Continence Care Part 3: Evidence Based Bowel Assessment

1. Introduction to Bowel Physiology

This chapter will introduce normal bowel function, using graphic images to present structures and function of the colon, rectum, and digestive system. Similarly, the neurological system including spinal nerves (through sacrum and thoracic regions) and the neurological controls will be discussed. Neurological, gastrointestinal, gastro-hormonal and neuromuscular controls that guide digestion and water resorption will be presented. A description of digestion and defecation controls by the parasympathetic/sympathetic and somatic nervous systems will be described. Abnormal bowel function will be introduced briefly, using graphics to discuss trauma and other various disease states that can result in bowel dysfunction.

2. Risk Factors for Dysfunction

This chapter provides a description of various risk factors for bowel dysfunction. Each element is briefly described in simple terms. Like bladder dysfunction, risk factors will be discussed including: neuro-cognitive, structural, and common disease-states that cause bowel function.

3. The Patient Interview: Screening for Bowel Dysfunction

This chapter will introduce the patient interview process and will promote the use of the Bristol Stool scale to assist the patient in providing useful information to the nurse. The inquiry will include how to identify any current bowel symptoms, previous bowel problems, normal patterns prior to hospitalization, the history and effect of laxatives if previously used and any past experience with fecal incontinence or recurring diarrhea (screening for functional or chronic bowel conditions). Red flag symptoms that require a specialist’s attention will also be presented.

4. The Physical Assessment

This chapter will introduce a systematic approach to a patient assessment to identify bowel dysfunction. These will include examination of oral/swallow ability, a focused neurological exam (external and internal anal reflexes), an abdominal exam, inspection of the perineal skin and urethral meatus and, finally, a functional assessment: mobility, comprehension, problem solving and balance.

5. Data Collection

This chapter will introduce the importance of collecting data to evaluate a patient’s bowel patterns. This module proposes the use of a specially designed frequency-volume/elimination chart. Additional data to collect includes dietary consumption patterns (hydration, fiber intake). This section will also present the use of previous antibiotics, length of stay in the hospital and other factors that increase the patient’s risk for C-diff colitis. A comprehensive medication review will be presented (to identify medications that contribute to bowel symptoms, specifically narcotics that cultivate constipation).

6. Symptom Identification and Nursing Diagnosis: Designing Bowel Programs

This chapter introduces the “next steps” after performing a comprehensive assessment of the patient and provides instructions to define and plan for managing constipation (and its various forms) and diarrhea with or without fecal incontinence. This final chapter will provide an introduction to the bowel management module.