The Bowel Interest Group (2019) note that there are approximately 6.5 million people in the UK today with some sort of bowel problem. That equates 1 in 10 of us. Nearly 200 people per day are admitted to hospital with constipation alone, and three quarters of those admissions are unplanned. The Nursing and Midwifery Council (accessed 2024) states that registered nurses must be competent in bowel care. The Royal College of Nursing (2023) states that bowel management is a basic skill which all staff can learn; and argues that without this, the quality of life and care for many patients is severely compromised. Furthermore, if bowel care is not undertaken when required, patients may suffer from embarrassing and possibly painful faecal incontinence and constipation.
Le Bar (cited in RCN 2023) infers that lack of bowel care is commonly about about competency and recommends that more training is needed. This course is intended for any discipline of Allied Health Professionals, and will focus on competence in relation to taking a history, making a digital rectal examination, formulating a diagnosis and negotiating an appropriate management plan with each patient, to include, as required, prescribing and/or administration of suppositories and enemas, digital removal of faeces and digital rectal stimulation. Content includes patient and carer education including self or carer bowel care.
CONTENT
Signs, symptoms, common risk factors and causes of lower bowel problems
Bowel Assessment
The importance of taking a history
Making relevant examinations including abdominal and digital rectal examination (DRE)
Diagnostic reasoning including tests and investigations to identify common bowel problems and associated red flags:
Constipation
Impaction with overflow
Obstipation / obstruction
Autonomic dysreflexia
Benign prostatic hyperplasia
Management including:
Administration of suppositories and enemas including modes of action
Contraindications, precautions, adverse drug reactions, risk of anaphylaxis
Digital removal of faeces (DRF)
Digital rectal stimulation (DRS)
Self and carer management
Dietary education
Positioning
Brace and pump technique
Perineal support
Vaginal digitation
Transanal bowel irrigation
Infection control, storage and disposal of bowel care products paraphernalia
Monitoring, follow up and ongoing care including health promotion and support
Legal and professional accountability including:
Principles associated with policies, procedures, protocols and clinic/session/appointment management
Supervised practice, competence and indemnity
Prescribing and authorisation to administer eg PSDs
Informed consent
Record keeping
AIMS AND OUTCOMES
To facilitate diagnosis and management of patients with bowel problems
To be able to explain about examination, tests, investigations and treatments for bowel problems
To develop competence in providing a safe, effective and high standard of care
To be able to provide accurate, evidence based information and health promotion about bowel management
To be able to support patients and their carers when management of bowel habits is difficult
