Palliative Bowel Care

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“Though my soul may set in darkness, it will rise in perfect light, I have loved the stars too fondly to be fearful of the night.”

SARAH WILLIAMS

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Patients receiving end-of-life and palliative care frequently require regular assistance to successfully manage their bowel care.

While some guidelines on palliative care have been initiated in the last few years, there is a shortage of regulation exclusively on bowel management for people pending death.

This article focuses on the lack of direction and deliberates how medical staff can ease and improve patients’ suffering and best protect their self-respect while handling their bowel care.

At the end of life, a patients’ functional dependency will rise, resulting in them requiring assistance to cope with personal issues such as bowel care. Patients with life-threatening illnesses have recognised loss of self-worth as the main worry as they near death.

This is linked to reduced control of their biological functions and loss of discretion, mainly during personal care such as washing, toileting and continence issues.

Constipation is one of the biggest issues endured by palliative care patients. It can cause intense distress and pain to those who often have many healthcare needs. It can also affect patients’ day-to-day lives to such a degree that they can develop constant anxiety over their bowels issues.

In an effort to control it, patients may decline their analgesia.

Continuous or badly managed constipation also causes additional issues and difficulties such as urinary retention, urinary incontinence or terminal restlessness.

Efficient symptom control is the foundation of palliative care, but constipation and bowel incontinence management remain a challenging area. Indications have revealed that even specialist nurses may lack the essential understanding to provide ongoing bowel care for patients with malignant illness and evaluate bowel function according to bowel occurrence as opposed to than stool type and difficulty of defecation or using a bothersome score.

In the past few years, procedures regarding end-of-life care have improved substantially.

The Department of Health recognised the significance of refining and regulating end-of-life services by developing the end of life strategy.

The European Consensus Group on Constipation and Incontinence in Palliative Care makes suggestions for daily evaluation, analysis and the managing of constipation, which are reviewed in a valuable algorithm.

The Liverpool Care Pathway for the Dying Patient (LCP) – a part of the end-of-life care strategy – is a model of distinction for the care of the dying.

Despite these outstanding examples, however, minimal direction exists on how to achieve some of the more complicated areas related with both palliative and end-of-life bowel care such as metastatic spinal cord compression, anal fissures due to localised malignancy, constipation instigated by hypocalcaemia and the end stage of neurological diseases.

End of Life Care cites lack of information and education of health workers as an added difficulty to providing suitable end-of-life care.

Skills for Care and Skills for Health acknowledged common core proficiencies for effective end-of-life care to support staff development, training and education; in debating these essential competencies it may be conceivable to highlight where clinical guidance is absent and the need for palliative/end-of-life bowel care guidance.

Incontinence Products To Help Palliative Care Patients

It is fairly common for a palliative care patient to suffer from some form of incontinence, this could be constipation, urinary tract infections or urinary retention. In the case of urinary incontinence, this may not be related to the palliative diagnosis and maybe a longstanding symptom.

When urinary incontinence is diagnosed, it is sometimes beneficial to administer a urethral catheter as a containment measure, however, both the risks and benefits need to be considered first.

Often a better solution is the use of disposable incontinence products such as pads, pants and adult nappies, as these are throwaway products they are more hygienic and help to avoid the embarrassment and discomfort that a urethral catheter can cause.