National Institute for Health and Clinical Excellence (NICE)
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New NICE guidance published to help manage distressing bowel problem
The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Acute Care have today (27 June 2007) issued a guideline on the care and treatment of adults with faecal incontinence. Faecal incontinence is the involuntary loss of solid or liquid stool, a condition that 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 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.”
Christine Norton Professor of Gastrointestinal Nursing, and Chair of the Guideline Development Group, said: “This guideline really puts faecal incontinence on the map and says to health care professionals and people with the condition that it is time to take the problem seriously. There are many treatment options available–for some people it may include simple changes to diet or taking a small dose of loperamide to firm loose stools. Importantly, in every case, healthcare professionals will look at the cause of the problem and not assume it is down to an existing condition which that person has. It is true that in some cases it may not be possible to cure the condition but in every case we can ensure that the condition is managed in the best possible way – this may be through contact with support groups, advice on skin care and ensuring individuals carry a RADAR key to have access to public toilets.”
Marlene Powell, Community based continence advisor: “Faecal incontinence has a massive impact on the quality of life of the individual – it may stop them doing the activities they previously did every day such as going to church, shopping, going on holiday, even using public transport. The condition is the cause of such embarrassment that many people will even give up their careers, for fear of being caught in an awkward situation. One lady I met recently gave up her career as head of department at a secondary school – if she missed the call of nature in the morning and needed to go in the middle of a lesson, she knew she would not be able to hold on and did not want to tell her colleagues about the problem. There is no need for anyone with faecal incontinence to suffer in silence – this guidance aims to give people with faecal incontinence confidence to know that there are a number of options for curing the problem or managing it and that they will be able to get their life back to normal.”
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 find out all the contributory factors - after all it is just as likely that the faecal incontinence problem is linked to child birth or 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.”
Notes to Editors
1. NICE is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
2. NICE produces guidance in three areas of health:
• public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
• clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
About the guidance
3. The guidance is available at www.nice.org.uk/CG49 (from 27 June)
4. Faecal incontinence occurs when a person loses the ability to control their bowel movements, resulting in unplanned leakage of faeces. They may have bowel accidents that are caused by not being able to get to a toilet quickly enough, or they may experience soiling or leaking from the bowel without being aware of it.
5. The toilet access card is a small card you can carry that explains that you have a medical condition that means you need to use the toilet urgently
6. The RADAR key allows you to use ‘disabled’ toilets in the National Key Scheme. For more information see www.radar.org.uk/radarwebsite/tabid/41/default.aspx