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Faecal incontinence in palliative and end-of-life care

02 November 2019
Volume 24 · Issue 11


Faecal incontinence can be a distressing and undignified experience, and is particularly a care delivery need for those at the end of life. There are various publications by national bodies including NHS England, the Department of Health, NHS Scotland and others, discussed in this article, to inform readers of the best way to care for someone experiencing faecal incontinence who is being looked after through palliative care in the community. The article will also discuss the application of recommended faecal collection devices and some of the associated risks. The devices discussed are: anal pouches, rectal tubes and catheters, and rectal trumpets. The article aims to inform the practice of community and district nurses providing palliative care.

Faecal incontinence can be a highly undignified experience for most people. It can happen for numerous reasons, one of which would be being at the end of life, when the body cannot function in the same way any longer. There are various publications by national bodies in the UK, including NHS England, the Department of Health and Social Care (DHSC) and NHS Scotland, which will be discussed in this article, with the aim to inform readers of the best way to care for someone requiring palliative care in the community and experiencing faecal incontinence.

In 2018, NHS England published a document aimed at commissioners and discusses continence. The publication recognises that continence is an important component in a person's health and wellbeing at any stage of life and is also an important consideration in the use of health resources (NHS England, 2018). Adult incontinence is recognised as causing a significant loss of self-esteem, alongside depression and a loss of independence (NHS England, 2018). Incontinence and associated bladder and bowel disorders may be connected to physical problems, such as skin breakdown, falls, urine infection and catheter-associated urinary tract infection. The latter can cause confusion, which, in turn, may lead to falls, head injury or femur fractures that would require hospitalisation (NHS England, 2018). For people to receive the best continence care, appropriately trained professionals should concentrate on early assessment, thus allowing a patient-centered and cost-effective care pathway to be followed (NHS England, 2018). Following the assessment of the patient, triage according to the level of intervention required, and planning can take place to incorporate their care needs, such as the requirement for containment products/devices and medication. Therefore, NHS England (2018) stated that it is appropriate to fund and effectively resource a continence team as part of an integrated service, with a view to fund more local specialist requirements depending on the need for those resources at the local population level.

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