Bowel Care

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 residents 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