The key to managing and preventing bowel incontinence

Bowel incontinence, also called fecal incontinence or anal leakage, is the unintentional loss of stool and/or gas. There are many reasons why bowel incontinence may occur. An assessment can help to narrow down the causes and allow you to establish an effective plan for prevention and management.

Bowel incontinence can be caused by many different factors. If the muscle that controls the opening and closing of the anus is weakened or damaged, fecal leakage becomes a risk. Other conditions like long-term diarrhea, constipation or nerve damage can also increase the risk. Fecal leakage has been associated with illnesses such as diabetes, multiple sclerosis, hemorrhoids and dementia. 

Cognitive impairment can also be a risk since it can make it difficult to remember the way to the toilet, or even recognize the need to go.

Other factors may include not drinking enough fluids during the day, which can result in constipation and bladder irritation, and lead to urgency feelings and fecal leakage. Well-hydrated urine is pale yellow. Urine that is dark or reduced in volume could indicate the need for more fluids.

If constipation needs to be treated with laxatives, always start with the gentlest measure. Laxatives should be tailored to meet individual needs and monitored for side effects like diarrhea.

A bowel management plan is a person-centred care plan to manage, treat and prevent bowel problems. To set up a good plan, you'll need to collect information and do an assessment to detect risks, as the appropriate treatment for a resident's fecal incontinence will depend on the underlying cause of the problem. Here are some factors to consider when making an incontinence assessment:

• Toileting ability, cognition, and mobility to ensure right help at the right time
• Bowel patterns and stool consistency, to ensure regular bowel movements and normal consistency
• Diet and drinking habits, to identify dehydration and risks of constipation and diarrhea
• Skin care status, to identify fragile skin and risks of skin problems
• Medicines that could have side effects on the bowel
• Other factors that might influence bowel habits (it's important to find out what the resident considers normal bowel habits)

Where bowel incontinence is an issue, proper skin care is essential to avoid incontinence-associated dermatitis (IAD) - a type of skin inflammation caused by prolonged exposure to urine or feces. Feces contain harsh enzymes and corrosive compounds that can degrade the skin quickly, resulting in redness, dryness, itching, swelling, blisters or pain. The 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 is not exposed to feces more than necessary. When accidents occur, it's important to remove feces promptly. Following each episode of incontinence, use the TENA ProSkin 3-step Skin Solution to promote good skin health and prevent IAD.

• Ensure the resident is toileted when needed to prevent constipation and fecal leakage.
• A good toilet position with support for the feet facilitates bowel emptying.
• Keep the skin clean and dry. Always clean and thoroughly dry buttocks and between legs when changing used pads.
• Use no-rinse products (i.e. TENA Wash cream) to clean, moisturise and protect the delicate skin around the genitals and perineal area.
• Pat dry carefully. Do not rub.
• Use incontinence products with a soft surface and breathable material.
• Apply a thin layer of barrier cream to 'at risk' skin to protect it from irritants like urine, feces and sweat. This includes the skin around the stomach.

When a fecal accident has occurred, stool will inevitably encounter the skin. As stool contains enzymes that break down the skin, it should promptly be removed, and the skin cleaned. When choosing a product for bowel incontinence it's important that the product is adapted to meet individual requirements. TENA offers several different types of products, in different sizes, that can be adapted to the needs of the individual and help them feel safe and secure.

Audited by Josefine Grandin, District nurse, urotherapist, 2022-08-01