Complex Bowel Conditions and Care
Published: 15 June 2020
Published: 15 June 2020
While bowel management is a standard component of personal patient support, those at risk of constipation or incontinence require a greater level of care so that their quality of life is not adversely affected.
Bowel care is a regular component of personal support that is imperative to a patient’s quality of life (NDIS 2018; NHS 2017).
However, a patient at high risk of severe constipation or faecal incontinence may require complex bowel care from healthcare staff with a specialised skill set (NDIS 2018).
This care must be proportionate and appropriate for each patient’s individual needs (NDIS 2020).
Complex bowel care may include:
Treatments used in complex bowel care may include:
(ACARES 2019; ACIA 2017)
Not only is complex bowel care essential to ensuring clients’ quality of life, it is also a requirement for NDIS (National Disability Insurance Scheme) providers under the NDIS Practice Standards and Quality Indicators module for High Intensity Daily Personal Activities.
Under these standards, care providers must meet the following quality indicators:
Complex bowel care may be required for patients with mobility-limiting conditions. These include:
(NHS 2017; NDIS 2018)
A patient who is receiving non-routine treatment such as PRN medication for bowel care may also require complex support (ACARES 2019).
Defecation is considered a voluntary process prompted by the movement of faeces into the rectum. When the individual moves into a sitting or squatting position, the anorectal angle straightens and the external anal sphincter and puborectalis muscle relax (RCN 2019).
When abdominal pressure raises, the muscles of the anterior abdominal wall tense and shift this pressure to the pelvis. The stool enters the rectum and is pushed out by a spontaneous rectosigmoid contraction (RCN 2019).
Once the rectum is empty, the external sphincter closes in order to maintain continence (RCN 2019).
Normal defecation varies between individuals, ranging from three times per day to three times per week. The average faeces output per day is between 150 to 200 grams, however, consistency and production depend on gender, diet and health (RCN 2019).
The Bristol Stool Chart can be used to assess a patient’s bowel motions and determine whether there is any abnormal bowel function that requires intervention (Premium Health 2017).
Complex bowel care may be required by patients who are at risk of severe constipation or faecal incontinence.
Constipation refers to difficulty defecating over an extended period of time. It is defined as the occurrence of less than three bowel movements per week (Premium Health 2017).
A patient who is constipated may simply have difficulty defecating (with a normal defecation frequency), or they may have a delayed colonic transit time of food from the mouth to the anus, which causes stools to become hard, dry and infrequent (Premium Health 2017; RCN 2019).
There are three types of constipation:
The concept of continence refers to an individual’s ability to urinate and defecate voluntarily, hygienically and in a socially acceptable manner (NHS 2017).
A patient experiencing faecal incontinence has difficulty with bowel control, causing involuntary loss of stools. This can be highly embarrassing for the patient (RCN 2019). There are three types of faecal incontinence:
Causes of faecal incontinence include:
Note: Always refer to your facility’s policies on complex bowel care.
Generally, patients who are identified as requiring complex bowel care should be assessed by a suitable health practitioner. Together, the patient and health practitioner will establish a bowel management plan to guide the patient’s care staff. This should include an action plan that details how to escalate care in the event of an emergency and when to refer (ACARES 2019).
The goals of this bowel management plan are generally to:
Bowel health is essential to quality of life, and complex bowel conditions, especially faecal incontinence, can have profound social and emotional consequences. Therefore, the management and treatment of bowel conditions predominantly aim to improve QoL (NSW DoH 2016; Duyos & Ribas 2019).
Assessing the impact of bowel conditions requires patient input, however, many patients are reluctant and embarrassed to discuss bowel issues, sometimes even limiting their social lives and avoiding seeking treatment due to the stigma. It is reported that only 5 to 27% of people experiencing faecal incontinence report their symptoms to a physician (Duyos & Ribas 2019).
It is helpful for patients to share their experiences and be included in discussions about their treatment options. Ensure you communicate with them in an empathetic and sensitive manner so that they are comfortable discussing their symptoms without feeling judged (RCN 2019).
The patient should be referred to a health practitioner if they are experiencing the following complications:
(RCN 2019; NDIS 2018)
Despite significantly affecting patients’ quality of life, bowel health can be an embarrassing topic for many, hindering their ability to seek treatment. In order to identify bowel issues, provide complex bowel care and escalate treatment if necessary, it is essential to communicate with patients empathetically so that they feel comfortable addressing their concerns.
Note: When providing bowel care, always adhere to infection prevention precautions and use the appropriate PPE in order to minimise the risk of infection transmission.
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