Bowel Incontinence (Fecal Incontinence) Nursing Diagnosis & Care Plan

Bowel incontinence is one of the most underreported problems you will manage, and patients rarely bring it up first. This guide covers assessment, diagnosis, goals, and interventions for fecal incontinence on the floor.

What is Bowel and Fecal Incontinence?

Bowel incontinence, also called fecal incontinence, is the inability to control bowel movements, so stool leaks unexpectedly from the rectum. It follows damage to the nerves, muscles, or other structures involved in normal elimination, or disease that alters defecation.

True anal incontinence is loss of anal sphincter control with unwanted or untimely release of feces or gas. Distinguish it from other conditions that pass stool through the anus, and separate it from fecal urgency, which often points to a medical problem other than sphincter disruption (Ferzandi & Strohbehn, 2023).

Common causes are injury to rectal, anal, or nerve tissue from trauma, childbirth, radiation, or surgery. Infection with resulting diarrhea, or neurological disease such as stroke, multiple sclerosis, and diabetes mellitus, can also cause it. It shows up in older adults with dementia and with age alone.

Prevalence is hard to pin down because social stigma drives underreporting. Reported overall prevalence ranges from 2% to 21%. It runs about 7% in women younger than 30 years and rises to 22% by their seventh decade. In older adults, prevalence reaches 25% to 35% of nursing home residents and 10% to 25% of hospitalized clients. Fecal incontinence is the second leading cause of nursing home placement in older adults (Roland, 2022).

Treatment depends on the cause, so identifying it drives everything else. Reestablishing a continent elimination pattern and protecting skin integrity directly affect the client's recovery and self-esteem, and head off the social isolation this condition produces.

Nursing Care Plans and Management

Care of the client with bowel incontinence is systematic and collaborative: promote comfort, prevent complications, restore self-esteem, and help the client regain control of bowel function.

Nursing Problem Priorities

1. Bowel function. Establish regular bowel routines and healthy habits.
2. Skin integrity. Prolonged contact with stool breaks down skin and drives pressure injury and infection.
3. Social isolation and decreased self-esteem. Address emotional wellbeing, counsel the client, and build support systems to counter isolation and embarrassment.
4. Altered body image. Promote positive coping to protect body image and self-esteem.
5. Physiological complications. Watch for infection and fluid and electrolyte imbalance. Monitor hydration, control infection, and modify diet.
6. Client and caregiver education. Teach the condition and home care so both the client and caregiver manage it well.

Nursing Assessment

Do a detailed neurological exam when neurological disease is suspected. The rectal exam is the core of the workup and runs in four steps: inspection, anal wink reflex, digital rectal exam, and anal muscle tone. Accuracy depends heavily on examiner experience (Roland, 2022).

Assess for the following subjective and objective data:

• Fecal seepage. Unwanted leakage of stool after a bowel movement with otherwise normal continence and evacuation.
• Urge incontinence. Passage of feces and flatus despite active attempts to retain them.
• Passive incontinence. Involuntary passage of feces and flatus with no awareness.
• Encopresis. The term used mostly for fecal incontinence in children.

Nursing Diagnosis

Nursing diagnoses are shaped by clinical judgment and the client's specific picture, and their use varies by setting. Common examples:

• Bowel Incontinence related to weakened sphincter control and impaired nerve response as evidenced by frequent involuntary passage of stool and reported embarrassment and social withdrawal.
• Bowel Incontinence related to decreased muscle tone and impaired voluntary control as evidenced by involuntary stool leakage and observed use of absorbent pads.
• Bowel Incontinence related to reduced sphincter function and decreased rectal tone as evidenced by passive leakage of stool and documented need for frequent perineal care.

Nursing Goals

Goals and expected outcomes may include:

• The client is continent of stool or reports fewer episodes of incontinence.
• The client follows a daily bowel program until a pattern develops.
• The client evacuates a soft, formed stool.
• The client voices a sense of self-control over bowel movements.
• The client names which foods to eat and how much fluid to take to keep movements regular.

Nursing Interventions and Actions

1. Restoring Bowel Function

Restoring bowel function means treating the underlying cause and getting the client back in control of their movements. Interventions vary with the client's condition.

Assess ability to participate in bowel continence

Identify the cause of incontinence. This is baseline data and directs every later intervention. Many clients have more than one contributing factor. Stool seepage that soils undergarments can come from hemorrhoids, enlarged skin tags, poor hygiene, fistula-in-ano, and rectal mucosal prolapse. Inflammatory bowel disease, laxative abuse, parasitic infection, and toxins also degrade bowel control (Ferzandi & Strohbehn, 2023).

