How Healthcare Facilities Can Save Money with an Improved Bowel Care Program

Bowel dysfunctions, such as constipation and bowel incontinence, can be physically, psychologically, and socially debilitating conditions for patients both in and out of the long-term care setting. The loss of independence felt by those suffering from bowel disorders, along with the perceived negative stigma surrounding it, leads to social isolation and a decrease in quality of life for long-term care residents.

Constipation and bowel incontinence are costly to both patients and facilities, as they are some of the primary causes for a patient’s need for admission or continued long-term care.

It is essential for facilities to prioritize bowel care and have a regimented and effective bowel care program to improve the physical and mental health of patients and reduce patient illness, injury, and cost of care.

Health and Financial Costs of Constipation in Long-Term Care

Constipation is one of the most common gastrointestinal conditions¹ found in the United States. It is associated with a myriad of physical and mental comorbidities, including urinary tract infection, hemorrhoids, diarrhea, anal fissures, skin breakdown, depression, obesity, and neurological disorders¹.

Studies measuring the actual costs of bowel care to long-term care facilities are relatively rare, but a 2002 study² found that constipation costs facilities approximately $9,500 per patient annually, including staffing costs (nursing and care staff spend nearly an hour per day, per patient, managing fecal incontinence and related issues), laundry, and supply costs².

This same study also found that the per patient annual cost of constipation was approximately $2,253. While costs would be significantly higher today, this gives an overall sense of the high costs of constipation for healthcare facilities.

The overall economic costs of constipation are also high. A 2007 study¹ revealed that constipation costs the American healthcare system between $1912 and $7522 per patient, per year, and that those who suffer from constipation generally have poorer health, mental health, and social support networks as well.¹

About Bowel Incontinence

Constipation is one of the leading causes of bowel incontinence, also known as fecal incontinence (FI)³, or the inability to control bowel movements, causing stool to leak unexpectedly from the rectum. FI affection about 10% of the population⁴ and is more common in women and people over the age of 65⁴.

There are two main types of FI⁵:

Urge Incontinence: patients who have a sudden urge to defecate before leakage occurs.

Passive Incontinence: patients who have no urge to defecate before leakage occurs.

An effective bowel care program can have a significant positive impact on patients’ overall health, facility costs, staff morale, and better quality of long-term care.

Determining the Effectiveness of a Bowel Management Program

Signs that your facility’s bowel management program may be ineffective include, but are not limited to:

Patient stool that is hard or rocky/pellets/not producing a bowel movement daily or every other day.
A bowel care program that takes longer than an hour.
Bowel accidents or incontinence.
Skin irritation related to incontinence or usage of products that continue to stimulate the bowel.
Patient has excessive gas.
Patient lifestyle revolves around bowel management program.

Constipation Relief and Treatment

Studies have also shown⁶ that patients who had complete rectal emptying with oral and rectal laxatives had 35% fewer episodes of fecal incontinence, and 42% fewer incidents of soiled laundry than those who did not take laxatives.

It’s important to be aware, however, of potential side effects surrounding more commonly used products.

Potential Problems with Stimulant Laxatives

Some of the most commonly used stimulant laxatives contain bisacodyl. While stimulant laxatives can be effective, they can come with harmful side effects including diarrhea, dehydration, malabsorption, and loss of electrolytes (especially potassium).

Stimulant laxatives are also more likely than other types of laxatives to cause intestinal cramping. Bisacodyl provides a reproducible model of acute injury to the rectal mucosa within 30 minutes of exposure, and these changes may be misinterpreted as mild, acute colitis.⁷

Here are some additional startling facts about bisacodyl usage⁷:

Bisacodyl provides a reproducible model of acute injury to human rectal mucosa within 30 minutes of exposure.
For up to 30 hours after administration of bisacodyl, there was still histological evidence of mild inflammation, specifically in neutrophils.
Stimulant laxatives such as bisacodyl are not recommended for use as a regular part of a bowel program.
Studies provided no evidence to indicate the usefulness of bisacodyl in bowel retraining and that the full range of possible toxic effects from long continued use was not fully known.

ENEMEEZ® Products Provide Patient Progress and Reduce Costs

Forty-two percent of bisacodyl users experienced at least one episode of incontinence when using a suppository, whereas that number drops significantly, to only 3%, when using ENEMEEZ® mini-enemas.

The traditional bowel management program of oral stimulants, suppositories, and digital stimulation is time consuming and labor intensive. Patients and caregivers can find this program highly unpleasant and become resistant to learning the program. This leads to more frequent bowel accidents and interferes with patients’ full participation in therapy.

The ENEMEEZ® mini-enema as an essential part of a patient’s bowel care program has gained wide acceptance with long-term care facilities. With ENEMEEZ®, it has shown that bowel evacuation is much more efficient, with most bowel programs being completed in 15-30 minutes compared to 1-2 hours with the traditional bisacodyl suppository program.

Bowel evacuations were more complete with fewer incidence of fecal incontinence between bowel programs. Patients experienced less fatigue and were more able to participate in therapy. Less time was spent sitting on the toilet, which decreased the patients’ risk for development of pressure ulcers. The mini-enema program was less labor intensive resulting in fewer nursing hours devoted to the bowel program and reduced cost for attendant care upon discharge.⁸

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Disclaimer: The material contained is for reference purposes only. Quest Healthcare, A Division of Quest Products, LLC, does not assume responsibility for patient care. Consult a physician prior to use. Copyright 2023 Quest Healthcare, A Division of Quest Products, LLC.

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