The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [194]
Faecal collection devices can be useful if the person is cared for in bed as undue movement may cause leakage (Nazarko 2007, Wilson 2008). This type of device is fitted over the anus and fluid stools drain into a drainage bag similar to a drainable stoma bag.
Diet
A diet rich in fibre can cause diarrhoea. In this case the person should be advised to reduce the amount and space it out over the day (Nazarko 2007). Chilli and other spices can irritate the bowel and should be avoided. Sorbitol (artificial sweetener), beer, stout and high doses of vitamins and minerals should also be avoided.
Faecal incontinence
Faecal incontinence is a clinical symptom associated with diarrhoea (Nazarko 2007). When it is not possible to treat the cause of the diarrhoea, a care plan should be created to prevent complications and manage incontinence (NICE 2007). Factors that can contribute to the development of faecal incontinence are (Nazarko 2007):
damage or weakness of the anal sphincter: obstetric damage, haemorrhoidectomy, sphincterotomy or degeneration of the internal anal sphincter muscle
severe diarrhoea
faecal loading (impaction): immobility, lack of fluids
neurological conditions: spinal cord injury, Parkinson’s disease
cognitive deficits.
Diarrhoea can potentially disrupt a person’s well-being. Community nurses and hospital-based specialist nurses have an essential role in supporting those affected by this condition. Diagnosis, treatment and management of diarrhoea and potential faecal incontinence can take place at home where individuals are more familiar with the environment.
Constipation
Definition
Constipation results when there is a delayed movement of intestinal content through the bowel (Walsh 1997). It has been defined as persistent, difficult, infrequent or incomplete defaecation, which may or may not be accompanied by hard, dry stools (Norton 2006, Thompson et al. 1999). There is a lack of consensus amongst both healthcare professionals and the general public as to what actually constitutes constipation (Norton 2006, Perdue 2005).
Anatomy and physiology
The rectum is very sensitive to rises in pressure, even of 2–3 mmHg, and distension will cause a perineal sensation with a subsequent desire to defaecate. A co-ordinated reflex empties the bowel from mid-transverse colon to the anus. During this phase the diaphragm, abdominal and levator ani muscles contract and the glottis closes. Waves of peristalsis occur in the distal colon and the anal sphincter relaxes, allowing the evacuation of faeces (Tortora and Derrickson 2009). The stimulus to defaecate varies in individuals according to habit, and if a decision is made to delay defaecation, the stimulus disappears and a process of retroperistalsis occurs whereby the faeces move back into the sigmoid colon (Perdue 2005). If these natural reflexes are inhibited on a regular basis, they are eventually suppressed and reflex defaecation is inhibited, resulting in such individuals becoming severely constipated.
Related theory
It has been estimated that up to 27% of a given population experience constipation (Cook et al. 1999, Longstreth et al. 2006). Constipation is a common symptom in cancer and palliative care. Constipation has been reported in 55% of patients in their last week of life (Conill et al. 1997) and 70–100% of patients receiving treatment in hospital (McMillan 1999). It can affect this patient group at any stage of their disease and for a variety of reasons.
Constipation occurs when there is either a failure of colonic propulsion (slow colonic