Faecal incontinence – how

to reduce this occurring in

care home residents

Bose Adegbola & Bernadette Donnelly, Older People’s

Specialist Nurses,

Care Homes Support Team

Outline

Definition

Causes

Staff skills

Assessment

Management

Good Practice tips

Faecal incontinence

Faecal incontinence is defined as involuntary loss of faeces including staining or smearing.

The prevalence rises in older age groups, particularly in advanced old age.

Higher rate of faecal incontinence in institutions than in general population.

Impact of faecal incontinence

Distressing and socially isolating

Increases risk to skin integrity

Time consuming for carers and costly to

manage

Causes of faecal incontinence

Overflow due to faecal impaction

Loose stools

Ano-sphincter weakness

Neurological disease

Functional

Functional incontinence

What skills do care home staff need to

reduce the incidence of faecal

incontinence

Awareness

Knowledge

Familiarity with assessment tools, Bristol

stool chart

Risk Assessment

Record keeping

Positive attitude

Onward referral.

Assessment of faecal

incontinence

Medical and obstetric history

General examination,abdominal palpation, possible stool specimen

Anorectal examination

Cognitive Assessment

Identify normal bowel habit

Assessment of diet and fluid intake

Assessment of mobility and dexterity

Life style

Medication review

Initial Management of Faecal

Incontinence

Treat Faecal loading

Treat causes of diarrhoea

Look out for warning signs for colorectal

cancer

Identify rectal prolapse or third degree

haemorrhoids

Definition of Constipation

Two or fewer bowel movements per week

Or

Two or more of the following symptoms

Straining on one in four occasions

Hard stools on one in four occasions

Feeling of incomplete evacuation on one in four occasions

Contributing factors associated

with constipation

Inadequate fluid intake

Lack of exercise and/or immobility

Insufficient dietary fibre

Toileting facilities

Polypharmacy

Some medical conditions

MONITORING OF BOWEL

ACTIONS

Bowel activity should be documented at

the end of each nursing shift.

Systematic monitoring is required using

a chart

Tools such as the Bristol stools chart can

aid monitoring of bowel actions.

Bristol stool chart

Types 1 and 2 indicate constipation,

commence on laxatives

Types 3 and 4 are the easiest to

pass, maintain laxative dose

Type 5 slightly too soft, decrease

laxative dose

Type 6 too soft, decrease laxative

dose

Type 7 too soft, stop taking laxatives

for a day or so

Bowel chart

Date Time Stool type Did you

reach the

toilet on

time?

Did you

mark your

underwear

or pad?

Any other

comments

Long Term Management of

Faecal Incontinence

Monitoring and care planning

Continued management of diarrhoea and constipation

Individualised toileting routine

Skin care

Psychological and Emotional Support

Provision of continence product if necessary

6 monthly review of symptoms

Possible Specialist referral

Scenario

Mrs M has history of long term constipation and urinary incontinence as well as occasional faecal incontinence.

She has other medical conditions such as atrial fibrillation, neoplasm of lung, reduced mobility and poor hearing

She is able to mobilise with Zimmer frame to the toilet but needs assistance of one staff

She has episodes of urinary and faecal incontinence while mobilising to the toilet

Problems

Staff not responding quickly to call bell

Lack of routine toileting

Lack of record of bowel action

No care plan for constipation

Action plan

Staff educated on need for timely

response to call bell and assisting with

toileting

Routine toileting regime

Care plan for constipation and

occasional faecal incontinence

Review of laxatives by the GP

Outcome

Reduction in incidence of faecal

incontinence (once in 5 weeks)

Daily/alternate bowel actions, stool type

4 or 5

Good practice tips

Focus on the individual – what is normal for them?

Plan toilet visits according to each individuals needs

Remember about Signage

Look for signs of full bowel – fidgeting, aggression, discomfort

Use mechanisms such as the gastro-colic reflex to increase success with bowel continence

Foot stool

Do not be tempted to put pads on those that do not have a problem!!

Conclusion

Continence promotion is enabling and

supporting people in your care to keep

dry and clean.

Staff should aim to prevent or reduce

incontinence wherever and whenever

possible.