Bowel Health in Older People in Viet Nam: From Constipation and Fecal Incontinence to Safe, Dignified and Coordinated Care Across Settings

AGE-FRIENDLY CARE QUALITY · LONG-TERM CARE QUALITY

Last reviewed: October 2026

An older man recovering from hip surgery has not had a bowel movement for several days. He becomes uncomfortable and loses his appetite, but his bowel problem receives little attention while the clinical team focuses on pain management and rehabilitation. When watery stool begins to leak, his family assumes that he has developed diarrhea. At home, an older woman has gradually stopped attending family gatherings because she worries that she may not reach the toilet in time. She has experienced occasional stool leakage but feels too embarrassed to mention it to her doctor.

These situations illustrate an aspect of older-person care that can easily be overlooked. Constipation may be dismissed as an ordinary consequence of aging, while fecal incontinence often remains hidden because people are reluctant to discuss it. Sometimes treatment begins before the underlying problem is understood. In other cases, symptoms are documented but not followed by an appropriate assessment or care plan.

Bowel health affects more than gastrointestinal comfort. Persistent constipation, difficult evacuation and fecal incontinence can interfere with appetite, mobility, rehabilitation, sleep, social participation and independence. They may also lead to avoidable complications when symptoms are misunderstood or treatment is inappropriate. For someone who needs help using the toilet or managing an episode of incontinence, the experience can be particularly distressing because it involves one of the most private aspects of everyday life.

As Viet Nam develops more age-friendly, integrated and long-term care services, bowel health deserves greater attention within routine older-person care. The goal should not simply be to increase bowel movement frequency or prevent visible accidents. It should be to recognize clinically important problems, understand their causes, provide safe and appropriate treatment, and help older people maintain comfort, independence and dignity wherever they receive care.

Bowel Problems Are Not Simply an Inevitable Part of Aging

Normal bowel function depends on several processes working together. The colon moves and stores intestinal contents, the rectum senses stool filling, and the anal sphincters and pelvic floor muscles help control when stool is passed. Successful bowel movements also depend on sensation, muscle coordination, physical mobility and the ability to reach and use a suitable toilet.

Aging may influence some of these processes, but chronological age alone does not explain persistent bowel difficulties. Many older people maintain satisfactory bowel function throughout later life. Others develop symptoms associated with neurological conditions, diabetes, medication use, reduced mobility, inadequate dietary intake or pelvic floor dysfunction. Previous childbirth injuries, anorectal surgery, cognitive impairment and changes in the living environment may also contribute.

Constipation is commonly associated with infrequent bowel movements, but frequency alone is not enough to determine whether someone has a problem. Some people normally pass stool less frequently than others without discomfort or difficulty. Clinically important constipation may involve hard or lumpy stools, excessive straining, incomplete evacuation, a sensation that stool cannot pass or the need for manual assistance. Chronic functional constipation is assessed using established symptom-based criteria, such as Rome IV, while considering other possible explanations, including medication effects and underlying disease.

Fecal incontinence involves the involuntary passage of stool. Some people experience a sudden urge to defecate but cannot delay it long enough to reach the toilet. Others experience leakage without a clear sensation that stool is being passed. Symptoms may range from occasional staining to repeated episodes that substantially restrict everyday activities.

Constipation and fecal incontinence can also occur together. Severe stool retention may allow liquid stool to leak around impacted feces, creating the appearance of diarrhea. Conversely, excessive laxative treatment may cause loose stools and worsen leakage in someone who already has difficulty maintaining bowel control.

There are also situations in which an older person retains much of their physiological bowel control but cannot reach or use the toilet in time because of reduced mobility, cognitive impairment, inaccessible facilities or delayed assistance. This functional component matters because the most useful intervention may involve improving toilet access and caregiving arrangements rather than treating a primary anorectal disorder.

The first challenge is therefore to recognize that similar bowel symptoms may arise from different mechanisms. Persistent constipation, fecal leakage or a significant change in bowel habits should not automatically be attributed to aging or managed in the same way for everyone.

What Does the Available Evidence Tell Us About Viet Nam?

Reliable information about constipation and fecal incontinence among older Vietnamese people remains limited, particularly across community, hospital and long-term care settings. Available studies provide useful observations but do not establish a nationally representative picture.

A study published in Tạp chí Dinh dưỡng và Thực phẩm in 2017 examined constipation and related nutritional knowledge among 210 older inpatients at the National Geriatric Hospital, using data collected in September 2015. Constipation was identified in 41% of participants under the study's assessment approach. Approximately half of the patients also lacked adequate knowledge about constipation, including aspects of its symptoms, contributing factors and management.

