From the Guidelines
It is generally contraindicated to place a fecal management system for a patient who is actively undergoing bowel preparation, as the liquid stool induced by bowel prep medications would render the FMS ineffective and potentially cause leakage around the device 1. The purpose of an FMS is to contain and divert formed or semi-formed stool away from the skin to prevent skin breakdown and manage fecal incontinence. During bowel prep, the patient will produce large volumes of liquid stool that the FMS is not designed to handle effectively.
Some key considerations for bowel preparation include:
- Limiting dietary modifications to the day before colonoscopy for ambulatory patients at low risk for inadequate bowel preparation 1
- Using a split-dose administration of bowel preparation purgatives for all patients, regardless of high-volume or low-volume preparation 1
- Assessing bowel preparation quality only after all washing and suctioning have been completed, using reliably understood descriptors that communicate the adequacy of the preparation 1
Additionally, the frequent liquid output could compromise the seal of the FMS, leading to skin irritation and breakdown—the very complications the device aims to prevent. It would be more appropriate to wait until after the bowel prep is complete before considering placement of an FMS, or to use alternative methods such as absorbent pads, frequent cleansing, and barrier creams to manage the liquid stool during the bowel preparation process.
The recent consensus recommendations by the US Multi-Society Task Force on Colorectal Cancer emphasize the importance of optimizing bowel preparation quality for colonoscopy, but do not address the specific issue of FMS placement during bowel prep 1. However, based on the principles of bowel preparation and FMS function, it is clear that placement of an FMS during bowel prep is not recommended.
From the Research
Fecal Management Systems and Bowel Prep
- The use of fecal management systems in patients who are bowel prepping is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that fecal management systems can be used safely in hospitalized patients with diarrhea and fecal incontinence 2.
- The ConvaTec Flexi-Seal® faecal management system (FMS) and other similar systems have been shown to be efficient and cost-effective in managing fecal incontinence 3.
- The management of fecal incontinence typically involves a focused history and physical examination, and may include optimized stool consistency, medications, pelvic floor muscle strengthening, and devices placed anally or vaginally 5.
- There is no clear evidence to suggest that using a fecal management system would be contraindicated in someone who is bowel prepping, but it is essential to consider the individual patient's needs and medical history when making decisions about fecal management 4, 5.
Key Considerations
- The safety and efficacy of fecal management systems in patients with bowel prep have not been specifically studied 2, 3, 4, 5, 6.
- The use of fecal management systems should be based on a thorough evaluation of the patient's individual needs and medical history 5.
- Healthcare providers should consider the potential benefits and risks of using a fecal management system in patients who are bowel prepping, and make decisions based on the best available evidence 2, 3, 4, 5, 6.