Manual BM Removal

  1. I know this isn't a very pleasent subject and I'm sorry, but I ran into a LOL at my new LTC that is apparently obsessed with her bowels.

    The other nite she insisted that she was 'just full of BM' and wanted me to remove it - she had had 3 bowel movements in the past 2 days - the evening nurse had done a rectal check and felt nothing - so I refused.

    She is A/O and I tried to tell her the dangers of poking around in her rectum, but she was having none of it. My preceptor says she eats very little, has had psych consults, and even her doctor doesn't know what to do with her anymore.
    I think she could benefit from an anti-anxiety med, but they tell me that she won't take them.
    I tried to offer her some hot tea, but she was upset still that I wouldn't go digging in her bottom. Any suggestions?
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  2. 22 Comments

  3. by   CapeCodMermaid
    YUCK!! Tell her it is against regulations for a nurse to 'go digging' as you so poetically put it. It can cause major cardiac problems. I hate to play along with people but is there some kind of suppository...say a preparation H or something that would make her feel you are doing something?...good luck
  4. by   whoamiRN
    We have a resident like this on my unit. After r/o all possible physiologic problems (masses, constipation, hemmorhoids, etc) we now just give her some surgi-lube and a glove. Gross, but she did it at home for years prior to admission. You can't teach an old dog new tricks, so we just let her conitnue with the "tricks" she already had. Also saved the CNAs from some nasty nail care.
  5. by   CoffeeRTC
    Yah know, I think if you stick around in LTC, you will meet one of these type of residents sooner or later. I would refuse too. It is bad enough when you absolutly need to do this, but for her wanting it done when she is having BMs..Heck no. What type of bowel regeme is she on?
  6. by   BSNtobe2009
    Hey, I'm not a nurse, but I'm sure other RN's that work in LTC can testify, both my Mom and Granda used to tell me that the elderly very often become obsessed with their bowel movements..when they went, how they went, was it an easy or hard job...you get the picture.

    They also used to say when the men got past the BM thing, then they started talking about sex.
  7. by   marjoriemac
    I truly feel that a high percentage of those obsessed with their bowels or water works in old age, do so to get attention, to have something to control! When you lose control of everything else, you get more focused on what you can control, also for many, going to the loo needs assistance, having problems with the bowels brings interest and therefore more company.
  8. by   banditrn
    Quote from CapeCodMermaid
    YUCK!! Tell her it is against regulations for a nurse to 'go digging' as you so poetically put it. It can cause major cardiac problems. I hate to play along with people but is there some kind of suppository...say a preparation H or something that would make her feel you are doing something?...good luck
    Geez, capecod, how could I have forgotten the cardiac implications!!! I know that in the hospital we absolutely don't do this anymore.

    As one of you said, it could very well be a control issue. I did read her H&P, and her family stated that she's had 'issues' like this for years. I would imagine the with years of taking bowel meds, and digging herself out, she has no peristalsis left.

    I do know that she has bisacodayl and MOM prn, so I guess I'll have to check that stuff out, but I hate like heck to fall into this game, and cause further harm.
  9. by   banditrn
    I've decided that this lady is going to be an interesting character to take care of!

    The other nite she sent the CNA out to tell me that she had a 'sore throat', so I looked to see what she had ordered - and went in to offer her Tylenol (I'd done her temp. earlier, and it was normal.)

    She behaved as tho I'd offered her dirt!! "Now, why?" she says "Would you offer me Tylenol for a sore throat?" Because it's a pain reliever, I tell her - then I asked her what she wanted. "An antibiotic!" she tells me.

    Well, I'm starting to feel as tho I'm in Oz - but I explained that we don't just keep antibiotics around to hand out - and I also tried to explain the dangers of overuse of antibiotics. She told me that she had had a 'sore throat' a couple weeks before - and her doctor had given her an antibiotic! All this time, she's behaving like I'm a stupid child!

    I said something to the other nurse, and she told me that the LOL will call her doctor herself if she doesn't get what she wants - and they'll call it in for her.

    Good grief!
  10. by   scmrn
    "It can cause major cardiac problems."

    Really? Like what? Syncope? Come on. What about our duty to remove, digitally, fecal impaction? Are you not going to do that because of the "major cardiac problems" you might cause?

    Please. If the patient is in genuine distress over the matter and has no PRNs and is not open to reason (or who may be incapable of being open to reason) I'm with the nurse who suggested a rubber glove and a little surgi-lube for a brief pretend survery. It will give her the relief she seeks at small expense to yourself. I would also speak with the nursing supervisor about a psych consult.

    Giving dulcolax to a patient who is not constipated borders on abuse.
    Last edit by scmrn on Dec 9, '06
  11. by   truern
    Quote from scmrn
    "It can cause major cardiac problems."

    Really? Like what? Syncope? Come on. What about our duty to remove, digitally, fecal impaction? Are you not going to do that because of the "major cardiac problems" you might cause?

    Please. If the patient is in genuine distress over the matter and has no PRNs and is not open to reason (or who may be incapable of being open to reason) I'm with the nurse who suggested a rubber glove and a little surgi-lube for a brief pretend survery. It will give her the relief she seeks at small expense to yourself. I would also speak with the nursing supervisor about a psych consult.

    Giving dulcolax to a patient who is not constipated borders on abuse.

    Fecal Impaction Removal Information on Healthline


    Precautions

    This digital breaking up and removal of impacted stool can potentially damage the mucous membrane linings in the bowel, and the stimulation to the vagus nerve that has endings in the rectum can cause heart irregularities. It is therefore a procedure that is undertaken only with extreme caution. Most often, nurses remove fecal impactions upon receiving a physician's order, or under a physician's supervision.

    Complications

    Vagus nerve stimulation, causing cardiac irregularities with possible fainting or weakness, is the most serious potential complication. However, rectal bleeding, the result of trauma to the bowel mucosa, can also occur.
  12. by   scmrn
    Yes, yes, we all know (or I hope we all know) about vagal nerve stimulation, which is why I mentioned syncope. I'm not talking about stabbing around in the colon for God's sake, I'm talking about using a little common sense.
  13. by   banditrn
    Quote from scmrn
    "It can cause major cardiac problems."

    Really? Like what? Syncope? Come on. What about our duty to remove, digitally, fecal impaction? Are you not going to do that because of the "major cardiac problems" you might cause?

    Please. If the patient is in genuine distress over the matter and has no PRNs and is not open to reason (or who may be incapable of being open to reason) I'm with the nurse who suggested a rubber glove and a little surgi-lube for a brief pretend survery. It will give her the relief she seeks at small expense to yourself. I would also speak with the nursing supervisor about a psych consult.

    Giving dulcolax to a patient who is not constipated borders on abuse.
    Did you not read the part about the resident having 3 BM's within 24 hours? Or the evening shift nurse doing a rectal check? Or that the res has already had a psych eval?

    If I'm going to do 'whatever the patient wants' to make them them more comfortable, why bother to go to school? And, yes, poking around in a rectum CAN cause more than just syncope!!

    And, no, where I've worked, and with the docs I work with, manually removing impactions is no longer done.

    You have your opinion, I have mine, and playing around with mock procedures is just as abusive in my eyes!
  14. by   mauxtav8r
    In my hospital, digital removal of impaction in elderly or pt with h/o cardiac issues is only performed by a physician.

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