The key to managing and preventing bowel incontinence

What is bowel incontinence, and what are its symptoms?
Care home residents sitting outside laughing together with a nurse Care home residents sitting outside laughing together with a nurse

Bowel incontinence, also called faecal 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.

Causes of bowel incontinence

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, faecal leakage becomes a risk. Other conditions like long-term diarrhoea, constipation or nerve damage can also increase the risk. Faecal leakage has been associated with illnesses such as diabetes, multiple sclerosis, haemorrhoids 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 faecal 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 diarrhoea.

Talking about bowel incontinence

If we don't ask, they won't tell. By detecting incontinence early, we can intervene in good time. Faecal incontinence is an extremely private matter and can be 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 can make them isolate themselves from communal situations. Here, caregivers can play an important positive role in discussing the topic with the resident in a caring, matter-of-fact, destigmatizing way.

A nurse wears a face mask while talking to a nurse home resident
. A nurse wears a face mask while talking to a nurse home resident

Talking about bowel incontinence

If we don't ask, they won't tell. By detecting incontinence early, we can intervene in good time. Faecal incontinence is an extremely private matter and can be 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 can make them isolate themselves from communal situations. Here, caregivers can play an important positive role in discussing the topic with the resident in a caring, matter-of-fact, destigmatizing way.

Smiling care home residents sit outside with a nurse standing next to them

Managing bowel incontinence

The right treatment and management will not only improve the quality of life for your residents, it will also allow your staff to spend more time caring for them instead of dealing with unnecessary leaks and unplanned washing and changing. Further, a proper bowel management plan will help reduce the amount of laundry and waste your organization handles. Most importantly, your residents will benefit from better skin health.

Establishing a bowel management plan

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 faecal 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 diarrhoea
  • 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)

Incontinence and skin health

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 faeces. Faeces 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 faeces more than necessary. When accidents occur, it's important to remove faeces promptly. Following each episode of incontinence, use the TENA ProSkin 3-step Skin Solution to promote good skin health and prevent IAD.

Practical tips

  • Ensure the resident is toileted when needed to prevent constipation and faecal 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, faeces and sweat. This includes the skin around the stomach.

"TENA Flex are secure, easy to use, and aesthetic. The faeces is kept inside, minimizing leakage of faeces enormously. Very handy in a busy everyday usage."

Gerd Johnsen, specialist nurse in faecal incontinence and with diploma in healthcare management.

Incontinence products and faecal leakages

When a faecal 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.

TENA Flex is convenient for faecal incontinence, especially diarrhoea, since it provides a tight, comfortable, and secure fit that prevents watery leakages. TENA Flex is easy to fit and removed from front to back to ensure that faecal bacteria do not spread to the urethra. In general, products should be changed immediately after an accident so that the skin is not exposed to faeces for longer than necessary. 

Online training: managing bowel habits and faecal incontinence

Take advantage of this great e-learning course to build your confidence!

Topics covered:

  • Faecal incontinence
  • Basic anatomy and physiology of the gastrointestinal tract
  • What can cause faecal incontinence
  • How to assess bowel function
  • How to manage faecal incontinence
  • Knowledge test

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

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