By Brigitte Collins, Head of Clinical Education
Following a recent British Journal of Nursing roundtable discussion, I was struck by just how aligned clinicians were in their views on bowel management. The conversation reflected real clinical experience, and it challenged some long-held assumptions about how we structure bowel care.
Hear from the panel of experts who joined the discuss:
In my view, the conversation around bowel management is beginning to shift – and rightly so. Through ongoing engagement with clinicians across the bowel care setting, it is becoming increasingly clear that the traditional bowel treatment pyramid may no longer fully reflect the realities of modern clinical practice or the complexity of today’s patient needs. What stands out to me is the consistency of this viewpoint. Across roles, settings, and experience levels, there is a shared recognition that bowel care is evolving, and that existing frameworks do not always account for the current day-to-day decision-making. This is by no means a reflection of the quality of care being delivered, but rather an acknowledgement that the context in which that care sits has become more complex, expectations are changing, and flexibility is increasingly important.
A theme that I have been hearing is the need for clarity around clinical pathways and education. Clinicians often face complex situations without coherent guidance to help them make decisions.
At the same time patients are being encouraged to take a more active role in their care, and yet structured education can vary. In my opinion, this is where a real opportunity exists: not to redefine care itself, but to better support how it is understood, accessed, and applied in practice.
This direction aligns closely with the goals outlined in the NHS Long Term Plan, especially the focus on earlier intervention, prevention, and supporting patients towards self-management. There is for sure a move for proactive care, alongside an initiative to reduce variation of treatment through clearer, more consistent approaches. All of this for me points to the need to think beyond traditional stepwise models. A purely linear treatment pyramid may not always reflect the realities of clinical practice or the individuality of patients. Instead, a more personalised, multimodal approach to bowel management feels better suited – one that allows clinicians to draw on a range of options, guided by patient need rather than progression alone.
Ultimately, this is not about replacing one model with another, but about evolving our thinking in line with the world around us. The drive is already there. By focusing on clarity, strengthening educational support, and working collaboratively across the system, there is a real opportunity to structure a usable and patient-centred future for bowel care.
