CC09 Enable individuals to effectively evacuate their bowels


This standard covers enabling individuals to effectively evacuate their bowels through the use of bowel emptying techniques (e.g. positioning, timing, defaecation dynamics, rectal medication, abdominal massage).  It involves reviewing the need for bowel emptying techniques and explaining such techniques to the individual and relevant others.  It also involves assisting the individual to perform bowel emptying techniques.

Users of this standard will need to ensure that practice reflects up to date information and policies.

Version No 1

Knowledge and Understanding

You will need to know and understand:

  1. the current European and National legislation, national guidelines, organisational policies and protocols in accordance with clinical/corporate governance which affect your work practice in relation to bowel emptying techniques to improve or maintain bowel function
  2. the importance of working within your sphere of competence and when to seek advice if faced with situations outside of your sphere of competence
  3. the importance of applying standard precautions for infection control and the potential consequences of poor practice
  4. the importance of documentation, the data protection act, care of patient records and disclosure of information with consent from the patient and your employer and the legal and professional consequences of poor practice
  5. the anatomy and physiology of the male and female lower gastro intestinal tract in relation to lower bowel function and continence status including:
    1. stool production and what influences this
    2. types/consistency of stool
    3. normal defaecation
    4. the nervous system, including autonomic dysreflexia
    5. the bowel
    6. the pelvic floor muscles/complex, including the anal sphincter
    7. the endocrine system
    8. reflex actions related to bowel function
    9. applied anatomy and physiology to constipation and spurious diarrhoea
  6. the causes of poor bowel emptying and constipation, and the impact of other conditions
  7. the types of constipation, and how to classify stool by use of an appropriate chart
  8. the signs and symptoms associated with poor bowel emptying and constipation
  9. the risks and complications associated with poor bowel emptying and constipation including dehydration, skin breakdown because of spurious diarrhoea, cross infection, obstruction and perforation, and how to take measures to minimise them
  10. the range of interventions (including curative) for individuals with poor bowel emptying and constipation
  11. how to select an appropriate and acceptable bowel emptying technique or combination for an individual
  12. the particular risks which specific bowel emptying techniques may have
  13. the use of appliances, adaptations and foot stools that assist with the use of a toilet and enhance effective defaecation and bowel evacuation
  14. the correct positioning of the individual related to the particular bowel emptying technique being used
  15. the methods of enabling the individual to be as comfortable as possible and maintaining their dignity and privacy given the constraints of the particular bowel emptying technique and the setting
  16. how to establish the effectiveness of bowel emptying techniques, the clinical rationale for review and follow up
  17. the situations in which it is necessary to seek further opinion for an individual, refer on, how this should be implemented and how urgently
  18. the types of surgical interventions used to improve bowel evacuation:
    1. the main types of operations
    2. broad outcomes of specific surgical procedures
    3. be able to select appropriate individuals for surgery
  19. how certain categories of medication cause poor bowel emptying  and constipation as applied to individuals
  20. the available oral and rectal pharmacological interventions and how they can be combined with bowel emptying techniques to enhance the effectiveness of outcomes for individuals with bowel dysfunction
  21. the prescribing, recommending and administration of rectal medication and laxatives, the indications, hierarchy of choice, usage times, duration of treatment, licensed usage, local formularies, indications, cautions, contra indications, side-effects, interactions and expected outcomes
  22. the ethical, safety, legal and professional implications of recommending unlicensed and untested substances in the treatment of bowel dysfunction

Performance Criteria

You must be able to do the following:

  1. apply standard precautions for infection prevention and control and take other appropriate health and safety measures
  2. review the need for bowel emptying techniques with the individual and relevant others
  3. obtain valid consent from the individual and agree the information which may be passed to others
  4. ensure the environment is suitable for bowel emptying techniques and that the privacy and dignity of the individual is maintained
  5. explain the relevant bowel emptying techniques to the individual and relevant others and describe what they involve, expected outcomes, side-effects and any complications
  6. encourage individuals and relevant others to seek clarification of any bowel emptying techniques, information and advice relevant to them
  7. obtain equipment and medical devices for individuals to meet their needs in accordance with protocols and guidelines
  8. assist the individual to perform the appropriate bowel emptying techniques in line with national and local guidelines
  9. produce records and reports that are clear, comprehensive, and accurate, and maintain the security and confidentiality of information

Additional Information

This National Occupational Standard was developed by Skills for Health in partnership with the Royal College of Nursing in December 2007.

This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004):

Dimension: HWB5 Provision of care to meet health and wellbeing needs
CC09 Enable individuals to effectively evacuate their bowels
Final version approved June 2010 © copyright Skills For Health
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