These findings suggest that constipation can be a substantial concern among hospitalized older people. However, the study involved a selected inpatient population at one hospital. Its results cannot be used to estimate constipation prevalence among all older Vietnamese adults.

A more recent study published in Tạp chí Y Dược Thái Bình in March 2026 examined functional constipation among older patients attending Hue City Traditional Medicine Hospital. The researchers described a sample of 115 older patients and reported 34 cases classified as functional constipation. Straining during bowel movements was particularly common among those identified as having the condition. Associations were also reported with bowel habits, physical activity, dietary patterns, fluid intake and physical health.

The findings require caution. The published abstract contains an ambiguity between the description of participant eligibility and the classification of constipation within the sample. This limits confidence in interpreting the reported proportion as a prevalence estimate. The single-center, cross-sectional design also prevents causal conclusions about the associated factors. The study is therefore more useful as a description of observed clinical characteristics than as evidence of the prevalence of functional constipation among older people in Hue or Viet Nam.

For fecal incontinence, a systematic review and meta-analysis published in the Journal of the American Medical Directors Association in 2026 provides a broader international perspective. The review included 95 studies involving 595,019 older adults across community, hospital and long-term care settings. The pooled prevalence was 14.1%, with a 95% confidence interval of 11.7% to 16.7%.

This estimate must be interpreted carefully. The researchers found extremely high heterogeneity between studies, with an I² value of 99.86%. Differences in definitions, assessment methods, study populations and care settings substantially limited the generalizability of the pooled findings. Long-term care settings were associated with a greater burden of fecal incontinence, but considerable unexplained variation remained.

The 14.1% figure should therefore not be presented as the prevalence of fecal incontinence among older people in Viet Nam. Similarly, results from selected Vietnamese hospital studies should not be generalized to the country's entire older population.

What the available evidence supports is the importance of recognizing bowel problems in clinical practice and improving the quality of local data. More representative Vietnamese research is needed to understand constipation, fecal incontinence and related functional difficulties among older people living independently, receiving hospital treatment or requiring long-term support.

In the meantime, the absence of comprehensive national prevalence data should not prevent healthcare professionals from asking about bowel symptoms, investigating clinically important changes and providing appropriate care.

Good Assessment Begins With the Person's Usual Bowel Pattern

A useful bowel assessment begins with understanding what is normal for the individual rather than assuming that everyone should have a bowel movement every day.

Someone who normally passes stool every other day and feels comfortable may not need treatment simply because their frequency differs from another person's. By contrast, a significant change from a previously satisfactory pattern may deserve attention, particularly when accompanied by discomfort, prolonged straining, urgency or leakage.

Assessment should explore bowel movement frequency, stool consistency, difficulty initiating or completing evacuation, abdominal symptoms, urgency and episodes of fecal incontinence. It should also establish when the problem began and whether symptoms developed after an illness, surgery, medication change or alteration in diet, mobility or living arrangements.

The Bristol Stool Form Scale can help describe stool consistency more consistently. A bowel diary may also be useful for people with persistent or unpredictable symptoms. It can document bowel movements, stool characteristics, urgency, leakage episodes, laxative use and difficulties reaching the toilet. These tools support assessment and monitoring but do not independently establish a diagnosis.

Medication history deserves particular attention. Opioid analgesics, iron supplements, calcium supplements and medications with anticholinergic effects can contribute to constipation. Some calcium channel blockers and other commonly prescribed treatments may also affect bowel function. Conversely, excessive laxative use or medications causing diarrhea can contribute to fecal leakage.

The person's medical conditions and functional abilities are equally relevant. Parkinson's disease, stroke, diabetes and spinal disorders may affect bowel function through different mechanisms. Cognitive impairment may interfere with recognizing or communicating the need to use the toilet, while reduced mobility can make otherwise manageable bowel habits difficult to maintain.

Physical examination may be necessary to identify clinically important findings such as fecal impaction, rectal prolapse or impaired sphincter function. When indicated, this may include an anorectal examination performed by an appropriately qualified healthcare professional. The procedure should be explained beforehand, with appropriate consent, privacy and respect for the person's preferences and legal rights.

