two old residents talking in a nursing home

How to support bowel control loss in elderly residents

Bowel incontinence – also known as faecal incontinence – is the involuntary loss of bowel control. It affects almost 50% of nursing home residents. Many cases can be reduced or prevented by identifying contributing factors early and supporting healthy bowel function. When incontinence does occur, the right continence care approach is essential to maintain comfort, dignity and skin health.

Common contributing factors include reduced mobility, cognitive impairment, diet, medication and chronic constipation. A structured bowel assessment and a clear understanding of the condition can help caregivers minimise episodes and improve outcomes. This page provides evidence-based guidance on supporting bowel control in elderly individuals.

TENA ProSkin Flex

Secure protection for bowel incontinence

Skin Health Tips

How to clean individuals with incontinence and maintain skin health

What are normal bowel habits?

A typical healthy adult has between one and three bowel movements per day, with a minimum of three per week¹.Bowel activity is naturally lower during the night but increases in the morning after waking and eating. When food enters the stomach, it triggers a reflex that stimulates the bowel – known as the gastrocolic reflex. A bowel movement soon after a meal, especially after breakfast, is a sign of a normal, healthy bowel. Stools should be sausage-shaped and passed without effort or discomfort.

An unhealthy bowel: Four signs caregivers should look out for:

Fewer than three bowel movements per week
Straining or discomfort during a bowel movement
A change in stool consistency – harder, looser or different in appearance
Diarrhoea or rectal bleeding

A female professional caregiver crouches down in front of a seated nursing resident and talks in a reassuring and comforting way

What can cause bowel incontinence in elderly residents?

Physical causes

Damage to the rectum, anal sphincters or nervous system can impair bowel control
Hard stools stretch and weaken the rectum; loose stools are difficult to control – both increase risk of faecal incontinence
Weakened abdominal and pelvic floor muscles make full bowel emptying difficult, increasing risk of constipation and leakage

Functional causes

Cognitive impairment may mean residents don't recognise the urge to defecate or can't locate the toilet
Reduced mobility and dexterity can prevent residents from reaching the toilet in time or manage clothing
This is functional incontinence, where physical barriers rather than bowel function are the cause.

Risk factors

Irregular eating and poor appetite can disrupt the gastrocolic reflex, increasing the risk of constipation
Certain medications, including antibiotics, laxatives and antidepressants, can contribute to constipation or worsen bowel incontinence

A carer helping an elderly resident off a chair

Functional causes

Cognitive impairment may mean residents don't recognise the urge to defecate or can't locate the toilet
Reduced mobility and dexterity can prevent residents from reaching the toilet in time or manage clothing
This is functional incontinence, where physical barriers rather than bowel function are the cause.

Risk factors

Irregular eating and poor appetite can disrupt the gastrocolic reflex, increasing the risk of constipation
Certain medications, including antibiotics, laxatives and antidepressants, can contribute to constipation or worsen bowel incontinence

How can a bowel health assessment support bowel control?

A bowel health assessment identifies the root cause of a resident’s bowel incontinence and guides a person-centred care approach. All residents should be assessed on admission and whenever their bowel status changes. A thorough bowel assessment helps identify problems early and allows for timely interventions, which can prevent impairment and improve care.

A bowel health assessment supports bowel control by:

Identifying absorbent and skin care products that meet resident's individual needs
Informing person-centred care routines that promote bowel control
Helping prevent bowel incontinence from worsening over time

What should professional caregivers focus on during a bowel health assessment?

Observe the resident’s bowel habits and stool consistency for at least seven days to identify patterns and detect problems such as constipation.

Ask about the resident’s diet, medication and lifestyle to identify factors that may contribute to bowel problems.

Record fluid intake for residents at risk of dehydration, which is a common and preventable cause of constipation.

Assess the resident’s mobility and dexterity to identify any need for toileting assistance or solutions that support independence, such as easy-fastening clothes and easy-to-handle pads.

Identify the need for any toileting aids such as a raised toilet seat, handrails or foot support to ensure the resident sits on the toilet in a position that eases bowel movement.

Assess the resident’s cognitive ability by establishing whether the resident recognises the need to use the toilet, can communicate this to staff and can find the toilet independently.

Assess the resident’s skin to determine effective skincare products and routines that prevent incontinence-associated dermatitis (IAD), a painful condition caused by prolonged contact with urine or faeces. Faeces poses a particularly high risk due to its harsh enzymes and irritants.

What are the results of bowel health assessments used for?

