A patient on regular opioids has not opened their bowels for several days. What is the likely cause and response?

Opioid-related constipation; address fluids, fibre, mobility and consider laxatives

Nothing to worry about; opioids do not affect bowels

Immediately stop all their pain relief

Ignore it unless the patient complains of pain

A patient develops diarrhoea that may be infectious. What is an appropriate first step?

Isolate the patient, send a stool sample, and use soap and water for hand hygiene

Give anti-diarrhoeal medication straight away

Use alcohol gel only for hand hygiene

Why is soap and water used rather than alcohol gel after caring for a patient with C. difficile?

Alcohol gel does not kill C. difficile spores

Alcohol gel is always harmful to skin

There is no difference between them

How should a nurse approach helping a patient with intimate bowel care?

Protect privacy, be respectful and matter-of-fact, and respond promptly

Discuss it openly in front of other patients

Part B4 of 8 Providing and Evaluating Care Chapter 51 of 75

Bowel Care and Elimination Questions

NMC CBT bowel care practice: the Bristol Stool Chart, constipation, diarrhoea and infection control, dignity, and worked scenario answers.

Start reading ← All 75 chapters ~5 min read

By JobLabs Editorial · UK healthcare reference editorial team

· July 16, 2026 · Updated Jul 17, 2026 · 2 min read

Bowel care is basic nursing that patients find deeply undignified when it is done badly, and it also carries real infection risks. The CBT tests the practical knowledge and the compassion together.

The Bristol Stool Chart

The shared language for describing stool is the Bristol Stool Chart, running from type 1 to type 7. Types 1 and 2, hard lumps, indicate constipation. Types 3 and 4 are considered normal. Types 6 and 7, mushy or liquid, indicate diarrhoea. The chart gives staff an objective way to record and communicate, and questions test whether you know which end is which.

Type	Description	What it suggests
1	Separate hard lumps, like nuts	Constipation
2	Lumpy, sausage-shaped	Constipation
3	Sausage-shaped with surface cracks	Normal
4	Smooth, soft sausage	Normal
5	Soft blobs with clear-cut edges	Lacking fibre
6	Mushy, ragged edges	Diarrhoea
7	Watery, no solid pieces	Diarrhoea

Constipation

Constipation is common in hospital, and the causes are usually predictable: opioids and some other medicines, immobility, dehydration, low fibre, and simple lack of privacy. A patient on regular opioids who has not opened their bowels for days is showing an expected side effect, which is why laxatives are often co-prescribed with opioids. Management addresses the causes, more fluids, fibre and movement where possible, with laxatives as needed. Stopping pain relief abruptly, or ignoring the problem, are wrong answers.

Diarrhoea and infection control

Diarrhoea may be infectious, and this is where the exam is strict. A patient with possible infectious diarrhoea is usually isolated, a stool sample is sent, and anti-motility drugs are avoided until infection is excluded, because slowing the gut can be harmful in infection.

Hand hygiene deserves a special note. For an organism like Clostridioides difficile, which forms spores, alcohol hand gel does not work. Hands must be washed with soap and water to physically remove the spores. This is one of the most commonly tested infection control points in the whole exam.

Dignity throughout

Running through all of it is dignity. Bowel care is intimate and can be distressing, so you protect privacy, keep a respectful and matter-of-fact manner, and respond promptly. Rushing, delaying, or discussing it within earshot of others all fail the person and the Code. Next: end of life care. Five bowel care scenarios first.

Sources & further reading

Key takeaway from Bowel Care and Elimination Questions

Frequently asked questions

What causes constipation in hospital patients?

Common causes include opioid and some other medicines, immobility, dehydration, low fibre intake, and lack of privacy putting people off. Managing it usually means addressing these, with more fluids, fibre and movement where possible, plus laxatives if needed.

What infection control is needed for a patient with diarrhoea?

Diarrhoea may be infectious, so the patient is usually isolated, a stool sample is sent, and strict hand hygiene with soap and water is used, since alcohol gel does not kill spores like Clostridioides difficile. Anti-motility drugs are avoided if infection is suspected.

Why is dignity so important in bowel care?

Bowel care is intimate and can be embarrassing and distressing. Protecting privacy, being matter-of-fact and respectful, and responding promptly to needs preserves the person's dignity, which is a core part of the Code and of compassionate care.

Check your understanding

Quick quiz: Bowel Care and Elimination Questions

5questions. Click an answer to see the explanation. Your score is saved on this device only.

1
On the Bristol Stool Chart, which types suggest constipation?
Types 1 and 2, separate hard lumps and a lumpy sausage, suggest constipation. Types 3 and 4 are considered normal, and types 6 and 7 suggest diarrhoea. The chart gives a shared, objective way to describe stool.
2
A patient on regular opioids has not opened their bowels for several days. What is the likely cause and response?
Opioids commonly cause constipation, so this is expected and managed proactively with fluids, fibre, mobility and often laxatives, which is why laxatives are frequently co-prescribed with opioids. Stopping pain relief abruptly or ignoring the problem are not appropriate.
3
A patient develops diarrhoea that may be infectious. What is an appropriate first step?
Possible infectious diarrhoea prompts isolation, a stool sample, and hand washing with soap and water, since alcohol gel does not remove spores such as C. difficile. Giving anti-motility drugs before infection is excluded can be harmful, and a shared bay risks spread.
4
Why is soap and water used rather than alcohol gel after caring for a patient with C. difficile?
Clostridioides difficile forms spores that alcohol hand gel does not destroy, so hands must be washed with soap and water to physically remove them. This is a specific and commonly tested infection control point.
5
How should a nurse approach helping a patient with intimate bowel care?
Bowel care is intimate and can be distressing, so protecting privacy, a respectful and matter-of-fact manner, and a prompt response preserve dignity. Rushing, discussing it in front of others, or delaying all undermine dignity and the Code's expectations.