Assess the client's normal bowel elimination pattern. Normal varies by person: some have 2 bowel movements a day, others go every third or fourth day. Most feel the urge soon after the first oral intake of the day (coffee or breakfast) from the gastrocolic reflex.

Review medications and treatments that may contribute. Explosive diarrhea can come from hyperosmolar tube feedings, bowel prep agents, pelvic and abdominal irradiation, some chemotherapy, and certain antibiotics. Antipsychotics are also implicated, highest with clozapine, with reports for olanzapine, asenapine, and risperidone (Singh et al., 2019).

Check manually for fecal impaction. Liquid stool leaks past a hard, dry impaction the client cannot expel, sometimes presenting as overflow diarrhea. Use ample lubrication and remove the stool gently with the index finger (Setya et al., 2022).

Prepare the client for diagnostic tests. These find the cause: flexible sigmoidoscopy, barium enema, colonoscopy, and anal manometry (function of the rectal sphincters). Testing is guided by whether incontinence relates to stool consistency. With no diarrhea, pursue more specific testing (Roland, 2022).

Assess use of diapers, sanitary napkins, incontinence briefs, fecal collection devices, and underpads. Clients and caregivers often use familiar products to catch leakage, especially at night. Absorbent pads vary in size, shape, and absorbency. Too much or too little absorbency damages skin (Yates, 2017).

Evaluate the client's ability to reach the bathroom independently. Rearranging the environment prevents soiling from not getting there in time and shows the client's mobility, coordination, and physical limits.

Take a careful obstetric history in female clients. Document number of vaginal deliveries and risk factors tied to them. Prolonged second stage of labor, forceps delivery, significant tears, and episiotomy raise the risk of anal sphincter disruption and pudendal nerve injury (Ferzandi & Strohbehn, 2023).

Use fecal incontinence survey tools. Tools such as the Fecal Incontinence Quality of Life Scale and the Fecal Incontinence Questionnaire quantify severity and capture symptom impact quickly, mostly as outcome measures (Ferzandi & Strohbehn, 2023).

Assess the rectal area

Check for the anal wink reflex. Gently stroke the perianal skin with a cotton bud, which triggers brisk contraction of the external anal sphincter. An absent reflex signals loss of the spinal arc and possible neurological disease (Roland, 2022).

Assist with the digital rectal examination. It detects obvious anal pathology and gives an initial read on resting tone. Resistance is met at the anal verge. Little resistance with a patulous anus suggests significant sphincter dysfunction (Ferzandi & Strohbehn, 2023).

Assess resting rectal tone and pelvic floor muscles. Resting tone reflects the internal anal sphincter. Have the client bear down to assess the puborectalis and pelvic floor, then squeeze to feel external anal sphincter contraction (Roland, 2022).

Medical management of bowel incontinence

Remove fecal impaction manually when needed. Impaction blocks a regular bowel routine. With hard stool palpable in the rectum, use ample lubrication and remove it gently with the index finger. An anoscope and suction can help (Setya et al., 2022).

Keep a bedside commode and assistive device in reach. Immediate access cuts accidents. Clients spend significant time planning around and worrying about accidents, and symptoms worsen with aging and with trying to keep working (Peden-McAlpine et al., 2018).

Assist with mobility or exercise as tolerated. Movement stimulates peristalsis. Pelvic floor activity ties to abdominal muscle activity during lifting, spinal stabilization, and tasks like head and shoulder raises, so overall physical activity benefits the pelvic floor (Staller et al., 2018).

Create a bowel training program

A bowel training program builds regular habits and prevents uninhibited elimination. Interventions may include:

Schedule elimination at the same time daily. Soon after breakfast is best, since food or fluid triggers the gastrocolic reflex. Regular, complete emptying of the lower bowel produces continence. Attempt evacuation within 15 minutes of the set time each day.

After breakfast or a warm drink, or before the scheduled time, give a suppository and perform digital stimulation every 10 to 15 minutes. Some cases need direct stimulation of the rectal sphincter and lower colon to start peristalsis. The anorectal reflex can be triggered by a suppository or mechanical stimulation. Use mechanical stimulation only in clients with a disability who have no voluntary motor function and no sensation from injuries above the sacral spinal cord (quadriplegia, high paraplegia, severe brain injury). It does not work without an intact sacral reflex arc.

