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What is faecal incontinence? Symptoms and consequences

Bowel incontinence, also called faecal (fecal) incontinence or anal leakage, is devastating for individuals and can have a social and psychological effect. There are many reasons why bowel incontinence occurs, and the cause can have a number of factors. Working out when and how, can help to narrow down the causes and allow for an effect plan for prevention and management.
Why does this happen?
Faecal incontinence is often the result of an underlying medical problem or condition which causes diarrhoea, constipation or weakening of the muscle that controls the opening and closing of the anus. It has also been associated with long-term conditions such as diabetes, multiple sclerosis and dementia. Cognitive impairment is also a risk since it can make it difficult for a person to remember the way to the toilet or recognize the need to go to the toilet.
Identifying social and hygienic problems
Early detection of problems enables quick intervention. Bowel elimination habits are a highly private matter and many people find it difficult to talk about. Social and hygienic problems faced by residents with faecal incontinence are significant. The worries and embarrassment associated with leaking and smelling may make them isolate themselves from social situations. 

Faecal incontinence in residents

Incontinence can be an incredibly distressing experience for a resident. They might feel embarrassed, frustrated and even angry with themselves. After all, incontinence is seen as a loss of control - we are trained to know and recognise when we need to visit the bathroom from a young age - so it is totally normal and understandable to feel all these emotions.

Help improve the quality of life of residents
The right treatment and management can help care staff better plan their time, avoid handling leakages, unplanned washing of residents, reduce laundry and reduce skin breakdown.

Can bowel incontinence be prevented?
There are a things that can be done to help manage, prevent or even treat faecal incontinence. It is important to know what the bowel incontinence is caused by to know the best treatment options. Diet changes, drinking enough fluids. Being physically active and practising good toilet and eating habits are some examples.

Dehydration can cause constipation and/or bladder irritation

  • Ensure that your residents drink enough fluid during the day.
  • More fluids should be drunk in hot weather or after exercise/physical therapy.

Are the residents drinking enough fluid? Well hydrated urine will be pale yellow. Small amounts and dark urine could be one indication that not enough fluids have been drunk. 

What is a bowel management plan?

A bowel management plan is an individualized care plan to manage, treat and prevent bowel problems. You need to collect information and do an assessment in order to detect risks for bowel problems. Things to consider when making an assessment:
  1. Toileting ability, cognition and mobility
  2. Bowel patterns and stool consistency
  3. Diet and drinking habits
  4. Skin care needs
  5. Medicines that could have side effects on the bowel
  6. Other factors that might influence bowel habits (it is important to find out what the resident considers normal bowel habits).

Maintaining skin integrity can be a challenge.

Good skin care is essential where bowel incontinence is an issue as it can be distressing, uncomfortable and socially isolating for the resident.
Episodes of faecal incontinence can cause inflammation of the skin surface, resulting in redness, pain and itching and sometimes swelling and/or blisters, dryness, flaking or itching. This damage leaves the skin vulnerable to infection.
A good hygiene routine, designed for fragile elderly skin, can help prevent skin irritation and infection. Make sure that the skin does not get exposed more than necessary to faeces. When accidents occur, prompt removal of faeces is needed. Following each episode of incontinence, an optimal routine helps to prevent the occurrence of incontinence-associated dermatitis; it should include gentle cleansing, application of a moisturizer and the use of a skin barrier or protectant ie TENA Barrier cream if necessary.[1]
Practical tips
  • Ensure the resident is toileted when needed to prevent constipation and diarrhoea
  • A good toilet position with support for the feet facilitates bowel emptying. 
  • Keep the skin clean and dry. Always clean buttocks and between legs when changing used pads.
  • Use no-rinse products i e TENA Wash cream or since they are gentle clean, restore and protect even the most delicate and fragile skin.
  • Pat dry carefully – do not rub.
  • Use incontinence products with a soft surface and breathable material.
  • Avoid dry itchy skin, scratching can often damage the skin. Moisturize the skin with lotion.
  • If a barrier cream is needed, use only a thin layer

Importance of incontinence supplies

Residents with faecal leakage should be offered incontinence supplies that help them to feel safe and secure. Make sure that their skin is not exposed more than necessary to faeces.
When choosing a product for bowel incontinence it is important that the product is adaptable to meet individual preferences, different types of activities, and to the time of use.
An individual with frequent faecal leakages requires regular changes of incontinence products. In these cases, the individuals can usually be managed with a low absorption capacity, as the product is changed often.
An individual with diarrhoea may require an incontinence product that covers a larger area of skin and with a higher absorption capacity, to ensure leakages are avoided.

  1. Bardsley A. (2013). Prevention and management of incontinence-associated dermatitis. Nursing Standard, 27(44), 41−46.