Title: Bowel Management

Originated: 07/2010 Reviewed:

POLICY STATEMENT:
It is the policy of Douglas Services LLC to ensure the Health and Safety of our
Participants. Douglas Services shall identify in a timely manner Participants who may
be at risk for developing bowel complications, and establish protocol.

BACKGROUND / PURPOSE:
Bowel Management is important for Individuals who are at risk for developing
constipation, impaction, and/or bowel obstruction. There are a variety of contributing
factors that place a Participant at risk of harm or death. This policy will promote our
Participants safety.

IMPLEMENTATION / PROCEDURE:

DEFINITIONS

• Bowel obstruction: For the purposes of this policy, a bowel obstruction is the partial
or full blockage in either the small intestine or large intestine that inhibits stool from
passing.

• Constipation: For the purposes of this policy, constipation is an acute or chronic

condition in which bowel movements consist of unusually hard, dry stools which are
painful or difficult to pass. It often involves vigorous straining and/or a person sensing
they have not completely emptied their bowels. Although bowel habits vary, an adult
who has not had a bowel movement in three days or a child who has not had a bowel
movement in four days is considered constipated.

• Normal bowel function: For the purposes of this policy, a normal bowel function is
characterized by a minimum of three stools per week and no more than three per day.

TRAINING
Training will be provided in Douglas Services LLC Initial Orientation and annually
thereafter for Direct Support Professionals (DSP) regarding the causes of impaction and
bowel obstruction and their symptoms.
Some of the causes are:

Diet:
• Insufficient fiber or bulk in diet
• Inadequate fluid intake

Altered bowel habits:

• Repeatedly ignoring defecation reflex
• Excessive use of laxatives and/or enemas

Prolonged immobility and/or inadequate exercise:

• Spinal cord injury
• Bed rest

Medications:
• Opioids
• Anticholinergic preparations
• Antipsychotics
• Antidepressants
• Calcium and aluminum-based antacids
• Diuretics
• Vitamin supplements (e.g., iron and calcium)
• Sleeping medications
• General anesthesia

Bowel disorders:
• Irritable colon, diverticulitis or tumor

Neuromuscular disorders:
• Neurological lesions
• Cerebral palsy
• Paraplegia
• Spinal cord injury or compression
• Cerebrovascular accident with slight paralysis of motor function
• Weak abdominal muscles

Depression

Environmental factors:
• Strange or hurried environment
• Excess heat leading to dehydration
• Change in bathroom habits (e.g., use of a bedpan)
• Lack of privacy

Other Factors:
• Chronic illness
• Anorexia
• Immobility

Symptoms of Constipation, Impaction, and Bowel Obstruction

 Hard, small dry stools
• Stomach pain or discomfort
• A bowel pattern that differs from the Participant’s normal pattern
• Hemorrhoids
• Spending a lot of time sitting on the toilet
• Straining and/or grunting on the toilet
• Bloated stomach that feels hard to the touch
• Feeling of rectal fullness
• Indigestion
• Increased gas, either flatus or burping
• Nausea
• Seizure activity
• Other – back pain, headache, decreased appetite

Staff must immediately report any noted changes to the Participant’s nurse or physician
if the individual appears gravely ill, produces vomit that smells like a bowel movement,
vomits what appears like coffee grounds or dark jelly, has a very hard, protruding
abdomen or reports severe abdominal pain.

If risk factors or symptoms of constipation and/or bowel obstruction have been identified
by any DSP, the DSP making the observation is responsible for documenting the
observation in the bowel tracking record and immediately notifying the designated
licensed healthcare professional. Collateral reports made to DSP by family members
and other contact sources (e.g., service providers) are also reported promptly.
Upon notification of risk factors or signs/symptoms of constipation and/or bowel
obstruction, the licensed healthcare professional consults with the Participant’s primary
physician for treatment options. Treatment interventions are documented in the
individuals’ medical record.

Bowel Tracking & Management

Any DSP for a Participant identified as being at risk must accurately record the
Participant’s bowel status during their shift. This also entails communicating with family
members and service providers (e.g.day programs) to ensure accuracy. Communication
is done in a manner that is sensitive to the rights and dignity of the person served.
Bowel movements are tracked by DSP and noted on the bowel tracking record. Each
day, DSP should ascertain whether individuals have had a bowel movement. This
information must be documented in the Participant’s bowel tracking record in order to
learn what the Participant’s normal routine is to monitor for the onset of problems. The
bowel tracking record; at a minimum, must document the following information:

• Number of bowel movements per day

• Listof the Participant’s medications that increase the risk of constipation, impaction,
and/or bowel obstruction
• Abdominal pain reported by the individual
• Consistency of bowel movement
• Treatment intervention(s)

Familiarity with the individuals’ routines and adeptness at detecting non-verbal cues of
pain or discomfort are especially important for DSP assisting those who may have
difficulty communicating their needs.

Trained DSP who assist with the self-administration of medications are responsible for
the daily review of the bowel tracking record to determine if the criteria are met for
intervention as ordered by the person’s primary physician.
 BOWEL MOVEMENT TRACKER

DATE Bowel Regular Constipation How many Treatment / Any

Movement times did you Bowel Aids abdominal
Describe stool Describe stool pass stools
condition/color condition/color pain

Yes No Yes No

List Participants Medication that increase the risk of constipation, impaction, and/or
bowel obstruction

DSP____________________________________DSP_________________________________

DSP_____________________________________DSP_________________________________