The Pings, Growls and Grumbles of Bowel Sounds

This is a relatively simple skill, but none the less important. For example, post–op patients can have what is known as paralytic ileus where the small intestines temporarily cease to move due to the trauma of surgery. In that case there are NO bowel sounds. 

Usually, the other signs you ask the patient about regarding paralytic ileus is if they have passed any flatus (gas) or had a bowel movement which would indicate that function is returning to normal. 

Obviously, if the bowels are not able to move food along, then the patient should not be fed until the ileus is resolved.

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When listening to the bowel sounds, you can start at any quadrant. Maximum time to listen to any area is 5 minutes. However, 5 minutes times 4 quadrants is 20 minutes. I can guarantee you that NO ONE listens that long.

Listen long enough to see if you would consider the sounds hyperactive (greater than the normal), normal (every 5 – 15 seconds) or hypoactive (less than the normal).

Documentation is usually as simple as stating “+ BS x 4” which translates to “positive bowel sounds in all four quadrants”.

Or you could state they were “hypoactive BS x 4”.

Your Job As a Nurse

Part of your job as a nurse is to assess the bowels regularly along with other signs and symptoms. This is to determine when things are normal or when there is a problem.

What does it all mean?

What you hear could mean lots of different things. I usually ask a few casual questions as I’m listening. For example, I may say that their abdomen is pretty quiet right now, when was the last BM? 

Or, are you taking narcotic pain meds? (That would slow down the bowel function).

If the bowel sounds are hyperactive, I would ask if they were having any loose stool or did they just finish eating. 

illustration of intestines

If they said they’d been having diarrhea, I’d check the MARS (Medical Administration Record) to make sure some yahoo hasn’t been giving them laxatives or stool softeners and causing the diarrhea. Trust me it’s happened many times. 

If that was the case I would see if the order was prn (as needed) or if it was scheduled. If it’s scheduled, I’d call the Doc and ask to have it changed to prn so they don’t have to take it unless needed.

Basically, I’m looking to find out how what I hear translates into what the patient is experiences. It may or may not be a problem. I would also document what the patient told me along with what I heard with my stethoscope.

The Significance of Bowel Sounds

“Hypoactive bowel sounds x4, patient states no BM x 3 days and has taken Percocet q4hrs for the past 4 days.”

That particular situation equates to the reasonable nursing action of calling the physician for an order for a laxative to get things moving again ASAP.

Sometimes the bowels can be technically hypoactive with no real problem. Perhaps they haven’t eaten in a while. A GI doc once told me that if you hear any sounds within 60 seconds that is normal. And if your patient isn’t experiencing any subjective problems like no BM or pain, they are probably OK.

Always think about how it relates to the patient. Is it a problem? And what can be done to correct the problem? Sometimes asking for an order from the physician is appropriate, sometimes, just informing the doctor of the issue is all you can do as a nurse. 

That to me, is the hard part of being a nurse. We are meant to do more than just document a situation and move on. We are there to make every attempt to fix things. You will meet plenty of nurses that don’t. They will be the ones you HATE to follow after their shift because there will be plenty of work that went undone.

If a patient has hyperactive bowel sounds in the left quadrants but very quiet in the right, it probably means there is an obstruction, either partial or complete.

Think about it. The job of the intestines is to move the food from one end to the other. If there is a blockage, very little can get past it and so the bowels on the right side work harder and harder, more and more, faster and faster in order to get the stool moving.

On the other side of the blockage there is little or nothing for the bowels to move along so it is very quiet.

If that patient also complains of having frequent little “squirts” of BM or suddenly has a very distended abdomen when it never was before, those too are sometimes a sign of an obstruction.

Understand, technically, you can’t determine an obstruction or even constipation. That is considered “diagnosing” which is legal only if you have a medical license. That’s where the nursing diagnoses came into existence in order to get around that technicality. 

However, I don’t know a single doc or a nurse that doesn’t accept an RN or LPN saying, “Wow, I think this guy may have an obstruction, Doc, and this is why….” Because it’s a heck of a lot faster than spewing out a long winded nursing diagnosis. 

So get your stethoscope and start listening to anyone’s belly who will let you. Get used to different sounds and different frequencies.

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