17 December 2017
Bowel Function Clinic

Bowel Function Clinic

What is the purpose of this clinic/service?

This is an outpatient clinic for pat ients affected by:


The causes of these symptoms are multifactorial however the bulk of referrals commonly include:

  • Patients with benign functional bowel disorders
  • Women  with bowel problems associated with a previous obstetric anal sphincter injury
  • Patients with poor bowel function following rectal resection
  • Patients with neurogenic bowel disorders


How does the system work (clinic pathway)?  

Referral:

  • Patients may be referred to the clinic by other members of the pelvic floor MDT
  • Referrals from other sources are reviewed by a Colorectal Surgeon from the pelvic floor MDT prior to any appointment

 

Assessment/Management:

  • Detailed assessment of current bowel problem, history of complaint and severity, toilet habit, evacuation pattern, continence etc.
  • Relevant medical/obstetric/urology history and medications
  • Impact on lifestyle. Continence score as appropriate. QOL score
  • Baseline investigations – radiology, physiology or endoscopy as advised
  • MDT review and management plan
  • Explanation and discussion with patient

 

Advice:

  • Diet, toilet posture
  • Toilet retraining
  • Use of laxatives or anti-diarrhoeals
  • Use of suppositories or enemas
  • Rectal irrigation
  • Perineal skin care and hygiene
  • Radar key

 

Sacral nerve stimulation

  • Pre-operative preparation, patient information, continence score, review of bowel diary
  • Post-operative review, removal of temporary wire and assessment of bowel diary
  • Permanent device programming
  • Routine follow ups, assessment of bowel diary
  • Troubleshooting


Rectal irrigation

  • Assessment of physical ability, suitability to irrigate and explanation of risks and benefits
  • Demonstration of systems and practical usage issues
  • Practical training and involvement of third parties where appropriate
  • Provision of equipment and how to obtain further supplies
  • Provision of HEFT patient information including troubleshooting advice
  • Follow-up/telephone reviews


Referral on:

  • Anorectal physiology/endoanal ultrasound
  • Biofeedback
  • Pelvic floor physiotherapy
  • Consultant surgeon review
  • GP
  • Continence Advisor
  • Community Nurse
  • Peristeen Nurse Advisor

   

Clinical competences  

The clinic is provided by a Colorectal Nurse Specialist who has in depth knowledge and experience in the assessment, investigation and conservative management of patients with functional bowel disorders.  

Such disorders may be symptomatic of many possible causes. The CNS must demonstrate an awareness of common causes of altered bowel function and investigations.  

The CNS has in-depth knowledge about functional, post-surgical and post-obstetric bowel problems and is knowledgeable about available conservative and surgical treatment options.. She is aware of pelvic floor disorders and their assessment and management.  

The CNS has an awareness of other conditions such as neurological, spinal or inflammatory and common medical disorders, medications, cognitive disorders and disabilities which can also affect bowel function.

 

Education  

The CNS is required to have undertaken a programme of advanced practice education at Masters level and demonstrated clinical competence in:  

  • Clinical assessment skills including history taking
  • Physical examination including anal inspection and digital rectal examination
  • Differential diagnosis and choosing appropriate investigations
  • Requesting radiological investigations
  • Prescribing skills 


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