Position the client upright or squatting to defecate. Sitting upright with feet flat on the floor aids defecation. The squatting position straightens the rectum for more complete emptying, relaxes the pelvic floor, and reduces straining. Give privacy when possible.

Discourage pads, diapers, or collection devices for long-term management. These work short term to prevent soiling but irritate skin over time. Prolonged wetness causes diaper rash, and friction or skinfolds sticking together cause chafing (National Association for Continence, 2022).

Using fecal collection systems

Use fecal collection or bowel management systems selectively over pads and diapers. They collect and dispose of stool without exposing perianal skin, contain odor, and reduce embarrassment. They cut cross-contamination in clients with C. difficile and save cost through less linen use, less nursing time, and fewer complications (Arndt, 2020). Options include:

External anal pouch. A bendable wafer with a central opening. One side adheres to skin around the anus, the other connects to a drainable collection bag. Applied properly it can stay in place for 24 hours. Remove it if stool leaks, since leakage irritates skin (Mount Sinai, 2022).

Intra-anal stool bag. Latex (20cm non-extended, 26cm extended) inserted into the anus, secured by an adhesive attachment (10cm diameter) around the anus. Correct positioning and application usually take a pair of experienced clinicians (Arndt, 2020).

Rectal tubes and catheters. Inserted into the rectum to direct loose stool into a collection bag. A balloon near the tip inflates with water or normal saline to block leakage around the catheter and keep the tube in place during a movement (Arndt, 2020).

Rectal trumpets. A nasopharyngeal airway connected to a drainage bag, with the wide flange end inserted into the rectum. Shorter than a rectal tube, so less chance of damaging the rectal lining. It improves nursing satisfaction and reduces incontinence-associated dermatitis without raising pressure injury rates, and places faster than adhesive pouches. It can cause rectal hemorrhage requiring PRBC transfusions, hypotension, and invasive procedures (Glass et al., 2018).

Administering medications

Give medications as prescribed. The goal is fewer stools and firmer consistency, using laxatives, bulking agents, and antimotility drugs.

• Bulk-forming laxatives. Retain fluid in stool and increase weight and consistency. Psyllium, dietary fiber, and methylcellulose are common. Take with plenty of water (Bashir & Sizar, 2022).
• Antimotility agents. For diarrhea from noninfectious causes, or reduced rectal compliance from radiation proctitis or inflammatory bowel disease. Loperamide hydrochloride increases gut transit time, allowing more water absorption for firmer, more controllable stool. Usual dose is 2 to 4 mg twice or three times daily to control symptoms (Ferzandi & Strohbehn, 2023).

Assist with biofeedback. A safe, minimally invasive technique using auditory or visual feedback to reeducate the pelvic floor, mainly rectal sensitivity training and anal sphincter strength training (Ferzandi & Strohbehn, 2023).

Surgical management of bowel incontinence

Prepare for and assist with surgical procedures as appropriate. When medical therapy is maxed out, minimally invasive and surgical options follow, chosen by history, exam, and workup (Ferzandi & Strohbehn, 2023). Procedures may include:

Anterior sphincteroplasty. Dissect out the external anal sphincter, divide the midline scar, and overlap the scar so muscle meets muscle. Studies show improved resting and squeeze pressures (Ferzandi & Strohbehn, 2023).

Sacral nerve stimulation. Minimally invasive. Helps clients with minor sphincter deficits from a neurological cause by raising squeeze and resting pressures and colonic motility (Roland, 2022).

Internal anal sphincter repair. Dissection along the intersphincteric plane to identify and repair the internal anal sphincter. In one study, continence scores improved in all clients and two achieved full continence (Ferzandi & Strohbehn, 2023).

Postanal repair. Used for anal incontinence from a neurogenic or idiopathic cause, where clients sense impending defecation poorly and notice it only after passing stool. The aim is to restore the anorectal angle and lengthen the anal canal (Ferzandi & Strohbehn, 2023).

Injection of anal bulking agent. A hyaluronic acid derivative injected into the anal mucosa, repeatable. Early results show some clients have fewer episodes (Roland, 2022).

Artificial bowel sphincter. An implantable inflatable cuff placed around the anus, with an inflation reservoir in the space of Retzius. The client squeezes a control pump to force water out of the cuff and allow a bowel movement (Ferzandi & Strohbehn, 2023).

Vaginal bowel control device. The Eclipse System is a vaginal insert for women 18 to 75 years old with at least four incontinence episodes in a 2-week period. An inflatable balloon in the vagina presses through the vaginal wall onto the rectal area, cutting the number of episodes, with no reported serious adverse outcomes (Ferzandi & Strohbehn, 2023).

