Overview

• This policy sets the principles for providing bowel care to people that HWH support. 
• Quality bowel care is about ensuring a person’s bowels are effectively managed in a safe, consistent and hygienic manner that promotes a person’s overall health and wellbeing. 
• All clients we support deserve:
  • appropriate advice
  • monitoring
  • support and intervention.
• Above all, clients must be treated with dignity regarding sensitive and essential bodily functions.
• A healthy bowel can be affected by several factors, including:
  • a poor diet
  • insufficient fluid intake
  • disruption to regular diet or routine
  • delaying bowel actions due to pain (such as from haemorrhoids)
  • certain types of medications—narcotics, opioids, sedatives, and Codeine-based medications will slow down bowel movements
  • recent illness or hospitalisation
  • low activity levels and reduced mobility—particularly those who are in wheelchairs, bed-bound or post-surgery
  • reduced physical and emotional well-being.
• People with disability are more vulnerable to suffering from bowel dysfunction (a bowel that is not functioning correctly) for any of the reasons described above. 
• Bowel function can also be affected by diabetes, obesity, heart problems and other conditions. 
• The main types of bowel dysfunction are:
  • constipation and poor bowel emptying
  • diarrhoea
  • faecal incontinence.

• Constipation is when bowel movements occur less often than usual or consist of hard, dry stools that are painful or difficult to pass. 
• While bowel habits vary, an adult who has not had a bowel movement in three days or a child who has not had a bowel movement in four days is considered constipated.
• Constipation has many possible causes, including low mobility, inadequate diet, slow movement of faeces through bowels, or abnormality of the muscles involved in emptying the bowel.
• Preventing constipation is best practice and involves ensuring a person:
  • has an adequate intake of fluids (typically 6-8 glasses of water a day)
  • reduces or avoids intake of caffeine drinks (tea, coffee and cola)
  • has regular exercise
  • goes to the toilet when the urge is felt and has enough time.
  • has an established toileting regime

• Diarrhoea is defined as more than 300mls of loose, watery stools in 24 hours. 
• Diarrhoea can be short-lived, such as with food poisoning or a bowel infection (which can be spread to other people), or it can be a result of:
  • inflammatory bowel disease
  • irritable bowel syndrome
  • coeliac disease
  • Crohn’s disease.
• Diarrhoea may also be caused by food allergies, medications, radiation therapy, overuse of laxatives and diabetes. 
• Consult a doctor if a client suffers from ongoing diarrhoea.

• Faecal incontinence is leakage from the bowel due to poor bowel control. 
• Incontinence can often be experienced by people with health conditions such as diabetes, obesity, heart problems, stroke, cancer, prostate and kidney problems, and neurological conditions such as spina bifida, autism, spinal cord injuries and Parkinson’s disease. 
• Incontinence is best managed or prevented with a healthy diet, staying active, and regular bowel habits.

• Call a doctor or seek medical advice if a client experiences any of the following:
  • vomiting blood or faecal matter
  • diarrhoea and/or vomiting that is more than a one-off event
  • bleeding from the bowel
  • fresh (red) or old (black) blood in faeces (note: a person may also have black faeces when taking iron supplements)
  • unusual pain before, during or after a bowel action
  • constipation not resolved by medication—bowels not open for three days may indicate: 
    • faecal impaction 
    • bowel obstruction 
    • paralytic ileus.

• when clients require ongoing bowel management.
• applies to all managers and employees supporting clients with ongoing bowel management need

• NDIS (Quality Indicators) Guidelines 2018 (Cth)
• Bowel Management - Accessible

Policy

• Guidelines for promoting good bowel management:
  • ensure clients have sufficient fluid intake
  • ensure clients have adequate physical activity
  • provide a relaxed and unhurried setting with which clients can move their bowels
  • if necessary, provide planning and daily bowel diary for clients with bowel management needs

• Guidelines for providing good bowel care:
  • maintain good hand hygiene
  • use disposable incontinence pads and pants if needed
  • suggest clients wear underwear made of natural fibres such as cotton
  • clean and wash surrounding perianal skin/rectal region/moist areas of buttocks and groin with warm water and mild unscented soap
  • monitor for skin reaction inflammation, redness, breakdown, bleeding or erythema.