Bowel assessment results are used to help create a person-centred continence care plan with an individualised bowel management plan. This plan sets clear goals – such as daily bowel movements and normal, soft stools – and specifies appropriate products and preventive routines tailored to the resident’s needs.

How should bowel health be maintained?

Bowel health is maintained through person‑centred routines including appropriate diet, hydration, physical activity, and regular toileting. These routines are the priority for supporting bowel control and reducing the risk of faecal incontinence.

How should faecal incontinence be managed when it occurs?

When incontinence occurs, it should be managed using appropriate absorbent products, consistent skin care routines, and person‑centred support tailored to each resident’s needs.

How does preventive care support bowel control loss and improve quality of life?

Preventive care supports healthy bowel function and quality of life by reducing constipation, diarrhoea and faecal leakage. It also helps prevent complications such urinary tract infections (UTIs) and IAD by minimising the skin’s exposure to faeces or urine. Below are some preventive care tips to support bowel control and resident wellbeing.

Ensure regular mealtimes to support the gastrocolic reflex

Encourage toilet visits after meals, especially after breakfast

Encourage residents to respond promptly to bowel signals as waiting increases the risk of constipation

A carer speaking to multiple residents sat at a table

How does preventive care support bowel control loss and improve quality of life?

Ensure regular mealtimes to support the gastrocolic reflex

Encourage toilet visits after meals, especially after breakfast

Encourage residents to respond promptly to bowel signals as waiting increases the risk of constipation

An icon showing the correct toileting position

More tips on how to improve quality of life with preventive care

Ensure a good toilet position that facilitates complete bowel emptying. A footrest can help achieve the correct posture.

Monitor laxative use, as overuse increases the risk of diarrhoea and bowel incontinence. Side effects should also be monitored.

Remove faeces promptly after an incontinence episode to protect the resident’s skin.

Use Barrier Cream for residents showing signs of skin irritation, or for those with frequent faecal leakage, as this presents a significant risk of IAD.

Use no-rinse cleansers to provide efficient, gentle cleansing and skin protection during continence care.

Always wipe front to back after a toilet visit to prevent bacterial transfer

What should caregivers look for when reviewing a bowel management plan?

Regularly reviewing bowel management plans helps caregivers identify deviations and adapt care accordingly. Signs that a care plan no longer meets a resident’s individual needs include:

A change in the resident’s stool consistency
Skin irritation or breakdown in the perineal area
Unexpected leakage

Once the cause of any deviation is established, caregivers can respond effectively and evaluate and amend the plan as required.

How does person-centred care support bowel control and improve quality of life?

Bowel incontinence is a common but manageable condition in nursing home residents. Effective support begins with understanding its causes. A thorough bowel health assessment then provides the information caregivers need to create a person-centred care plan with appropriate products, realistic goals and effective preventive routines. This person-centred approach helps reduce incidence and support bowel control – ensuring residents benefit from better skin health, greater dignity and improved quality of life.

References

1. Cardozo L, Rovner E, Wagg A, Wein A, Abrams P, editors. Incontinence. 7th ed. Bristol, UK: ICI-ICS; 2023. ISBN: 978-0-9569607-4-0

Get in touch

Contact TENA to learn more about our products and solutions

With over 60 years of experience TENA is the world’s leading incontinence brand*. We offer a full range of absorbent products, skincare and digital health technology solutions that are tailored to the needs of individuals, their families and healthcare professionals.

With TENA, Essity is at the forefront of developing products and services that help improve dignity and the quality of people’s lives. We strive for sustainable continence care with better care and better products.

^{*Source: Euromonitor International Limited; Retail Adult Incontinence, all channels, RSP value sales, Tissue & Hygiene, 2024 edition.}

TENA, a brand of Essity – a global leading hygiene and healthy company. Everyday, our products, solutions and services are used by billion people around the world. Our purpose is to break barriers to well-being for the benefit of consumers, patients, caregivers, customers and society. Sales are conducted in approximately 150 countries under the leading global brands TENA and Tork, and other strong brands such as Actimove, Cutimed, JOBST, Knix, Leukoplast, Libero, Libresse, Lotus, ModiBodi, Nosotras, Saba, Tempo, TOM Organic and Zewa. In 2025, Essity had net sales of approximately SEK 138bn (EUR 13bn) and employed 36,000 people. The Company's headquarters is located in Stockholm, Sweden and Essity is listed on Nasdaq Stockholm. More information at essity.com.