A faecal management system (FMS) is a soft, flexible catheter inserted into the rectum to divert liquid or semi-liquid stool into a sealed collection bag. It is used in hospital and long-term care settings for patients who are bedridden or immobilised and experiencing faecal incontinence. The goal is straightforward: keep stool away from the skin to prevent breakdown, infection, and the constant need for bed changes.
How the Device Works
An FMS consists of three main parts: a silicone catheter, a small inflatable balloon near the tip, and a closed drainage bag. A healthcare provider inserts the catheter into the rectum and inflates the balloon to roughly the size of an egg. This holds the device in place and creates a seal so that liquid stool flows through the catheter and into the bag rather than onto the patient’s skin or bedding.
The system also has separate ports for maintenance. One port allows nurses to flush the catheter with water if stool starts to build up inside the tubing. Another port provides access to irrigate around the retention balloon. Some systems can also be used to deliver enemas or medications directly into the colon.
Who It’s Used For
Faecal management systems are designed for patients who are unable to get out of bed and have loose or liquid stool that is difficult to contain with pads or briefs. Common scenarios include patients in intensive care units, those recovering from major surgery, people with severe burns near the buttocks or sacrum, and individuals with existing pressure injuries that would worsen with repeated stool exposure.
The FDA’s cleared indications include diverting faecal matter to minimise skin contact, collecting stool for patients who need ongoing management, and providing access for colonic irrigation. In practice, most patients fitted with an FMS have some combination of immobility and uncontrolled diarrhoea.
Skin Protection Benefits
The primary advantage of an FMS is protecting fragile skin. Prolonged contact with liquid stool causes a condition called incontinence-associated dermatitis, a painful, red, sometimes blistered rash that can quickly progress to open wounds. For patients who already have pressure injuries on the sacrum or buttocks, faecal contamination dramatically increases the risk of infection and delayed healing.
A review of six studies found that five reported positive results when intra-anal bowel management devices were used to reduce incontinence-associated dermatitis and pressure injuries. By keeping the skin clean and dry, the system reduces the frequency of repositioning and cleaning that can itself cause friction damage. It also cuts down on nursing time spent on incontinence care, which allows staff to focus on other aspects of treatment.
Contraindications
Not every patient with faecal incontinence is a candidate. The device should not be used in patients with suspected or confirmed damage to the rectal lining, recent bowel or rectal surgery within the past year, rectal or anal stricture or stenosis, faecal impaction, poor rectal muscle tone, rectal or anal tumours, or severe haemorrhoids. Patients with known allergies to silicone or other device materials are also excluded. Each of these conditions increases the risk of the balloon or catheter causing further injury to already compromised tissue.
How Long It Can Stay In
A single FMS device can remain in place for a maximum of 29 days. After that point, it must be removed. If continued management is needed, a new device may be placed after the rectum has been assessed. In practice, many patients use the device for a shorter period, with nursing staff checking daily for signs of complications.
Potential Complications
While effective, faecal management systems carry real risks, particularly with prolonged use. The inflated balloon exerts constant pressure against the rectal wall. Over time, this pressure can cause ulcers in the rectal lining. If stool accumulates above the catheter, the added pressure on the bowel wall can lead to tissue death, a process similar to what happens in severe constipation when hard stool presses against the colon.
Reported complications include rectal ulcers, rectal bleeding, anal fissures, loss of anal sphincter muscle tone, abdominal distension, bowel obstruction, and in rare cases bowel perforation. Most of these result from either pressure injury caused by the balloon or traumatic removal of the device. Nurses are trained to check for warning signs like blood in the drainage bag, excessive leaking around the catheter, or abdominal bloating.
Daily Maintenance
An FMS is not a “set and forget” device. Nursing staff monitor it regularly and perform routine maintenance to keep stool flowing and the skin around the insertion site healthy.
- Flushing the catheter: If stool starts to accumulate in the tubing, nurses flush the system through a dedicated port using water and a syringe. This prevents blockages that could cause the system to back up or leak.
- Irrigating the balloon area: A separate irrigation port allows water to be flushed around the retention balloon, helping clear any stool buildup near the rectal wall.
- Managing leaks: Some leaking around the device is normal. When it occurs, the skin around the anus is cleaned, dried, and protected with a barrier product. Persistent or heavy leaking may indicate the device needs repositioning or replacement.
- Preventing blockages: Doctors may prescribe stool softeners to keep the consistency liquid enough to flow through the catheter. If repeated flushing fails to clear a blockage and no external obstruction is found, the device is removed.
Common Products
The most widely used faecal management system in hospitals is the Flexi-Seal line made by Convatec. Their product range includes the Flexi-Seal PROTECT PLUS, Flexi-Seal PROTECT, and Flexi-Seal SIGNAL, each designed for bedridden or immobilised patients with liquid or semi-liquid stool. Convatec also makes the Flexi-Seal Fecal Collector, which is an external pouch rather than an internal catheter, used for patients where rectal insertion is not appropriate. Other manufacturers produce similar devices, but Flexi-Seal is the brand most commonly encountered in clinical settings.