Monitoring bowel actions

Bowel habits are variable between individuals and are influenced by lifestyle, eating habits and mental state. The average adult will pass 100–150 g of faeces once per day; change in this pattern and change in the nature of faeces passed can indicate disease. The health care professional will therefore need to monitor the bowel action of clients where actual or potential problems are indicated.

Normal faeces is made up of 75 per cent water and 25 per cent solid constituents (cellulose, dead epithelial cells, bacteria, mucus and bile pigments). Skatole and indole arise from bacterial decomposition and give faeces it characteristic odour. Faecal matter is normally brown in colour, soft in consistency and cylindrical in form.

The carer should observe the client’s faeces to identify any changes, and this should be documented in the client’s records or on a stool chart along with frequency of passage and appearance of the faeces. The Bristol Stool Chart is a useful classification system that has been developed to assist us in recording the stool type and can be found on the Internet. This information can assist in diagnosis and treatment and can inform care planning.

Constipation is the commonest problem that can occur. This is the passage of hard stools less frequently than the client’s normal pattern. Conversely, the term diarrhoea is used when faeces contains excess water and the frequency of defecation is markedly increased. Alternating constipation and diarrhoea is suggestive of irritable bowel syndrome but can indicate a partial obstruction.

Other less common abnormalities are:
• pale, putty-coloured faeces, indicative of problems in the biliary system
• presence of pus or excessive mucus, suggesting infection or inflammation
• black and tarry stools (meleana) with a characteristic smell of altered blood, suggestive of bleeding somewhere in the large bowel
• fresh blood in the faeces, which can indicate haemorrhoids or other abnormality
• black stools also occur as a result of taking iron tablets
• parasites
• foreign bodies, particularly in children, who may for example have swallowed a coin or placed something in their rectum.

All of these abnormalities usually require further investigation; therefore, a faecal specimen will be required.