Policy briefing

Essential bowel care advice for nurses

RCN guidance advocates a proactive approach to bowel care

The RCN has published new guidance on the assessment, treatment and management of lower bowel dysfunction

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Essential information

Bowel care is an area of patient care that is frequently overlooked.

Many people can find it difficult to admit to bowel problems, the RCN says.

Charity Bowel and Bladder UK says that 10% of adults may experience bowel incontinence, with 1 to 2% reporting major symptoms. Constipation affects about 20% of the population.  These symptoms can have a major impact on quality of life.

What’s new

Guidance on the assessment, treatment and management of lower bowel dysfunction has been published by the RCN.

It promotes a proactive approach to care delivery for bowel function and management of bowel disorders. 

It looks at how to assess the patient’s condition, and how and when to carry out digital rectal examination and digital removal of faeces.

Conditions including irritable bowel syndrome, diarrhoea, faecal incontinence and inflammatory bowel disease are covered in the updated guidance.

Bowel issues that can present at end of life are discussed, and particular bowel conditions and approaches that may affect a patient with a spinal injury.

The publication advises that among the examples of conservative approaches that can help improve some bowel conditions is healthy lifestyle advice, bowel retraining exercises, a regular routine for bowel emptying, abdominal massage and better bowel emptying techniques.

The RCN says people should also be encouraged to discuss their bowel problems with friends and relatives, and be told about the Just Can’t Wait toilet card to inform others that they have a medical condition that requires quick access to a toilet.

Nurses should be aware of red flags for lower bowel care emergencies, including bowel obstruction, bowel perforation, when the contents of the bowel leak into the abdomen, and faecal impaction. Undiagnosed diarrhoea may lead to dehydration and electrolyte imbalance.

Implications for nurses

  • Discussions about bowel problems should be approached with sensitivity to minimise the patient’s embarrassment and to build a therapeutic relationship.
  • When assessing a patient, include their own account of the condition. The three most common indicators of bowel function are frequency of the passage of stools, consistency of stools (according to the Bristol stool scale) and ease of passage.
  • It is important to incorporate a risk assessment to identify high-risk people, such as those with bowel cancer, severe faecal impaction, an obstruction, Clostridium difficile or a spinal cord injury.
  • Where possible, encourage the patient to keep a bowel diary to engage them in the assessment process and help identify their current bowel routine. The bowel diary should include frequency, consistency, effort/ease of passage/urgency, amount, colour, incontinence and time of episode(s) and if they are able to use the toilet with or without assistance.     

Expert comment

Jane Fenton, nursing teaching fellow in bowel and bladder care at Keele University and author of the RCN publication, says: 'Bowel care is an essential and fundamental aspect of care that crosses all fields of nursing and across the whole life span. It is every nurse’s business in every setting, including NHS, private and charitable organisations.

'All nurses need to know that bladder and bowel symptoms have an underlying cause and require individual assessment. Proactive approaches are of paramount importance for the quality of life for patients and residents.

‘But clinical practice is varied and there is a lack of knowledge and understanding, particularly when related to digital rectal examination and digital faeces removal, which remain taboo subjects. This is a particular issue in hospitals and emergency departments where staff may not have received education and training and do not see the interventions as part of their role. 

‘This updated edition includes updates on best practice and additional information on end of life care, nursing associates and safeguarding.’

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