Assessment and management of bowel problems in residential care

Mary-Anne Harris

Clinical Specialty Nurse

Continence

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Bowel Function

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Rectum

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

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Impact of bowel problems

• Embarrassment• Social restrictions/social isolation• Abuse• Perineal dermatitis• Depression/anxiety

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Constipation

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

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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

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

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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

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Assessment (continued)

Medical historyMedicationGynaecological/obstetric historySocial historyDiet and fluid intakeMobility/dexterityPresenting problemTheir perspective/expectations

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Treatment/management

•Diet•Fluid •Physical activity•Timing•Positioning •Privacy•Bowel retraining•Medications •Continence products

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Laxatives

• Bulking agents• Osmotics• Stimulants• Softeners• Lubricating

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Diet

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• Fibre recommendation – 38g men, 25g women (Woodford)

• Age related decline in saliva production• Senses of smell and taste decrease• Eating stimulates peristalsis• Oral health

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ExercisePhysically moving stimulates peristalsis

TimingEating and moving stimulate peristalsis

Privacy It is difficult to relax enough to pass a bowel motion when people are around (staff, other residents, family)

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.

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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.

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

Kingdom.

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