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Bowel Care

Bowel Care. A Palliative Approach to Care. Bowel Care . Bowel care is a key component of the palliative approach Most significant factor affecting bowel care for residents receiving a palliative approach is opioid induced constipation. What is Constipation? .

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Bowel Care

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  1. Bowel Care A Palliative Approach to Care

  2. Bowel Care • Bowel care is a key component of the palliative approach • Most significant factor affecting bowel care for residents receiving a palliative approach is opioid induced constipation

  3. What is Constipation? • Constipation is difficulty or straining on defecation of dry, hard stool • infrequent bowel movements over an extended period of time, with the sensation of incomplete evacuation of the bowel

  4. Constipation Constipation may occur with: • limitation to fluid intake in faecal waste • limitation to movement of faeces through colon • limitation to muscle contraction

  5. Types of Constipation Primary: • inadequate dietary fibre/ dehydration • reduced mobility/ reduced muscle tone • withholding faecal evacuation Secondary: • partial bowel obstruction • spinal cord compression • conditions such as hypercalcaemia

  6. Types of Constipation Iatrogenic: induced by the administration of drug therapies such as: • anti-inflammatory • anticholinergics • antidepressants • opioids • aluminium and calcium antacids • diretics

  7. Principles of Bowel Care • Initial assessment to be performed to identify what are normal bowel habits for each individual resident. • Daily assessment - includes resident’s treatment preferences, history of bowel habits and management • Ongoing assessment

  8. Principles of Bowel Care • Prompt and individually tailored treatments • Minimization of interventions that can cause loss of dignity • Comfort for the resident

  9. Bowel Assessment • Presence of desire to defecate • Signs of discomfort • Food and fluid levels • Full rectum • Skin problems due to leakage • medications that may contribute to constipation

  10. Symptoms of Constipation • Nausea and vomiting • Straining during defecation • Infrequent bowel movement • Feelings of incomplete emptying after bowel movements • Frequent small amounts of diarrhoea

  11. Symptoms • Rectal pain on defecation • Stomach pain, distension or discomfort • Hard stools • Faecal incontinence

  12. Pharmacological Management • Prophylaxis - essential part of management • prophylactic aperients should be routinely prescribed with opioids • combination of softening agent and stimulant is best choice eg. coloxyl with senna

  13. Pharmacological Management • Bulk laxatives when combined with suppositories associated with low rates of faecal incontinence • Suppositories after bowel clearing can prevent recurring constipation • Consider compensatory measures for dehydration and electrolyte depletion

  14. Non-pharmacological approaches Toileting: ensuring • comfort • privacy • timeliness - gastric reflux occurs after eating Encourage fluid, fibre intake Low intensity exercise

  15. Summary • Ongoing assessment and prompt tailored treatments • Consider causes and symptoms of constipation • Pharmacological management - faecal softener and bowel stimulant • Non-pharmacological approaches - toileting, fluid/fibre intake, exercise

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