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
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.
