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Assessment and management of bowel problems in residential care Mary-Anne Harris Clinical Specialty Nurse Continence 1.

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Presentation on theme: "Assessment and management of bowel problems in residential care Mary-Anne Harris Clinical Specialty Nurse Continence 1."— Presentation transcript:

1 Assessment and management of bowel problems in residential care Mary-Anne Harris Clinical Specialty Nurse Continence 1

2 Bowel Function 2

3 Rectum 3

4 Changes that can affect the bowel with aging Decreased sensation of thirst Less mobile Medications Diet Decreased motility 4

5 Impact of bowel problems Embarrassment Social restrictions/social isolation Abuse Perineal dermatitis Depression/anxiety 5

6 Constipation Elderly people are more prone to constipation 74% of rest home residents complain of constipation (Fosnes et al) 6

7 Diagnosis of constipation ROME III criteria Two or more of the following symptoms = constipation -Lumpy or hard stools 25% of defecations -Straining during >25% of defecations -Sensation of incomplete evacuation >25% of evacuations -Sensation of anorectal obstruction/blockage for > 25% of evacuations -Manual removals to facilitate >25% of defecations -< 3 evacuations per week

8 Faecal incontinence The involuntary loss of rectal contents through the anal canal, resulting in a social or hygiene problem. (Ness) More common in those with a neurological disorder Impairment of anorectal unit 8

9 Assessment Type of bowel motion Frequency of bowel motions aware of need to open bowels Difficulty opening bowels Pain Feeling of incomplete emptying Bloating/flatulence Incontinence 9

10 Assessment (continued) Medical history Medication Gynaecological/obstetric history Social history Diet and fluid intake Mobility/dexterity Presenting problem Their perspective/expectations 10

11 Treatment/management Diet Fluid Physical activity Timing Positioning Privacy Bowel retraining Medications Continence products 11

12 Laxatives Bulking agents Osmotics Stimulants Softeners Lubricating 12

13 Diet 13 Fibre recommendation – 38g men, 25g women (Woodford) Age related decline in saliva production Senses of smell and taste decrease Eating stimulates peristalsis Oral health

14 14 Exercise Physically moving stimulates peristalsis Timing Eating and moving stimulate peristalsis Privacy It is difficult to relax enough to pass a bowel motion when people are around (staff, other residents, family)

15 Fluid Though it is commonly suggested that fluid intake is important in avoiding constipation, there are no current studies to support this. Variation in recommended volumes of fluid required 20% of daily fluid intake comes from food. 15

16 References Farage, M.A., Miller, W.K., Berardesca, E., Maibach, H.I. (2007) Incontinence in the aged:contact dermatitis and other cutaneous consequences Spinzi, G.C. (2007). Bowel Care in the Elderly. Digestive Diseases. 2007, 25:160-165 Ministry of Health.2010. Food and Nutrition Guidelines for healthy older people. A background paper. Wellington. Ministry of Health. Ness, W. (2012) Faecal incontinence: causes, assessment and management. Nursing Standard, 26, 42, 52-60 Roach, M; Christie, J. (2008) Faecal incontinence in the elderly. Geriatrics February 2008, volume 63, number 2, p 13-22 Tack, J., Muller-Lissner, S., Stanghellini, G., Boeckxstaens, G., Kamm, M.A., Simren, M., Galmiche, J.P., Fried, M. (2011) Diagnosis and treatmetn of chronic constipation – a European perspective. Neurogastroenterology & Motility (2011) 23, 697-710. 16

17 References (continued) Woodford, H. (2010) Essential Geriatrics: Second edition. Radcliffe Publishing Ltd – United Kingdom. 17


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