1. Bowel Management
25/06/2015

2. Bowel Management
Focus should not be on managing episodes of incontinence or constipation
Focus should be on promoting normal bowel motions
as well as management
Needs to be realistic and maintainable
Needs to involve the person as appropriate

3. Where to start
If not possible to prevent problems, identify and treat issue
Complete bowel chart & assessment
Individualized and based on assessment

4. Management Needs to be a multi-disciplinary approach:
Nurses & care staff
Medical staff
Dieticians
Food services
Physiotherapists
Occupational therapists
Pharmacists

5. Bowel Management Step 1 Offer general advice to the person
Explain what is normal
Bristol stool form scale
Don’t deny the urge to pass a bowel movement
Avoid excessive straining
Don’t worry if you don’t go every day
Explain the correct toileting position

6. Correct positon for opening bowels
Bowel Management
Correct positon for opening bowels
Squatting is best position
When sitting on a toilet:
Feet supported, so knees higher than hips
Lean forward
Legs apart
Elbows on knees
Bulge out abdomen and widen waist
Do not hold breath

7. Bowel Management Step 1 Ensure the environment assists toileting
Privacy
Noise
Heating
Lighting
Confusing bathroom
Mirror

8. Bowel Management Step 1 Adequate hydration
6-9 drinks per day
Water is best
Check skin turgor
Must have extra fluids if increasing fibre
Encourage exercise
Encourages peristalsis
Assists regular bowel habits

9. Bowel Management Step 1 Well balanced diet Must have breakfast
Fruit snacks to assist with soft bowel motions
Plums, prunes, apricots, raisins, kiwi fruit, papaya, cantelope and peaches
Pear juice/prune juice
Homogenized diets – impact on fibre
Must have breakfast

11. Bowel Management Step 1 A dedicated time for toileting
When is the best time?
How often?

12. Bowel Management Step 1 Establish a bowel routine
20 minutes after a meal/s
Sit for 5 minutes
Correct sitting position
Raised toilet seats – foot stools – hand rails
Avoid straining

13. Bowel Management
Step 1
If person has chronic laxative use and there is no signs of constipation
Not confirmed diagnostically
Discontinue by withdrawing slowly
Offer reassurance and a regular sitting routine

14. Bowel Management Step 2 Treatment of Constipation Dietary fibre
Takes up water and makes stools bulkier
Bulky stools increase bowel movement
2 types:
Soluble: binds and firms
Oats, lentils, beans, peeled fruit and vegetables
Assists with diarrhoea/ IBS
Insoluble: speeds up bowel movement & softer
Multi/whole grain, wheat corn and rice cereals
Assists with firm stools

15. Bowel Management Step 2 Treatment of Constipation - fibre supplements
Many different types and can have different actions
Psyllium (e.g. Metamucil)
Ispaghula (e.g. Fybogel)
Inulin (e.g. Benefibre)
Increase fibre slowly
May cause bloating and flatulence/ diarrhoea/ no effect
Must have an adequate fluid intake (1.5 – 2litres)
Not appropriate if immobile
Increased fibre can make constipation worse

16. Bowel Management Step 2 Treatment of Constipation
Review medications and seek an alternative if possible
Pain medication – opioids /codeine
Anticholinergics

17. Bowel Management Step 2 Treatment of Constipation Stool softeners
If stool is hard & hasn’t improved with fibre and fluid intake
Coloxyl causes water to move from body to bowel
Coloxyl & Senna should be given separately
Prolonged use or overdose may result in
Diarrhoea
Water and salt imbalance esp. potassium loss
Onset hours

18. Bowel Management Step 2 Treatment of Constipation
Macrogol (Movicol, Osmolax)
Passes through the gut without being absorbed into the body
It relieves constipation by combining with the water it is mixed with and retains it in the bowel makes stool softer and easier to pass
Relief of constipation
Maintenance 1-2 per day (Movicol)
Disimpaction 8 per day (Movicol)
Onset 1- 2 days could be longer

19. Bowel Management Step 3 Treatment of Constipation
Osmotic laxatives (Lactulose, Sorbitol)
Draws fluid into the lower bowel from the body
Can cause increased flatulence and bloating/explosive stools
Onset up to 3 days
10-20mls per day

20. Bowel Management Step 4 Treatment of Constipation Stimulant laxatives
Increases peristalsis and stimulates a mass movement
e.g. Sennakot, Durolax
Can cause:
Cramping and diarrhoea
2 tablets nocte
Suitable for short term use

21. Bowel Management Last resort Suppositories
Can be useful if problem is rectal evacuation
Poor result due to:
Inadequate administration
Type of suppository
Position of person
Timing of insertion
Need to take advantage of gastro-colic reflex
Allow time to let it work
Insert against the rectal wall, not into the stool

22. Bowel Management Diarrhoea Cause need to be identified
Rule out diarrhoea is due to overflow
Review medications
Correct diagnosis before using anti-diarrhoea medications
Change of diet
Soluble fibre

23. Bowel Management
A sitting routine is the most important for bowel evacuation and management

24. Thank you.