and suppositories safely.
- Teaching the patient and family to manage at home.
Bowel problems the nurse must recognise
| Problem | What it is | What you see | What the nurse does |
|---|---|---|---|
| Constipation | Infrequent, hard or difficult stools | Fewer than three a week, straining, bloating | Fluids, fibre, activity and the ordered bowel plan |
| Faecal impaction | Hard stool collected in the rectum | A mass of hard stool; the patient does not feel the stool | Call; digital removal or an oil-retention enema as ordered |
| Diarrhoea | Frequent liquid stools | Several liquid stools | Hold laxatives, watch fluids and skin, call |
| Ileus or obstruction | Bowel contents do not move on | Bloating, pain, no flatus, vomiting, absent bowel sounds | Call at once; may need a nasogastric tube to suction |
In nursing practice
- Teach the patient to increase fluids, dietary fibre and activity, as allowed.
- Fibre supplements are taken with a full glass of water to avoid bowel obstruction.
- Before an enema or suppository, check for diarrhoea or active rectal bleeding.
- After an enema, the patient holds it until the urge is strong, usually about 5 to 15 minutes.
- The rectal route may not suit certain heart conditions.
Common mistakes
- Not asking about the last bowel movement until the patient has gone days without one.
- Giving laxatives to a patient who already has soft stools or diarrhoea.
- Placing a suppository into a mass of stool.
- Not watching for dizziness or bradycardia during an enema.
- Overlooking absent bowel sounds or increasing distension.
Test yourself
Think of the answer, then tap the question to see it.
In which position is an enema given?
Left side-lying (Sims' position), with the upper leg flexed towards the waist.
Which cardiovascular side effect is watched for during an enema?
Dizziness and bradycardia from vagal stimulation; the rectal route may not suit certain heart conditions.
Which bowel findings require calling at once?
Absent bowel sounds or signs of obstruction or ileus: bloating, pain, no flatus and vomiting.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nursing Fundamentals, 16.6 Constipation (Open RN (Chippewa Valley Technical College), LibreTexts, 2021); Nursing Fundamentals, 16.9 Elimination: Applying the Nursing Process (Open RN (Chippewa Valley Technical College), LibreTexts, 2021); Nursing Skills, 15.5 Checklist for Rectal Medication Administration (Open RN (Chippewa Valley Technical College), LibreTexts, 2021).
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Representative model, for educational purposes only.