Journal of Community Nursing

JCN 2020,Vol 34, No 4 63 F unctional bowel conditions, including faecal incontinence and constipation are some of the commonest gastrointestinal conditions affecting up to a quarter of all the population, with a particular prevalence in children and older people (Belsey, 2010; Tack et al, 2011; Holroyd, 2015). It is a widely cited statistic that around one in 10 of the population will suffer with a bowel incontinence problem during their lifetime (Bladder and Bowel Community, 2020; BBUK, 2020), but due to social embarrassment many people try to self-manage and do not seek appropriate help (Bedoya-Ronga and Currie, 2014). Digital rectal examination: why, who, how? Sharon Holroyd, retired lead continence nurse specialist Rectal interventions are a fundamental part of nursing care across all settings aimed at establishing whether effective bowel emptying is taking place. Functional bowel disorders, including constipation, are common conditions affecting many of the general population and often go undetected by both patients, who perceive it as their normal, and healthcare professionals, who may not include a thorough bowel assessment at every clinical contact due to time restraints, lack of knowledge, or fear of intimate procedures causing harm or embarrassment. An inaccurate or complete lack of appropriate bowel assessment can increase risk of harm or ill health for many patients and therefore should be an intrinsic part of everyday clinical contact. The Royal College of Nursing (RCN) recently reviewed its bowel care guidance (Fenton et al, 2019) to address some of the concerns around bowel assessment and management. With an ever changing workforce, multiple grades of registered and non-registered staff taking on additional tasks, it is prudent for all clinicians to review their current knowledge and practice to ensure that they are following the latest evidence-based guidance for safe and effective practice. KEYWORDS:  Bowel management  Bowel assessment  Knowledge Sharon Holroyd Isolation, anxiety, depression and embarrassment are commonly reported by people who have a bowel issue (Wan and Wang, 2014). Based on this evidence, bowel management should be an essential part of health and social care, yet in the author’s opinion, it does not receive the attention it deserves. Bowel care is often overlooked in some healthcare settings in favour of more perceived important factors, such as the more obvious presenting complaint/ condition (Ness, 2013; National Institute for Health and Care Excellence [NICE], 2018). Digital rectal examination (DRE) and digital removal of faeces (DRF) are intimate interventions, which have been carried out by nursing and medical professionals for decades — with DRE being an essential component of holistic bowel assessment. The intimate nature of the procedures has caused concern among some healthcare professionals, with fears of litigation or accusations of abuse cited as the reason for reluctance to carry out the procedures (Kyle, 2010; Royal College of Physicians, 2010; Ness, 2013). In the author’s experience, there is a widespread reluctance and at times an outright refusal by staff to carry out rectal examination or manual evacuation techniques in practice today. This can lead to increased risk for patients who rely on digital rectal procedures to maintain an effective bowel emptying programme. The Nursing and Midwifery Council’s (NMC) standards of proficiency for registered nurses (2018) is clear in its instruction that nurses must:‘demonstrate the knowledge, skills and ability to act as a role model for others in providing evidence-based nursing care to meet people’s needs related to nutrition, hydration and bladder and bowel health’. There are specific nursing procedures that all registered nurses should be competent at to achieve entry to the register. These are clearly identified in the annexe of the document — 6.4 assess bladder and bowel patterns to identify and respond to constipation, diarrhoea and urinary and faecal retention; 6.5 administer enemas and suppositories and undertake rectal examination and manual evacuation when appropriate. Interpretation of these documents therefore suggests that a registered professional cannot refuse to perform a DRE/DRF if there is a clear clinical need for the procedure. Healthcare provision has altered over the past few years with many non-registered grades of staff providing essential care and support CONTINENCE CARE INSIGHT... a JCN learning zone feature www.jcn.co.uk/learning-zone