Colostomy. When incontinence persists after medical and surgical therapy fails, a colostomy converts a perineal stoma into a manageable abdominal stoma and removes the constant fear of public humiliation.

Follow postoperative dietary restrictions as ordered. Many surgeons delay feeding and keep clients on clear liquids or soft foods for several days. Others allow a more liberal diet with stool softeners and mineral oil to keep stool soft (Ferzandi & Strohbehn, 2023).

Arrange a followup 4 to 6 weeks after the procedure. By then most swelling and tissue distortion resolve. Review bowel habits and address problems. Pain control matters given the location of the repair, so the client needs ready access to the surgeon for more medication (Ferzandi & Strohbehn, 2023).

2. Maintaining or Improving Skin Integrity

Prolonged contact with stool breaks down skin and drives pressure injury. Hygiene, protective barriers, and regular skin checks are the priorities.

Performing skin assessment

Inspect the skin, including perigenital skin. Note color, turgor, moisture, temperature, and any injuries. Use good lighting to catch subtle color changes. Reassess incontinent clients more often, since they are at higher risk for IAD (Francis, 2018).

Assess perineal skin integrity. Stool sensitizes skin, worsened by diapers, briefs, and underpads. The main result is incontinence-associated dermatitis (IAD), also called moisture lesions, irritant dermatitis, diaper rash, or perineal rash (Yates, 2017).

Watch for signs of IAD. Pain, burning, itching, or tingling; blotchy or poorly defined edges; kissing ulcers; and intact skin with erythema, with or without superficial partial-thickness loss. Secondary infections such as candidiasis may appear (Yates, 2017).

Use valid skin assessment tools. Assessment identifies IAD risk before it develops or grades severity once present. Tools include the Incontinence Assessment, IAD Risks Assessment, Skin Damage Assessment, Grade of Skin Damage, IAD Severity Instrument, Ghent Global IAD Categorization Tool, and Skin Moisture Alert Reporting Tool. Start by finding the cause of incontinence, the IAD risk, and the level of skin damage before planning care (Banharak et al., 2021).

Managing the risk for skin injuries

Wash the perineal area after each elimination with soap and water, then apply a moisture barrier ointment. Stool left on skin causes irritation, excoriation, and pain, and pain makes the client deny the urge to defecate, which leads to impaction and more incontinence. Cleanse after each episode and during or after bathing, pat dry, then apply a barrier (Canadian Continence Foundation, 2017).

Use soft, gentle materials to clean the perianal area. Use a soft cloth and a no-rinse cleanser with surfactants to lift irritants. Avoid products needing rinsing and towel drying, which irritate skin. Pick a cleanser with a pH matching the skin's acid mantle. An all-in-one cloth with cleanser, moisturizer, and barrier ensures all three steps happen (Francis, 2018).

Avoid hygiene products that irritate skin. No alcohol, chemical color, lotion, or fragrance. Skin cleansing pH should range from 4.0 to 6.8. Avoid soap and warm water, wet cloths and towels, and alkaline soap; if using soap, prefer liquid children's soap. Avoid rubbing, wiping, and rinsing (Banharak et al., 2021).

Provide appropriate absorbent products. Combined with frequent garment changes, they keep skin dry and prevent fungal dermatitis. Pads and briefs wick moisture away to cut IAD risk. Limit body-worn briefs to ambulatory clients to avoid fungal dermatitis from perineal occlusion in bed-bound clients (Francis, 2018).

Apply skin protectants or barriers after each cleansing. Put a direct barrier on the skin to block contact with stool. Baby powder and corn starch are not barriers. Avoid sensitizers like fragrance or lanolin. The four main protectant types:

• Petroleum jelly. A common ointment base. Forms an occlusive layer and boosts hydration but can reduce pad absorbency. Transparent when applied thinly.
• Zinc oxide. Opaque cream, ointment, or paste. Thick and uncomfortable to apply, and must be removed for skin inspection.
• Dimethicone. Silicone-based and non-occlusive. Does not affect pad absorption when used sparingly. Opaque or transparent.
• Acrylate terpolymer. Forms a transparent film. No removal needed, so skin inspection stays easy (Yates, 2017).

Position the client to reduce skin irritation and pressure injury. Side-lying on the right or left instead of the back lowers IAD severity (Banharak et al., 2021). Clients who get uncomfortable after 30 to 60 minutes prone need repositioning. The recumbent position beats semi-Fowler by spreading body weight over more surface area.

