Bowel Workshop Alison Bardsley – Continence Advisor and Continence Service Manager, Oxon. Clinical...
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Transcript of Bowel Workshop Alison Bardsley – Continence Advisor and Continence Service Manager, Oxon. Clinical...
Bowel Workshop
Alison Bardsley – Continence Advisor and Continence Service Manager, Oxon.
Clinical Director – Continence UK
Supported by an educational grant from
Function of the Large Bowel
• Storage of food prior to elimination
• Absorption of remaining water, electrolytes and some vitamins
• Synthesis of Vitamin K and some
Vitamin B by colonic bacteria
• Secretion of mucus to lubricate the faeces
• Elimination of food residual
How to Know when it’s time to ‘go’
• Faeces move from sigmoid colon into the rectum• Full rectum• Adopt correct posture• Raise intra-abdominal pressure• Internal and external anal sphincters relax• Rectum contracts to expel stool• Should pass soft formed stool with minimal effort• Sphincter “snaps shut” after completion
THE IDEAL BOWEL MOVEMENT
• The feeling you want to go is definite but not irresistible
• Once you sit on the toilet there is no delay
• No conscious effort or straining
• The stool glides out smoothly & comfortably
• Followed by a pleasant feeling of relief
Have a LookHave a LookHave a Look
• Change in ‘normal’ bowel habit persistent for 6 weeks• Undiagnosed rectal bleeding• Undiagnosed rectal pain• Blood/slime in stool• Accompanying abdominal pain/vomiting• Anorexia and weight loss• Suspected infected stool
*Refer to national colorectal cancer screening guidelines
BRISTOL STOOL FORM SCALE*
Type 1: Hard lumps like nuts
Type 2: Lumpy sausage
Type 3: Sausage with cracked surface
Type 4: Sausage with smooth surface
Type 5: Soft blobs with well-defined margins
Type 6: Fluffy with ragged
edges
Type 7: Watery, no solid pieces
* Reproduced by kind permission of Dr Ken Heaton, Bristol University.
9
Risk factors for Constipation
• Medical condition
• Medication
• Toileting facilities
• Mobility
• Nutritional intake
• Fluid Intake
Diet
Fibre softens stools and speeds transit Caffeine stimulates the gut Artificial sweeteners can cause diarrhoea Advice on fibre moderation if stool loose or
increase if hard Gradual caffeine reduction Look for sensitivities in diet
Dietary Fibre:18-30g per day
Fluid Intake:1.5 to 2 litres per day
Fruit and vegetables:5 portions per day
Introduce fibre gradually
if in doubt, liaise with dietician for specialist advice
Fibre don’t over do it
Insoluble & Soluble Fibre
• Insoluble - bulking (laxative) agents help prevent constipation– Examples: Oats, fruit, vegetables and pulses
• Soluble – help reduce blood cholesterol levels & can help control blood sugar levels– Examples: Wholegrain cereals and wholemeal
bread
What about laxatives?
Choice of agent will depend on
• Presenting symptoms• Nature of complaint• Efficacy• Side –effects• Speed of action• Patient acceptability• Compliance• Cost
Types of laxatives
• Bulk forming
– Fybogel®, Celvevac® Normacol®, Regulan®
Relieve constipation by increasing faecal mass which stimulates peristalsis
Usually work within 24 -36 hours
Stimulant Laxatives
• Senna, Bisacodyl, co-danthramer, co-danthrasate, dioctyl, docusol
Stimulate an increase in colonic motility (peristalsis) and mucus secretion
Rapid acting 8-12 hours
Faecal Softener
• Liquid paraffin, arachis oil
Lubricate and soften faeces to promote a bowel movement by lowering surface
tension of colonic contents and allowing fat and fluid to penetrate.
Osmotic/iso-osmotic Laxatives• Lactulose and Magnesium salts – Osmotic
Act by drawing fluid from the body into the bowel by osmosis
• MOVICOL® - iso-osmotic
MOVICOL increases stool water content and directly triggers colonic propulsive activity and defaecation.
4 in 1 mode of action: Bulks, softens, stimulates and lubricates.
Enemas & Suppositories
• Phosphate, Sodium citrate, Bisacodyl, Glycerine
Uses:
Acute or severe constipation
Retention or evacuation
Stimulation or lubricant
NEUROLOGICAL DISEASE• Most patients will have a degree of
dysfunction or suffer from constipation
• Caused by:-– Loss of mobility– Constipating medication– Obstetric trauma– Anal sphincter mechanism impairment– Dysphagia– Cognitive problems– Inadequate care & facilities– Lack of understanding of care needs
AUTONOMIC DYSREFLEXIAUnique to spinal injury above T6
SYMPTOMS Headaches Severe hypertension Flushing above the lesion Sweating below the lesion Blotching of the skin Nasal congestion Bradycardia / tachycardia Palpitations Dilation of the pupils
SYMPTOMS Headaches . Severe hypertention Flushing above the lesion Sweating below the lesion Blotching of the skin Nasal congestion Bradycardia / tachycardia Palpitations Dilation of the pupils
TREATMENT
• Acute medical emergency
• Remove the offending stimulus eg pr
• Elevate patients head
• Inspect skin & toe nails
• Medicate with nifedipine
• Sensation• Tone• Outcome• Medication• Presence• Effect & Evaluation• Removal• Stimulation
Indications for Digital Rectal Examination
Indications to perform a Manual Removal of Faeces
• Failure of other bowel techniques
• Loading or impaction
• Incomplete defaecation
• Inability to defaecate
• Neurogenic cause of bowel dysfunction
• Spinal Injury patients
Consent and legal issues
Lawful Consent
• Consent should be given by someone with the mental ability to do so
• sufficient information should be given to the patient
• Consent must be freely given
Considerations – • Adults unable to give consent • Children
Conclusion
• Health care practitioners play a key role
• An holistic assessment is essential
• Establish the underlying cause and thus plan treatment accordingly
• Patient/general public education on prevention of constipation
.
Any questions?
Norgine Pharmaceuticals Ltd. for providing an Norgine Pharmaceuticals Ltd. for providing an educational grant to support this workshop.educational grant to support this workshop.
Contact details:
With thanks to…