Practice NICE guidelines

Management of faecal incontinence in adults: summary of NICE guidance

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39231.633275.AD (Published 28 June 2007) Cite this as: BMJ 2007;334:1370
  1. Christine Norton, Burdett professor of gastrointestinal nursing1,
  2. Louise Thomas, project lead2,
  3. Jennifer Hill, director2
  4. Guideline Development Group
  1. 1Florence Nightingale School of Nursing and Midwifery, King's College London, London
  2. 2National Collaborating Centre for Acute Care, Royal College of Surgeons of England, London WC2A 3PE
  1. Correspondence to: C Norton, Burdett Institute of Gastrointestinal Nursing, St Mark's Hospital, Northwick Park, Harrow HA1 3UJchristine.s.norton{at}kcl.ac.uk

    Why read this summary?

    The prevalence of faecal incontinence in adults living in the community is 1-10%, depending on the definition used.1 2 Faecal incontinence is a neglected problem that receives limited medical attention, and despite its profound negative impact most patients do not tell their doctor about it.3 4 Simple, low cost interventions will often improve or even cure symptoms. More sophisticated second line investigations and treatments are available, but referral for these is not common. This article summarises the most recent guidance from the National Institute for Health and Clinical Excellence (NICE) on managing faecal incontinence in adults.5

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, a range of consensus techniques is used to develop recommendations. In this summary, recommendations derived primarily from consensus techniques are indicated with an asterisk (*).

    General approach

    All staff working with people with faecal incontinence should be aware of the physical and emotional impact this condition can have on patients and their carers. Consider patients' needs and preferences when planning treatment and ensure they have the opportunity to make informed decisions in partnership.

    Assessment

    Healthcare professionals should actively yet sensitively inquire about symptoms of faecal incontinence in high risk groups (box).

    Groups at high risk of faecal incontinence

    • • Frail older people

    • • Patients with loose stools or diarrhoea from any cause

    • • Women who have recently given birth (especially after third or fourth degree obstetric injury)

    • • Patients with neurological or spinal cord disease or injury

    • • Patients with severe cognitive impairment or learning disabilities

    • • Patients with urinary incontinence; pelvic organ or rectal prolapse; perianal soreness, itching, or pain

    • • Patients who have had colonic resection, anal surgery, or pelvic radiotherapy

    Faecal incontinence often has several contributory factors. Assumptions that it is caused by a single primary condition are therefore not appropriate.* Before …

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