Reposition at least every 2 hours. Frequent position changes relieve and redistribute pressure and promote blood flow to skin and subcutaneous tissue.

Teach wheelchair-bound clients to relieve pressure. They can do push-ups by pushing down on the armrests to lift the buttocks off the seat, half push-ups on each side, side-to-side shifts, or bending forward with the head between the knees.

Place supportive pillows over bony prominences. The bridging technique uses pillows to keep space between bony prominences and the mattress. A pillow or heel protector lifts the heels off the bed for supine clients. Pillows above and below the sacrum relieve sacral pressure.

Encourage protein-rich food. Tissue heals faster with nutrient-rich sources, especially protein, both to prevent IAD and to speed wound healing in those who have it (Banharak et al., 2021).

Use pressure-relieving devices as recommended. Specialty beds or alternative surfaces help. Fit and adjust wheelchair cushions individually using pressure measurement. Static support devices spread pressure by increasing body contact area. Gel flotation pads and air-fluidized beds reduce pressure. Soft moisture-absorbing padding distributes pressure and wicks moisture, free of wrinkles and friction.

Promote mobility and ROM exercises. Keep the client active and ambulate when possible. Remind seated clients to shift weight often. Active and passive exercise build muscular, skin, and vascular tone. Turning and exercise schedules are essential for clients at risk for pressure injury.

3. Increasing Self-Esteem and Decreasing Social Isolation

Fecal incontinence carries heavy quality-of-life costs: shame, embarrassment, low self-esteem, and distorted body image (Peden-McAlpine et al., 2018). Most clients have already overcome real embarrassment just to bring it up, so approach the topic in a way that keeps the conversation open and comfortable (Ferzandi & Strohbehn, 2023).

Assessing perception of self and body image

Evaluate how much incontinence changes the client's daily activities. Fear of accidents drives social isolation. Soiling and embarrassment limit work life for both men and women; some women postpone business meetings because of symptoms (Peden-McAlpine et al., 2018).

Check the surroundings for accessible toilets. No access at home, work, or in public intensifies the experience. In public, finding a bathroom becomes the first priority, travel stays limited to familiar places, and trips need heavy planning to avoid accidents (Peden-McAlpine et al., 2018).

Assess anxiety about social relationships. Clients see incontinence as a threat to social acceptability and privacy that strains relationships. Both sexes carry anxiety over potential isolation, and women hesitate to enter new relationships fearing they will have to disclose it (Peden-McAlpine et al., 2018).

Assess stigma and its effect. Clients stigmatize themselves over their lack of control. Women in particular feel shame and unworthiness, and some seek psychological help for feeling inadequate and vulnerable (Peden-McAlpine et al., 2018).

Identify the client's self-perception and body image. Loss of control damages body image and self-esteem and undermines emotional life and self-confidence (Peden-McAlpine et al., 2018).

Interventions to restore self-esteem

Encourage open communication and give emotional support. A safe, non-judgmental setting lets the client voice their feelings and concerns.

Reinforce information about the condition, its causes, and management. Teaching shows the client this is a manageable condition, not a personal failure, and gives them a sense of control and confidence.

Encourage fulfilling activities and hobbies. Enjoyable activity lifts self-esteem, improves relationships, shifts focus off the condition, and restores a sense of purpose.

Give positive reinforcement for effort and progress. Acknowledging progress builds a sense of accomplishment and self-worth and reinforces the client's belief that they can manage their life and condition.

Encourage positive coping strategies. Clients cope by holding onto hope and optimism, focusing on getting better, and asserting control over the aspects of life tied to incontinence and avoiding accidents (Peden-McAlpine et al., 2018).

Set goals that are meaningful and realistic. Common goals are fewer dietary restrictions, less leakage during exercise, confidence in controlling symptoms, and a normal daily routine (Peden-McAlpine et al., 2018).

Help preserve body image. Clients dress to conceal possible accidents, avoid large diaper-like pads as too visible, prefer small discreet pads, and wear dark clothing to hide stains (Peden-McAlpine et al., 2018).

Teach practical strategies to manage symptoms. Being prepared is key: morning bathroom rituals, moving the workstation closer to the bathroom, adjusting food and timing, taking a fiber supplement, or using antidiarrheal products. Pack a kit of absorbent products, cleansing supplies, and spare clothing before leaving home (Peden-McAlpine et al., 2018).

Bring in family and friends for social support. Support from spouses matters most. Clients credit loving, empathic, unconditional support for their adaptation, and talking through problems brings comfort (Peden-McAlpine et al., 2018).

