Purpose and scope
This best practice guideline (BPG) focuses on bladder and bowel management in adults (aged 18 years and older). In particular, this BPG provides evidence-based recommendations for effective strategies to support adults who live with urinary incontinence, fecal incontinence and/or constipation that will improve quality of care and lead to positive health outcomes.
This BPG is to be used by
- nurses,
- members of the interprofessional team, and
- caregivers across the continuum of care (e.g., acute care, long-term care, community and primary care, and rehabilitation),
and in all domains of practice
- administration,
- clinical,
- education,
- policy, and
- research.
Get started
Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020.
Recommendations
Do you want to learn about and implement the most- up-to-date evidence-based recommendations on this topic with your colleagues? Download and share the full best practice guideline (BPG), A Proactive Approach to Bladder and Bowel Management in Adults.
See below for a snapshot of the recommendations from this BPG. We strongly suggest you review the full BPG before implementing the recommendations and good practice statements. The BPG also includes further resources to support implementation and evaluation.
Good practice statement: The expert panel recommends that, prior to developing a plan of care or carrying out interventions, health providers conduct a focused initial assessment in collaboration with the person experiencing urinary incontinence.
Recommendation 1.1: The expert panel recommends that health providers encourage individualized toileting strategies in persons living with urinary incontinence.
Recommendation 2.1: The expert panel recommends that health providers encourage persons who live with urinary incontinence to engage in low-intensity physical activity, as tolerated.
Adopted recommendation: The expert panel recommends that health providers offer women who live with stress or mixed urinary incontinence a trial of supervised PFMT for at least three months as first-line management. A comprehensive assessment should be conducted to determine the applicability of PFMT for these women.
Recommendation 3.1: The expert panel suggests that health-service organizations implement an interprofessional approach to providing care for persons living with urinary incontinence.
Good practice statement: The expert panel recommends that, prior to developing a plan of care or carrying out interventions, health providers conduct a focused initial assessment in collaboration with the person experiencing fecal incontinence and/or constipation.
Recommendation 4.1: The expert panel recommends that as part of a wider multicomponent program, health providers encourage persons living with constipation to engage in low-intensity physical activity for about 30-60 minutes (as tolerated) at least three times a week to help manage constipation.
Recommendation 5.1: The expert panel suggests that health providers counsel persons on adequate fibre intake to prevent and manage constipation.
Recommendation 5.2: The expert panel recommends that as part of a wider multicomponent program, health providers counsel persons living with constipation on adequate fluid intake to help manage constipation.
Recommendation 5.3: The expert panel suggests that health providers promote the option of using psyllium fibre supplements for persons living with fecal incontinence in the community.
Recommendation 6.1: The expert panel suggests that health-service organizations implement an interprofessional approach to providing care for persons living with fecal incontinence and/or constipation.
Recommendation 7.1: The expert panel recommends that health-service organizations implement a bowel protocol to manage constipation, which can be individualized.
Disclaimer: These guidelines are not binding for nurses, other health providers or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work.
