Bowel & Bladder
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Overactive Bladder  Information on overactive bladder from

BOWEL ELIMINATION

CONSTIPATION

Bowel elimination habits can differ from person to person. Some people may move their bowels 2-3 times each week while others may move their bowels daily. A person with a serious illness may have less frequent bowel movements or difficulty passing stools which leads to CONSTIPATION. Pain medication, poor diet, and immobility are among the common causes of constipation. Avoiding constipation is important to preventing serious complications.

The following preventative measures should be undertaken daily:

Maintain a well-balanced diet, as much as possible. Add fresh fruits and vegetables and whole grain breads and cereals for a high fiber diet.
Provide a routine time, each day, for attempts at elimination (such as after breakfast).
Drink extra fluids, as tolerated, such as juices, nectars. Prune juice and hot beverages, as a bowel stimulant, are best if taken in the morning.
Use a stool softener (Docusate) daily as prescribed by your physician.
Use Milk of Magnesia, 2 tablespoons, each night when a BM has not occurred that day.
Use Dulcolax (Bisacodyl) suppository in the a.m. for difficulty passing stool.

Consult your Nurse for further directions on laxative administration. Notify your Nurse if prevention measures and laxatives are not effective in promoting regular bowel movements (adequate BM every 2-4 days). Additional laxatives and/or enemas may be recommended. Hemorrhoids should be treated regularly with medication to prevent pain, bleeding, and failure to move bowels.

GUIDELINES FOR USING BEDPAN OR BEDSIDE COMMODE

Run warm water over a metal bedpan prior to use.
Pad the backside of a bedpan with a towel; sprinkle powder on the bedpan to prevent sticking to skin.
Raise the bed bound person in an upright, sitting position.
Place the bedside commode close to the bed and offer assistance in moving in and out of bed.
Provide a private and relaxed atmosphere.
Wear disposable gloves. Always wash hands after handling toileting articles.

In the end stages of a progressive illness there may be no bowel movements. Trying to force bowel movements at this time may cause discomfort, pain, or trauma. Your Nurse will inform you if there is any concern.

BOWEL ELIMINATION - DIARRHEA

Diarrhea is characterized by frequent, watery stools (3 or more stools per day), and may be accompanied by cramping. Diarrhea is a common cause of dehydration and steps should be taken immediately to control excess fluid loss. If diarrhea occurs, notify your Nurse and stop laxative administration. If diarrhea persists, noting the character of the stools (consistency, color, frequency) will help in determining appropriate treatment.

During episodes of diarrhea, it may be necessary to determine if stool impaction is present in the rectum, thus allowing for only fluid passage past the stool blockage. Your Nurse may perform a rectal exam, and may need to assist in stool removal through enemas or digital manipulation.

Diarrhea may cause excessive skin irritation around the rectum due to contact with digestive enzymes. Diarrhea may also be associated with involuntary bowel evacuation (incontinence).

 

GUIDELINES FOR DIARRHEA CARE

Offer fluids or rehydration drinks often ( 1 to 2 cups of liquid to replace each loose watery stool).
Stop laxatives and consult with your Nurse or Physician.
Note consistency, color, frequency of stools, cramping.
Assist with toileting, often, to prevent accidents.
Clean skin gently and completely after each bowel movement.
Apply skin protective lotion or cream.
Use disposable bedpads or undergarments as needed for incontinence.
Administer medications as prescribed (Kaopectate, Imodium, Lomotil).
Avoid high fiber foods, such as fresh fruits and vegetables and whole grain breads and cereals.
Add "helpful fiber" foods to the diet, such as apples, bananas, potatoes, oatmeal, oatgrain, rice.
Take several small meals and/or snacks each day, rather than 2 or 3 large meals.
Avoid greasy-fried or heavily spiced foods
Avoid excessive amounts of fruit juices or sweetened beverages, which may contribute to fluid loss in diarrhea by drawing fluid into the intestinal tract.
Avoid gas-producing foods such as cabbage, broccoli, cauliflower, brussel sprouts, peas, onions, peppers, beans.
Consult with your Dietician is you have problems with digesting milk products or fat.

BLADDER ELIMINATION

Changes in the ability to urinate or in the character of urine are common in the person with a progressive illness. The person may have loss of control of urine (incontinence), or may find it difficult to empty the bladder of urine (retention). Urine may appear very dark orange or brown when a person is dehydrated, and urine volume may decrease if the body is trying to retain needed fluids. Pain with- urinating or foul odored urine may indicate an infection. Using the bedpan or the bedside commode may become disadvantageous during periods of acute weakness or shortness of breath.

For any of the above problems, your Nurse may recommend insertion of an Indwelling Foley Catheter which would continuously drain the urine into a collection bag ( or an external catheter for males, if possible ). Most often this is considered a comfort measure, as it provides relief from accidents, protects the skin from irritating body fluid, and prevents urine from collecting in the bladder and causing infection.

 

GUIDELINES FOR FOLEY CATHETER CARE

Although urine volume may not need to be measured, it is helpful to be aware of adequate urine flow through the collection tube. Blockage may be indicated by sudden reduction in urine flow or absence of urine flow, and by feeling of the need to urinate.
Notify your Nurse if blockage of the catheter seems apparent. This does not necessarily require an immediate visit from the Nurse. The Nurse will instruct you on how to properly remove the catheter. A new catheter may be inserted on the next Nurse visit.
The catheter is a foreign object in the body, thus, it should be considered as a risk for infection. Proper hygiene should be maintained at all times. Thorough cleansing around the insertion point (urethral opening) should be part of the daily bath. Do not allow stool to collect on or around the catheter. Cleanse immediately after every bowel movement. Observe for any drainage from the urethra (mucous, pus). Application of an antibacterial ointment at the insertion site may be helpful.
The collection bag should be emptied at least twice a day, or more if necessary. The collection bag should be replaced every week. Wear disposable gloves and wash hands after handling the bag. Bacteria growth may occur in the pool of collected urine.
Keep the collection bag below the level of the person so that urine will drain by gravity. Placing the urine bag on the bed or in the person's lap may cause old urine to backflow into the bladder, increasing the risk of bladder infection.
The Foley Catheter should be changed by the Nurse at least once every month, or more if necessary. Notify your Nurse if the catheter appears pulled out or if urine is leaking from around the catheter.
Your Nurse will instruct you on emptying the collection bag, changing the collection bag, and on irrigating the catheter (flushing the catheter and bladder) if necessary.