MANUAL FAECAL EVACUATION PROCEDURES

Lecturer : Iwan S. Setiawan, S.Kep.,Ns.,M.Kep

Arranged By:

1. Alisa Nur Pebriyani P1337420623027

2. Aisyah Alfiaturrohmah P1337420623049
3. Cynthia Aqila Cantika.A P1337420623022
4. Fadillah Tutobah P1337420623022
5. Zahra Anyq Adawiah P1337420623041
6. Nadia Yuka Nasywa P1337420623055
7. Nurrona Rizqina P1337420623062
8. Tsabitah Syahla P1337420623077

BACHELOR'S PROGRAM APPLIED NURSING

AND SEMARANG NERS PROFESSION PROGRAM
HEALTH POLYTECHNIC MINISTRY OF HEALTH SEMARANG
2024
 FOREWORD

Praise Gratitude, we are grateful to the presence of God Almighty, because thanks to
His grace and guidance we are able to complete the paper with the title "Manual faecal
evacuation procedures.” In this preparation, we cannot be separated from the help of various
individuals and we wish to express our sincere appreciation to all involved.

We realize that this paper might not be flawless, as we humbly welcome constructive
criticism and suggestions from various parties to perfect this paper. Our ultimate aspiration is
for this paper to be a source of knowledge and utility, benefiting both ourselves and our
readers. Thank you.

Semarang, October 7th, 2024

Autor
TABLE OF CONTENS
 CHAPTER 1

INTRODUCTION

1.1 Background

Fecal elimination is the process of removing the metabolic waste of the body in the
form of feces (bowel). Defecation is the expulsion of feces from the anus and rectum. It is
also called bowel movement. The frequency of defecation in each person varies greatly from
several times per day to 2 or 3 times per week. The amount of feces also varies from person
to person.

As peristaltic waves push feces into the sigmoid colon and rectum, sensory nerves in
the rectum are stimulated and the individual becomes aware of the need to defecate. Regular
elimination of the remnants of intestinal production is important for normal body function.
Changes in elimination can cause problems in the gastrointestinal and other parts of the body.
As bowel function depends on the balance of several factors, each person's elimination
patterns and habits are different.

Clients often seek help from nurses to maintain normal elimination habits. Illness may
prevent them from following a regular program. They may not have the physical ability to
use normal toilet facilities. In daily life, most people have experienced disorders of the
digestive system caused by various factors from food, old age, lack of fiber, lack of fluid
intake and so on. In some cases, it causes feces to become hard and difficult to remove, so the
nurse will perform manual fecal action. Manual fecal is the act of inserting a nurse's finger
into the rectum with the aim of crushing, retrieving and expelling it in a crushed form.
1.2 Statement of Problem

1. What is the definition of a manual faecal evacuation procedures?

2. What is the purpose of a manual faecal evacuation procedures?
3. What are the indications and contraindications of a manual faecal evacuation
procedures?
4. What are the preparation and execution of a manual faecal evacuation procedures?

1.3 Objective

1. To know the definition of a manual faecal evacuation procedures

2. To find out the purpose of a manual faecal evacuation procedures
3. To know the indications and contraindications of a manual faecal evacuation
procedures
4. To find out the preparation and execution of a manual faecal evacuation procedures
 CHAPTER II

DISCUSSION

2.1 Definition Manual Faecal Evacuation Procedures

Manual Fecal (using fingers) is the act of inserting fingers into the patient's rectum to
pick up or crush feces, then remove them. This procedure is performed on elderly patients,
patients who have difficulty removing feces voluntarily due to prolonged immobilization, or
unsuccessful enema administration. However, this procedure should not be performed on
patients with cardiovascular problems as it may cause cardiac arrhythmias due to excessive
verbal response.

Manual fecal evacuation is an activity performed to help meet the need for fecal
elimination by removing hardened feces by hand. This action provides assistance to patients
who experience interference with meeting the basic needs of fecal elimination due to
hardened feces in the sigmoid area. This condition occurs because the feces stay in the
intestines longer, so that a lot of water is absorbed.

Manual faecal evacuation procedure, also known as digital removal of faeces (DRF)
or digital evacuation, is a technique used to manually remove faeces from the rectum when
natural methods are ineffective. The procedure involves using a gloved and lubricated finger
to enter the patient's rectum and gently remove impacted or hard faeces. This technique is
commonly used in patients with neurological problems that affect bowel function, such as
spinal cord injury, multiple sclerosis, or other conditions that cause chronic constipation or
stool retention.

Manual fecal evacuation should be performed by a trained healthcare professional or

caregiver who has been properly instructed, taking into account aspects of hygiene, patient
comfort, and safe technique to avoid injury to rectal tissues. While this procedure can be
effective in addressing faecal impaction, its use should be considered with caution and is
usually performed only when other methods have been unsuccessful or inappropriate for a
particular patient.
2.2 Purpose of a manual Faecal Evacuation Procedures

Manual fecal evacuation procedures serve several important purposes in the health
management of patients with impaired bowel function. The primary aim is to remove
impacted or hard stool from the rectum when natural or conventional methods are ineffective.
This procedure aims to prevent serious complications that can arise from prolonged
constipation or fecal impaction, such as abdominal distension, pain, nausea, loss of appetite,
and in extreme cases, bowel obstruction or perforation (Coggrave & Emmanuel, 2010).

