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Understanding the Bowel
When caring for someone with faecal incontinence, you may find it useful to have a rudimentary understanding of how the digestive system works. This will be very helpful in your discussions with Healthcare Professionals.
The digestive system consists of the stomach, the small intestine and the large intestine; collectively the intestines are referred to as the bowel. It usually takes between 24 and 72 hours for food to pass through the digestive system.
Food is digested in the mouth, stomach and small intestine where it is absorbed into the bloodstream. The remaining excess water is absorbed back into the body by the large intestine and the waste that remains, known as faeces, is passed out of the anus when you go to the toilet.
How a normal Bowel works
Food passes from the stomach to the small intestine before proceeding through the digestive system to the large intestine. The small intestine absorbs nutrients and much of the liquid from foods. The large intestine runs from the small intestine to the rectum and anus and its job is to store, process and get rid of waste – as well as absorbing any remaining nutrients and water. Key to this process are the millions of bacteria resident in the bowel - both 'good' and ‘bad’. The rectum can store waste but most of the time it is empty. Waste is expelled through the anus.
Once the bowel has done its work and absorbed nutrients from food, the waste travels to the rectum which stretches, triggering a message to the brain to say that the bowel is full and needs to be emptied. The pelvic floor and anal sphincter muscles, when well toned, ensure the anus remains closed until it is time to go to the toilet.
When we need to go to the toilet, the brain tells the anal sphincter muscles, via the nerves, to relax. As the muscles relax, the anus opens and the rectum empties.
- There are a number of things the person you are caring for can do to try to keep their bowel healthy. These include:
- Eating a healthy, balanced diet
- Exercising regularly
- Maintaining a generally healthy lifestyle
What to Eat
- A well balanced diet is the best way for the person you are caring for to avoid bowel problems and help them to maintain a healthy digestive system. They should try to
- Select a wholegrain breakfast cereal or porridge in the morning, adding a handful of nuts and seeds or some fruit if possible
- Eat small regular meals.
- Swap white bread for wholegrain or granary bread.
- Eat a balanced diet, with a variety of different foods. They should choose foods that are rich in fibre such as fruit, vegetables and starchy carbohydrates. A moderate amount of lean meat, fish, eggs and protein alternatives are also recommended, along with milk and dairy foods.
- Eating fruit, vegetables and wholegrain cereals is associated with reduced risk of certain cancers including those of the digestive system. These foods are high in fibre, antioxidants and other protective nutrients. Drinking enough fluids is just as important as eating the right kinds of food. The minimum recommended daily fluid intake for an adult is between 1.5 - 2 litres (6-8 glasses) of fluid each day. Fluid intake should be increased during hot weather or when exercising. Urine should be a pale straw colour; if dark it is likely you are drinking too little.
- Always chew food well and break down each mouthful into small pieces. This helps release the enzymes that aid digestion so that food is processed thoroughly and all the goodness extracted.
- What to avoid
- Be careful not to eat excessive amounts of fibre as this can also cause problems with loose bowel movements that are difficult to control.
- Limit the amount of alcohol consumed. Women should drink no more than 2 - 3 units a day, men 3 - 4 units.
- Limit the amount of sugary and fatty foods eaten. If the person you are caring for feels hungry and needs a snack, try to get them to choose nuts or a piece of fruit.
- Try to avoid eating large or fatty meals before sleeping.
Bowel Regular exercise
The person you are caring for can help improve their bowel control by regularly exercising their anal sphincter muscles. This helps by strengthening the muscles so that they improve the support they provide. This will, in turn, improve their bowel control and improve or stop leakage of gas or faeces. As with any other muscle in the body the more they are used and exercised, the stronger the sphincter muscles will be.
Learning to do the exercises
It is important for them to learn how to do the exercises correctly to start with and to check from time to time that they are still doing them correctly.
How to Exercise
- At first you will probably need to help the person you are caring for with these exercises but you should try to get them to exercise independently if possible. They should follow the steps listed below from a seated position;
- Imagine they are trying to stop themselves passing wind from the bowel – tighten by squeezing and lifting the muscle around their back passage and feel the muscle move upwards. They should be aware of the skin around the back passage tightening and being pulled up and away from their seat.
- Now they should imagine they are passing urine and tighten the muscles around the front passage, as if to stop mid-stream.
- Then ask them to try Steps 1 and 2 at the same time. Tighten around the back passage and think about moving the contraction forwards to include the front passage – imagine the squeeze and upward lift, which this will produce. They should hold the contraction for a few moments then relax completely before trying again.
Note: If they squeeze tightly they will only be able to hold this for a few seconds, as the muscle will tire quickly. This will not reallyhelp in the long run. They should squeeze more gently, feeling how much longer they can now hold for than at the maximum squeeze. This willhelp them control the urgency on the way to the toilet.
- Make sure they do not:
- tighten their buttocks
- breathe and hold for too long
- tighten the abdominal muscles
If they do any of these things they are not exercising correctly.
- Tips to help exercise
- At first it is probably a good idea to set some specific time aside for these exercises and really concentrate on getting them right. Time invested with the person you are caring for at this stage will pay dividends later.
- Try to get the person you are caring for into the habit of doing the exercises at the same time as doing everyday things e.g. when reading, or every time they answer the phone.
- They should use their muscles when they need arises e.g. if they feel urgency and that they are about to leak. Remember, they are better using a gentle squeeze that they can hold for longer as this will gradually improve their control.
- Keep an eye on their weight as being overweight puts unnecessary additional strain on the muscles.
- Even as things improve, they should continue to do the exercises a few times each day to ensure the problem does not come back.
Pelvic floor muscle exercises
Pelvic floor exercises are important for the person you are caring for as they can help strengthen the pelvic floor muscles which will, in turn, improve bowel control. Like any other muscles in the body, the more they are used and exercised the stronger the pelvic floor will be
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