Nurse-initiated bowel management strategies for first-line management of faecal incontinence

Abstract

Low anterior resection with total mesorectal excision and reconstruction with coloanal anastomosis is the optimal treatment of nondisseminated rectal cancer in selected patients and has seen a decrease in permanent stomas. However, up to 60% of patients can suffer from bothersome functional bowel complaints associated with the surgery and neo-adjuvant and adjuvant therapies, which are known as low anterior resection syndrome (LARS). LARS symptoms include faecal urgency, incontinence, frequency, constipation and incomplete emptying, in which patients may suffer from one or multiple symptoms. Patients should be informed about the possibility of permanent changes to their bowel function and what impact it could have on their quality of life. Nursing involvement is key to optimising symptoms and patient quality of life for patients suffering with LARS. Nursing management includes performing a physical assessment and determining the severity of LARS symptoms and effect on quality of life. Treatments available for LARS are based around the symptoms the patient is suffering and can include dietary modifications; biofeedback and pelvic floor physiotherapy; dietary fibre supplements / bulking agents; medications; transanal irrigation; surgical options and education.