In addition, manual fecal evacuation aims to improve patient comfort, reduce the risk
of urinary tract infections that can occur due to fecal pressure on the bladder, and help
maintain a regular bowel movement routine. In patients with neurological disorders such as
spinal cord injury, the procedure also aims to prevent autonomic dysreflexia, a condition that
can be life-threatening (Coggrave & Emmanuel, 2010). Overall, the goal of this procedure is
to maintain optimal bowel function, prevent complications, and improve the quality of life of
patients with chronic defecation problems.

2.3 Indication and Contraindications of digestive system physical examination

1. Indication
a. Severe Constipation or Fecal Impaction:
This condition occurs when the patient's stool hardens and gets stuck in the rectum,
making it difficult for the patient to pass stool. This condition often occurs in people
suffering from neurogenic bowel disease, chronic constipation, or constipation caused
by opiate use.
b. Neurogenic Bowel Dysfunction:
Due to the loss of nerve control, people with neurological conditions including
multiple sclerosis or spinal cord injury may have difficulty defecating.
c. Post-surgical individuals:
After pelvic or abdominal surgery, patients may experience decreased bowel motility,
thus requiring manual evacuation.
d. Palliative Care:
It is often necessary to help empty the bowel to provide comfort to patients who are
very weak or immobilized, especially those receiving palliative care or hospice care.
 e. Fissure Ani or hemorrhoids:
In certain situations, manual evacuation is required to prevent pressure buildup after a
bowel movement, which can aggravate hemorrhoids or fissures.
f. Failure to Respond to Laxatives or Enemas:
Manual evacuation becomes a possibility if less intrusive techniques, such as laxatives
or enemas, are unable to induce a bowel movement.

2. Contraindications
a. Active Trauma to the Rectum or Anus:
Due to the potential for further harm or infection, conditions including anal
fissures, recent surgery, or trauma to the rectum or anus area may worsen as a
result of this therapy.
b. IBD (Inflammatory Bowel Disease):
Manual evacuation may worsen inflammation or injure the rectum in patients
suffering from active IBD (such as Crohn's disease or ulcerative colitis).
c. Severe hemorrhoids:
Using force during evacuation can aggravate hemorrhoids, leading to excruciating
discomfort, edema, or bleeding.
d. Rectal or Anus Cancer:
Due to possible trauma and tumor bleeding, patients with rectal or anal tumors
should not undergo this surgery.
e. Agitated or Uncooperative Patients:
Manual evacuation can be dangerous for patients who are agitated or
uncooperative as they may resist or become stressed during the process.
f. Risk of Perforation:
This treatment is not suitable for those with thin or fragile rectal wall conditions,
which greatly increases the risk of perforation.
2.4 Equipment
a. Sarung tangan bersih

b. Bengkok

c. Gunting

d. Kapas alkohol (alcohol swabs)

e. Kantong sampah non medis

f. Minyak pelumas/ GEL

g. Tissue

h. Waslap

i. Sabun
j. Air dalam baskom

k. Handuk

l. Pisvot

m. Perlak pengalas

n. Skerem
2.5 Preparation and execution of a digestive system physical examination
2.6
 CHAPTER III

CLOSING

3.1 Conclusions

Manual evacuation (also known as rectal cleansing) is used for people with non-reflex
bowel. Feces are emptied by gently inserting a finger into the rectum and removing it.
This procedure is usually done every day or every other day. Manual evacuation of feces
is usually done for people with non-reflex bowel, hyperreflexic and areflexic
bowel dysfunction.

3.2 Advice

With the preparation of this paper, it is hoped that it can increase the knowledge of readers
about Manual Faecal Evacuation Procedures . The author also hopes that this paper can be
useful for writers and readers. The author feels that there are still many shortcomings in the
preparation of this paper due to limited knowledge and existing sources. For that, the author
really hopes for criticism and suggestions from readers for the perfection of this paper.
 REFERENCES

Bliss, D. Z., Zehrer, C., Savik, K., & Smith, G. (2006). "Fecal incontinence in hospitalized
patients who are acutely ill." Journal of Wound, Ostomy, and Continence Nursing, 33(6),
563-573.

Coggrave, M., & Emmanuel, A. (2010). Neurogenic bowel management in adults with spinal
cord injury. Nature Reviews Urology, 7(10), 573-582.
https://doi.org/10.1038/nrurol.2010.130

Kyle, G., Prynn, P., Oliver, H., & Dunbar, T. (2005). The procedure for the digital removal of
faeces. Nursing Times, 101(48), 26-28.