A Proactive Approach to Bowel & Bladder Management in Adults

• Dietitians of Canada – Focus on Fibre
-Website with information on recommended amount of fibre by sex and age group and how to incorporate more fibre into the diet. For more information, see: https://www.unlockfood.ca/en/Articles/Fibre/Focus-on-Fibre.aspx

• Dietitians of Canada – Food sources of fibre
-Fact sheet with information on different forms of fibre. Including information on daily intake of fibre by age group. For more information, see: https://www.kfhn.ca/default/assets/File/Food%20sources%20of%20soluble%20...

• Dietitians of Canada – Find a dietitian.
-Website to find a dietitian who can provide person nutrition advice and practice solutions. For more information, see: https://members.dietitians.ca/DCMember/s/find-dietitian?language=en_US

• Dietitians of Canada – Facts on Fluids: How to Stay Hydrated
-Guidelines for fluid intake for men and women. Covers types of fluids, the signs and symptoms of dehydration and strategies to stay hydrated. For more information, see: https://www.unlockfood.ca/en/articles/water/facts-on-fluids-how-to-stay-...

-Website providing list of physiotherapists (including pelvic health physiotherapists) in Ontario and throughout Canada. The listing provides the names of physiotherapists and their company name, address, contact information and specialized training they have completed. For more information, see: https://pelvichealthsolutions.ca/

• Prior to giving psyllium fibre supplements, health providers should complete an assessment to identify the cause of fecal incontinence for persons living in the community.
• Encourage intake of food fibre sources prior to considering the option of using psyllium fibre supplements.
• There should be a graduated dosing of psyllium (e.g., start with a teaspoon and increase if tolerated).
• Do not offer psyllium fibre supplementation for persons who are bed bound or for the older adult population in long-term care settings; psyllium fibre is only indicated for persons living in the community.

• Encourage the intake of fibre-rich foods in the diet first and foremost, before suggesting fibre supplements
• Adequate fluid intake is 1500 mL to 2000 mL for adults; however this is to be tailored for adults on fluid restrictions (e.g. adults living with kidney disease or heart failure) or those with other relevant health conditions
• Refer to a registered dietitian for further, more comprehensive support

• Low-intensity physical activity refers to light, non-strenuous and repetitive bodily movement, such as walking, low-impact aerobic exercise and light resistance training
• Low-intensity physical activity should be individualized and appropriate to the person’s age, physical ability and associated health status.
• Low-intensity intake alone may not prevent or help manage constipation. It also is important for providers to encourage adequate fluid and fibre intake in persons living with constipation.

• The difficult and/or infrequent passage of stools (less than three bowel movements per week). Constipation may be acute or chronic (lasting more than three months), and it may be in response to a variety of physiological, mechanical and medically related factors, including medication use. However, the most common type is functional constipation, for which there is no underlying organic or medically identified cause.

For a full set of references refer to the BPG

• Diabetes Canada – benefits of physical activity

-Includes information related to benefits of physical activity, identifying barriers to physical activity and tips to overcoming barriers. For more information, see: https://www.diabetes.ca/diabetescanadawebsite/media/managing-my-diabetes/tools%20and%20resources/benefits-of-physical-activity.pdf?ext=.pdf

• Diabetes Canada – Introductory resistance program

-Includes information related to benefits of resistance training, safety considerations and tips on how to perform the training. For more information, see: https://www.diabetes.ca/diabetescanadawebsite/media/managing-my-diabetes/tools%20and%20resources/introductory-resistance-program.pdf?ext=.pdf

• Diabetes Canada – Maintaining aerobic exercise

-Includes information related to benefits of physical activity and understanding the intensity of aerobic activity. For more information, see: https://www.diabetes.ca/diabetescanadawebsite/media/managing-my-diabetes/tools%20and%20resources/maintaining-aerobic-exercise.pdf?ext=.pdf

• NHS Health Scotland – Walking

- Includes information related to physical and mental health benefits of walking. For more information, see: https://www.nhsinform.scot/healthy-living/keeping-active/activities/walking

• NHS University Hospitals of North Midlands – Older adults: Sit up, get dressed, keep moving

-Includes information on how activity can prevent deconditioning syndrome, which can contribute to constipation and incontinence. For more information, see: https://www.uhnm.nhs.uk/our-services/older-adults/

• Obtain a baseline history of person’s bowel pattern: type and quantity of stool, frequency and timing of bowel movements, and any straining with bowel movements.
• Assess stool consistency using a Bristol Stool Chart.
• Obtain a seven-day diet history of daily fluid and fibre intake.
• Conduct a review of medications to evaluate their effect on constipation.
• Examine co-morbid conditions that may cause or contribute to constipation.
• Assess the individual’s functional and cognitive status.
• Perform a digital rectal examination to determine fecal impaction

To view practice notes from expert panel click here