4. Preventing Complications

High prevalence brings complications: skin conditions, UTIs, higher fall risk, constipation, fecal impaction, lost independence, and reduced quality of life. Accurate assessment and timely intervention prevent most of them (Yates, 2017).

Assessing for complications

Assess for surgical site infection, bleeding, and hematoma. Infection risk after these procedures is 3 to 5%. Watch for swelling, erythema, worsening pain, and fever. Bleeding and hematoma can hide in the perirectal space and sequester large amounts of blood (Ferzandi & Strohbehn, 2023).

Assess pain severity. Pain with bowel movements and intercourse frustrates client and provider. Undertreated pain leads to mental anguish, depression, anxiety, and poor quality of life.

Preventing infection

Promote meticulous perineal hygiene and teach proper cleansing. Good hygiene cuts skin breakdown, irritation, and infection. Regular cleansing removes stool, lowers bacterial growth, and protects skin integrity.

Give antimicrobial prophylaxis for colorectal procedures. Oral prophylaxis is neomycin plus erythromycin, or neomycin plus metronidazole, started no more than 18 to 24 hours before surgery. A single preoperative dose given within one hour before incision is sufficient (Ferzandi & Strohbehn, 2023).

Keep wound drainage and collection systems working. Opening the wound for drainage and antibiotics can salvage the repair. Fistula formation occurs in fewer than 1% of reviewed cases but is more common when infection develops (Ferzandi & Strohbehn, 2023).

Improving hydration and nutrition

Assess fluid and fiber intake. Fiber and fluid normalize bowel function. Regularity, timing, nutrition, fluids, exercise, and positioning all promote predictable defecation.

Provide a high-fiber diet under a registered dietician unless contraindicated. Insoluble fiber moves material through the gut and adds bulk, helping irregular stools. Bulky stool stimulates peristalsis. Include vegetables, fruit, and bran.

Ensure fluid intake of at least 2000 to 3000 mL/day unless contraindicated. This prevents impaction, since moist stool moves more easily. With diarrhea, fluid replacement is vital. Prune juice (120 mL) 30 minutes before a meal once daily helps when impaction is a problem.

Encourage natural bulking foods such as bananas, rice, and yogurt. They absorb fluid from stool, add bulk and moisture, increase consistency, and help form well-shaped stools.

5. Client and Caregiver Education

Education drives self-management, adherence, and psychosocial wellbeing, and lets the client take an active role and make informed decisions.

Assess readiness for self and home care. Consider the client's knowledge, experience, social and cultural background, education, and psychological status. Spread teaching across the recovery period and update it as the client masters each skill. The same applies to informal caregivers.

Assess the support system. After discharge, family members usually take over care, so assess the support system well before discharge. Positive family attitudes toward the client, the disability, and the return home make for a smoother transition.

Build an ADL checklist with the client and caregiver. An individualized checklist helps the family assist the client reliably with specific tasks.

Give caregivers written instructions and resources for equipment. Teach family to use the equipment and provide the manufacturer's booklet, resource contacts, supply lists, and where to get them. Include a written summary.

Teach the role of fluid and fiber in soft, bulky stools. This boosts personal efficacy and adherence. Natural bulking agents and high-fiber foods or supplements add bulk and stimulate colon contraction for more predictable movements.

Teach caregivers to use a fecal device if needed. It can be challenging, but with guidance and feedback the caregiver learns to manage it. Education lowers client and family discomfort and anxiety. Discuss the goals and expected benefits of the bowel management program with both (Arndt, 2020).

Teach proper hygiene and use of soap and water plus a moisture barrier with zinc oxide or dimethicone. This prevents irritation and pain that lead to impaction and more incontinence. Use a barrier, not a moisturizer, in the perineal area; it coats the skin so feces cannot penetrate and reduces friction from linen, clothing, or pads (Canadian Continence Foundation, 2017).

Teach the value of a regular bowel elimination schedule. Understanding the rationale helps the client take responsibility for self-care. Natural gastrocolic and duodenocolic reflexes fire about 30 minutes after a meal, so after breakfast is one of the best times to plan evacuation.

Discuss assistive devices such as incontinence pads and how to use them. Pads vary in size, shape, and absorbency, so learning the options helps the client and caregiver choose well for home (Yates, 2017).

Refer the client to support services and community resources. A network of services supports independent living. The nurse coordinates these, makes added referrals as needed, provides skilled care, and acts as advocate and counselor.