Further investigations should be guided by the clinical history and examination findings rather than performed routinely for every older person with constipation. However, warning signs must not be overlooked. Rectal bleeding, unexplained weight loss, iron-deficiency anemia or a persistent new change in bowel habits may warrant investigation for colorectal cancer or another underlying condition. Severe abdominal pain, substantial distension, repeated vomiting or inability to pass stool and gas may indicate bowel obstruction or another acute abdominal problem requiring urgent medical evaluation. New bowel dysfunction accompanied by saddle-area numbness, significant leg weakness or bladder dysfunction may indicate a neurological emergency.

The purpose of assessment is not simply to establish how often someone passes stool. It is to understand what has changed, identify potentially treatable causes and determine which interventions are likely to help without introducing unnecessary risks.

Constipation Management Requires More Than Fiber and Laxatives

Dietary fiber, adequate hydration and physical activity can support bowel health, but they are not universal solutions for constipation. The appropriate treatment depends on the underlying problem, its severity and the person's overall health.

For someone whose symptoms are associated with inadequate dietary fiber, gradually increasing suitable fiber sources through vegetables, fruits, legumes and whole grains may help. Soluble fiber supplementation, particularly psyllium, can also be beneficial for selected patients with chronic constipation.

However, increasing fiber without adequate assessment may be inappropriate in some circumstances. A person with severe stool retention, suspected bowel obstruction or certain defecatory disorders may experience increased bloating or discomfort. Dietary recommendations should also account for chewing and swallowing difficulties, malnutrition risk, food tolerance and other medical conditions.

Fluid intake requires similar individualization. Inadequate hydration may contribute to hard stools, but encouraging excessive water consumption is not an appropriate treatment for every person. Older people with heart failure, advanced kidney disease or other conditions requiring fluid management need advice consistent with their clinical circumstances.

Physical activity may support bowel function and general health, but recommendations must be realistic. A person recovering from surgery, living with frailty or requiring assistance to move cannot simply be told to exercise more. Supported mobility, suitable rehabilitation activities and regular opportunities to change position may be more practical.

Bowel routines can also help. Colonic activity often increases after eating through the gastrocolic response, making this a useful time for some people to establish a regular toileting pattern. Allowing sufficient time, providing a stable seated position and avoiding excessive straining may improve comfort and ease of evacuation.

When medication is indicated, its selection should reflect the clinical problem, previous treatment response and individual risk factors.

The joint American Gastroenterological Association and American College of Gastroenterology guideline published in 2023 provides evidence-based recommendations for pharmacological management of chronic idiopathic constipation in adults. It gives a strong recommendation for polyethylene glycol compared with no treatment and offers additional recommendations for fiber, other osmotic laxatives, stimulant laxatives and selected prescription therapies. The strength of recommendation and certainty of evidence vary between treatments.

The American Society of Colon and Rectal Surgeons' 2024 guideline similarly supports appropriate dietary management, fiber supplementation when suitable and osmotic laxatives as first-line medical treatment. Stimulant laxatives may be used when indicated, including as short-term or rescue treatment.

These recommendations require careful application in older people. Frailty, renal function, electrolyte disturbances, medication interactions and treatment tolerance may influence the choice of laxative. Magnesium-containing preparations require particular caution in people with renal impairment. Sodium phosphate laxatives and enemas can also cause serious renal and electrolyte-related complications when misused, especially in susceptible individuals.

Constipation associated with opioid treatment deserves separate attention because its mechanism differs from that of chronic idiopathic constipation. The AGA guideline on opioid-induced constipation recommends traditional laxatives as first-line treatment and discusses additional options for people whose symptoms remain inadequately controlled. These treatment pathways should not be applied interchangeably without considering the underlying condition.

International recommendations also need to be adapted to local practice. The World Gastroenterology Organisation's 2025 global guideline on chronic constipation uses a resource-sensitive approach, recognizing that diagnostic and treatment options vary across healthcare systems. This is relevant for Viet Nam, where access to specialized gastrointestinal investigations, medications and pelvic floor rehabilitation may differ between facilities and regions.

The goal of treatment is not simply to increase bowel movement frequency. It is to achieve a comfortable, predictable and satisfactory bowel pattern without creating additional symptoms or complications.

Persistent Constipation May Require Assessment of Rectal Evacuation

An important update in constipation management came in January 2026, when the American Gastroenterological Association published a Clinical Practice Update on refractory constipation.

The update emphasizes that constipation should not be classified as refractory until relevant secondary causes have been assessed and appropriate treatments have been adequately tried. This includes evaluating medication effects, neurological conditions, defecatory disorders and colonic transit when clinically indicated.

Some people experience constipation because stool moves slowly through the colon. Others have difficulty evacuating stool because the pelvic floor muscles and anal sphincters do not coordinate appropriately during defecation. This may occur in pelvic floor dyssynergia, a type of defecatory disorder.

