Faecal Incontinence

This is one of the more embarassing problems which can have a negative effect on all aspects of a person’s life (social, psychological, physical, sexual) if not managed effectively. Because faecal incontinence for any period can have a detrimental effect on perianal skin integrity it is essential that the patient is assessed comprehensively and the most suitable management system is arrived at.

According to NICE less than 10% of adults are affected by faecal incontinence. In acute areas faecal and double incontinence are more prevalent. The main groups most at risk of faecal incontinence are those who are elderly/frail, those with cognitive impairment, neurological/spinal conditions, pelvic organ prolapse, colonic/anal surgery, learning disabilities, and also to an extent women after childbirth.

Because faecal incontinence is such a negative experience and care/treatment is often embarrassing and undignified, it is essential that a comprehensive assessment and care plan is undertaken in order to promote dignity, self-esteem and good health. Faecal incontinence can have various symptoms; urgency, abdominal pain and/or bloating, frequency; and can cause dehydration and associated electrolyte imbalance, breakdown of skin if not adequately managed.

Faecal incontinence may be a temporary yet unpleasant experience if the patient has infected diarrhoea (such as clostridium difficile). If this is the case barrier nursing must be put in place with the patient in a side room where possible, ensuring a supply of gloves, aprons and handwashing facilities (with soap and water rather than alcohol hand gel).

Faecal management systems (FMS) are enclosed systems which prevent the faeces coming into contact with the air. Not only does this reduce antisocial odour but also reduces the risk of cross-infection. this is ideal for diarrhoea or non/semi-solid faeces. FMS are also indicated for patients whose skin integrity is at risk. FMS is not suitable for patients who have had a rectal/anal injury or stenosis, or tumour, haemmoroids, spinal cord injury to T6 or above (risk of autonomic dysreflexia) rectal mucosa impairment, large bowel surgery, faecal impaction or sensitivity to FMS materials. FMS can cause infection (therefore needs to be managed adequately to reduce this risk), bowel obstruction, necrosis, bowel perforation, abdominal distension, rectal pain, constipation, loss of anal tone.

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