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Faecal incontinence – how to reduce this occurring in - Careinfo.org

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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
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Definition
Causes
Staff skills
Assessment
Management
Good Practice tips
Faecal incontinence
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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
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Distressing and socially isolating
Increases risk to skin integrity
Time consuming for carers and costly to
manage
Causes of faecal incontinence
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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
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Awareness
Knowledge
Familiarity with assessment tools, Bristol
stool chart
Risk Assessment
Record keeping
Positive attitude
Onward referral.
Assessment of faecal
incontinence
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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
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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
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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
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Inadequate fluid intake
Lack of exercise and/or immobility
Insufficient dietary fibre
Toileting facilities
Polypharmacy
Some medical conditions
MONITORING OF BOWEL
ACTIONS
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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
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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
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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
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Staff not responding quickly to call bell
Lack of routine toileting
Lack of record of bowel action
No care plan for constipation
Action plan
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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
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Reduction in incidence of faecal
incontinence (once in 5 weeks)
Daily/alternate bowel actions, stool type
4 or 5
Good practice tips
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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.
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