bowel bypass syndrome
bowel
[bow´el]The absence of bowel sounds is symptomatic of greatly decreased or totally absent peristaltic movement. This can occur in such conditions as paralytic ileus, advanced intestinal obstruction, gangrene of the bowel, enterocolic ulceration, myxedema, and spinal cord injury. In the early stages of bowel obstruction, high-pitched splashing sounds are heard in the intestine proximal to the obstruction. As the obstruction continues to constrict the lumen of the bowel, the sounds are of shorter duration and eventually cease altogether as the obstruction to the lumen of the bowel becomes complete.
Increased motility of the bowel usually results from some sort of irritating stimulus, such as gastroenteritis with diarrhea, bleeding in the intestine, and emotional disorders. Hyperactivity of the bowel produces a rush of sounds, with waves of loud, gurgling, and tinkling sounds called borborygmi.
Before planning a program of bowel control it is necessary to determine the cause of the difficulty, the patient's former bowel habits, and specific symptoms. The plan devised will depend on the patient's needs and physical, mental, and emotional capacities for cooperation in the planning and implementation of the program. It is necessary to know whether the person can realistically be expected to achieve complete control, or if neural damage or anatomical and structural changes in the intestine prevent reaching this goal. For example, a colostomy patient cannot achieve complete control over bowel movements, but regulation of diet and fluid intake can affect the number and consistency of the stools, giving some sense of security. Diet also is important in all other types of bowel training in which the goal is regularity of defecation and stools of normal consistency.
It is important that patients participate as much as possible in planning the program. They will need to give an accurate history of bowel habits, former use of laxatives and enemas, usual time of day for bowel movements, and the frequency, and whether or not they are aware of the urge to defecate. As the program is carried out, revisions may be necessary as the patient learns which techniques are most helpful.
The major components of a bowel training program are choosing the location to ensure some degree of privacy, getting the patient into a sitting position, having him attempt defecation at a specific time that is most natural for him, regulating the food and fluid intake, and establishing some plan of regular exercise and physical activity.
In some cases of paralysis it may be necessary to stimulate bowel function through the use of suppositories and digital stimulation. Enemas, laxatives, and bulk-forming medications are used only if necessary, not on a regular basis if at all possible. These measures may be necessary, however, at the beginning of a bowel training program to remove constipated stool and fecal impaction.