Managing faecal incontinence
NICE publishes guidance

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In June, NICE published guidance to help manage care and treatment of adults with faecal incontinence.

Faecal incontinence, defined as “ the involuntary loss of solid or liquid stool”, affects up to 1 in 10 people at some time in their lives. The new national standards call for healthcare professionals to actively ask people in high-risk groups (such as frail old people, women who have recently given birth and those with diarrhoea or with a neurological or spinal disease) about whether they have any signs of faecal incontinence. The guideline outlines treatments that can manage or sometimes cure the condition as well as strategies to help people cope with the condition where it is not treatable. It is hoped that the guideline will encourage people with the condition to feel more confident talking about faecal incontinence and be reassured that healthcare professionals will take their symptoms and concerns seriously.

The key recommendations include:

• A full assessment, including a medical history should be carried out in order to find out the cause of the faecal incontinence and provide the most appropriate treatment. Questions that should be asked include: 1) When/how often do you empty your bowels? 2) Do you need help when using or getting to the toilet 3) How do your symptoms affect your daily life?
• Healthcare professionals should provide advice about changing diet and fluid intake
• Healthcare professionals should encourage individuals with the condition to establish a regular bowel routine
• People who need to travel should be given advice on how to plan journeys so that they can use public toilets, and be told about a toilet access card and the RADAR key
• If simple measures do not resolve faecal incontinence, pelvic floor exercises should be encouraged to improve the coordination and strength of the pelvic muscles. These exercises should be incorporated into a programme and be assessed regularly
• After each stage of treatment, healthcare professionals should ask the person whether their faecal incontinence has improved. People continuing to experience symptoms should be involved in discussions about further treatment options or alternative coping strategies and asked if they wish to try further treatments.
• People who report or are reported to have faecal incontinence should be offered care to be managed by healthcare professionals who have the relevant skills, training and experience and who work within an integrated continence service.

Peter Littlejohns, Executive Lead for the guideline, said: “Faecal incontinence has remained a largely hidden problem, with many individuals feeling too embarrassed to admit their symptoms to healthcare professionals or even family and friends. This guideline will encourage patients to be more confident talking about faecal incontinence so that healthcare professionals can diagnose the cause and offer the most appropriate support and treatment.”

Susan Bennett, patient representative, Incontact: “I am pleased that healthcare professionals will carry out a full assessment in every case and try to find out all the underlying causes of the condition. Men and women of all ages call Incontact every day, concerned that the cause of their faecal incontinence has not been properly investigated and instead it has been assumed that it goes hand in hand with a long-term condition and is not treatable. So, for example, if a woman has a neurological disease such as MS and also signs of faecal incontinence, their healthcare professional should carry out a full assessment to ascertain all the contributory factors - after all it is just as likely that the faecal incontinence problem is linked to child birth or an unrelated bowel condition.”

Judith Wardle, patient representative, Continence Foundation: “The Continence Foundation is pleased that this guideline encourages health professionals to ask about faecal incontinence; reluctance to talk about the subject affects professionals as well as the public. It is no wonder, therefore, that so many people with problems fail to seek help, not realising how common these problems are and that there are treatments available. We also particularly welcome the recognition that professionals dealing with faecal incontinence should be working within an integrated continence service: while services for urinary incontinence are by no means a high priority in many areas, bowel services are often so much a poor relation that professionals struggle to obtain the skills, experience and training recommended.”

Kristin O’Leary
NICE