Recommend a diet and fluid intake that promotes an ideal stool consistency and predictable bowel emptying. Healthcare professionals should:
- take into account existing therapeutic diets
- ensure that overall nutrient intake is balanced
- advise patients to avoid caffeine, and to modify one food at a time if attempting to identify other potentially contributory factors to their symptoms
- encourage people with hard stools and/or clinical dehydration to aim for at least 1.5 litres intake of fluid per day (unless contraindicated).
- consider the opportunity to screen people with faecal incontinence for malnutrition, or risk of malnutrition
With respect to bowel habit and technique, people with FI should be encouraged to
- adopt a squatting position if emptying is incomplete
- do regular pelvic floor exercises, if necessary using squeezyapp.com
- Consider alternatives to medications that might be contributing to FI. A surprisingly common example is metformin (suspect if onset of FI follows starting metformin or an increase in dose).
- Antidiarrhoeal medication should be offered to people with FI associated with loose stools once other causes have been excluded. It should not be offered to those with hard or infrequent stools, acute diarrhoea without a diagnosed cause, or an acute exacerbation of colitis. The antidiarrhoeal drug of first choice should be loperamide capsules, meltlets or syrup. Begin at a low dose and escalate slowly as required. Some patients benefit from combining loperamide, fybogel and yoghurt in a paste. An alternative to loperamide is codeine.
Other coping mechanisms include pads, toilet passkeys, etc