Quality statement 4: Initial management

Quality statement

Adults with faecal incontinence have an initial management plan that covers any specific conditions causing the incontinence, and diet, bowel habit, toilet access and medication.

Rationale

Most symptoms of faecal incontinence can be improved, and many resolved, with initial management. Considering simple management options that may improve or resolve symptoms, in addition to providing support and advice on coping, should lead to the biggest improvements in quality of life for people with faecal incontinence. Effective initial management may reduce the risk of skin conditions and falls, and reduce the number of referrals to some specialist services. It can also help carers to cope, preventing carer breakdown and potentially delaying the need for domiciliary or residential care. People for who early specialist referral is indicated should also be offered initial management during any period of waiting.

Quality measures

Structure

a) Evidence of local capability to provide interventions for initial management of faecal incontinence.

Data source: Local data collection.

b) Evidence of local pathways (which are known to healthcare professionals carrying out baseline assessments for adults reporting bowel control problems) for accessing interventions for initial management of faecal incontinence.

Data source: Local data collection. The APPG Continence Care survey includes a question on what pathways are available for people with incontinence within the organisation.

Process

Proportion of adults with faecal incontinence who have had a baseline assessment and have an initial management plan that covers any specific conditions causing symptoms, and diet, bowel habit, toilet access and medication.

Numerator – the number of people in the denominator with an initial management plan that covers specific conditions that are causing symptoms, and diet, bowel habit, toilet access and medication.

Denominator – the number of adults with faecal incontinence who have had a baseline assessment.

Data source: Local data collection. The National Audit of Continence Care (NACC) collects data on whether there is a treatment plan, whether condition-specific interventions have been given or planned and whether the person's own goals and decisions for treatment and care have been documented.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure there are local pathways (which are known to healthcare professionals carrying out baseline assessments) for accessing initial management for adults with faecal incontinence and that staff have the knowledge, skills and attitudes to develop initial management plans that cover specific conditions that are causing symptoms, and diet, bowel habit, toilet access and medication.

Health and social care practitioners offer adults with faecal incontinence (or refer for) an initial management plan that covers specific conditions causing symptoms, and diet, bowel habit, toilet access and medication.

Commissioners ensure they commission services that provide access to interventions for initial management of faecal incontinence.

What the quality statement means for patients, service users and carers

Adults with faecal incontinence have their bowel control problems managed in the first instance as set out in a plan that covers any specific conditions causing the problems, diet, medication and getting to the toilet. The plan should be adapted to individual needs and preferences.

Source guidance

  • Faecal incontinence (NICE clinical guideline 49), recommendation 1.3.1.

Definitions of terms used in this quality statement

Faecal incontinence

This is any involuntary loss of faeces that is a social or hygiene problem [NICE clinical guideline 49, scope].

Initial management plan

This outlines the initial intervention(s) that have been discussed and agreed with the person with faecal incontinence (and carers, as appropriate), tailored to their individual needs and preferences. Interventions may include addressing specific conditions causing the incontinence and addressing diet, bowel habit, toilet access and medication needs [Adapted from NICE clinical guideline 49 recommendations 1.3.1 to 1.3.15].

Specific conditions

Specific conditions that might cause faecal incontinence and require condition-specific interventions include:

  • faecal loading

  • potentially treatable causes of diarrhoea (for example, infective, inflammatory bowel disease and irritable bowel syndrome)

  • warning signs for lower gastrointestinal cancer, such as rectal bleeding and change in bowel habit, as defined in recommendations 1.5.4 to 1.5.10 of Referral guidelines for suspected cancer [NICE clinical guideline 27]

  • rectal prolapse or third-degree haemorrhoids

  • acute anal sphincter injury including obstetric and other trauma

  • acute disc prolapse/cauda equina syndrome.

[NICE clinical guideline 49 recommendation 1.2.3]

The initial management plan will also incorporate coping strategies (statement 3) and the findings of the baseline assessment (statement 2) [Adapted from NICE clinical guideline 49 recommendations 1.3.1 and 1.3.11].

Medication

Managing medication includes reviewing medication and considering alternatives to drugs that are contributing to faecal incontinence (see table 4 of NICE clinical guideline 49), as well as prescribing anti-diarrhoeal drugs for people with loose stools and associated faecal incontinence [Adapted from NICE clinical guideline 49 recommendations 1.3.6 and 1.3.7].

Equality and diversity considerations

Faecal incontinence is associated with many protected characteristics that are covered by the Equality Act 2010, including age, disability, sex, and pregnancy and maternity. The consequences may also impact on others, including religion and belief. Without access to individually tailored initial management plans, appropriate care and treatment could be restricted for some people with faecal incontinence and protected characteristics. Effective management is likely to promote equality of opportunity by allowing increased participation in society and public life. An individually tailored initial management plan for people with faecal incontinence is therefore important for removing any unequal access to the most effective care.