Improving management of bowel dysfunction: need for updated best-practice guidance.

Bowel dysfunction is managed inconsistently across the UK, with variation in referral pathways and treatment access being reported. The existing guidance, notably the 2013 stepwise treatment pyramid proposed by Emmanuel et al and simplified by Magnuson et al in 2023, focuses largely on secondary care and therefore does not fully reflect complexities of individual patient needs. To explore the causes of variation and identify areas for improvement, British Journal of Nursing convened a roundtable of bowel-care specialists. The discussion highlighted the limitations of a linear treatment model and recommended a more holistic approach of a circular pathway to span primary and secondary care. The panel suggested reclassifying transanal irrigation as a conservative treatment and supporting long-term patient motivation, alongside a wider educational approach to increase awareness of bowel dysfunction across community and healthcare settings. The importance of national data on effective models, as well as health service access and economic burden, was also highlighted as an important step to inform a consistent best practice approach.