Someone with this problem may experience prolonged straining, incomplete evacuation or a sensation that stool cannot pass, even when laxatives have softened it. Simply increasing the laxative dose may not correct the underlying dysfunction and can sometimes worsen discomfort or leakage.

The 2026 AGA update advises that most patients with chronic constipation should undergo appropriate anorectal evaluation, including anorectal manometry and balloon expulsion testing, and complete pelvic floor biofeedback therapy when indicated before being labeled as having refractory constipation.

Biofeedback involves structured training to improve the coordination of muscles involved in defecation. It differs from simply advising patients to strengthen their pelvic floor muscles. The 2024 ASCRS guideline also recognizes biofeedback as an important first-line treatment for symptomatic pelvic floor dyssynergia.

Not every older person with persistent constipation needs specialist physiological investigations. Decisions should consider clinical findings, previous treatment response, frailty, cognition, preferences and the person's ability to participate in testing and treatment.

Nevertheless, persistent symptoms should prompt reconsideration of the diagnosis rather than automatic escalation of medication.

For Viet Nam, an important practical question is how clinicians can recognize possible defecatory disorders and refer suitable patients to services with the necessary anorectal testing and pelvic floor rehabilitation expertise. Where such services are unavailable, clinicians need appropriate arrangements for further evaluation rather than assuming that additional laxatives will resolve every case.

Fecal Impaction Can Be Hidden Behind Apparent Diarrhea

Fecal impaction is a particularly important complication to recognize in frail, immobile or hospitalized older people.

It occurs when stool accumulates and becomes difficult to evacuate. Symptoms may include abdominal discomfort, distension, reduced appetite, rectal pressure or difficulty passing stool. In some cases, liquid stool leaks around the retained fecal mass, producing overflow leakage that resembles diarrhea.

This can lead to inappropriate treatment. If watery stool is assumed to be ordinary diarrhea and an antidiarrheal medicine is administered without recognizing underlying impaction, stool retention may worsen.

Fecal impaction should be considered when an older person has prolonged constipation, reduced mobility, cognitive impairment, neurological disease or medications that slow bowel movements, particularly when new leakage or abdominal symptoms develop.

Clinical assessment is necessary to establish the cause. A rectal examination may identify impacted stool, although a normal finding does not exclude stool retention higher in the bowel. Imaging or additional investigations may be needed when complications are suspected or the diagnosis remains uncertain.

Treatment depends on the severity and location of retained stool and the person's overall condition. Appropriate management may include oral or rectal treatments, while selected patients require disimpaction performed by trained healthcare professionals. Suspected bowel obstruction and other acute complications must be assessed before potentially inappropriate interventions are undertaken.

Family caregivers should not be encouraged to perform invasive rectal procedures or repeatedly administer enemas without appropriate professional assessment and guidance.

After the immediate problem has been treated, preventing recurrence becomes important. This may require reviewing medications, dietary intake, mobility, toileting routines and the ongoing bowel regimen.

Fecal impaction illustrates why a change in stool consistency should be interpreted within the full clinical picture. The appearance of loose stool does not necessarily mean that the bowel is empty.

Fecal Incontinence Deserves Assessment, Not Embarrassment or Resignation

Fecal incontinence can be particularly difficult for older people to discuss. Some feel embarrassed, while others assume that leakage is inevitable because of aging, illness or disability. Healthcare professionals may also underestimate the problem when symptoms are not volunteered.

The causes vary considerably. Some people experience urge incontinence and cannot delay a bowel movement long enough to reach the toilet. Others experience passive leakage without clear awareness. Loose stool, constipation with overflow, impaired sphincter function, altered rectal sensation, neurological conditions and pelvic floor dysfunction may all contribute.

Previous obstetric injuries, anorectal surgery or pelvic radiotherapy may remain clinically relevant many years later. However, fecal leakage may also result from functional difficulties such as reduced mobility or delayed assistance, even when the person's underlying bowel control remains relatively preserved.

The American Society of Colon and Rectal Surgeons' 2023 clinical practice guideline recommends dietary and medical management as first-line treatment for many patients with fecal incontinence. Assessment should consider stool consistency, bowel habits, medications, urgency and the impact on quality of life.

For some individuals, improving stool consistency, identifying dietary triggers, adjusting medications or treating an underlying gastrointestinal condition may reduce leakage. Selected patients with incontinence associated with loose stools may benefit from antidiarrheal medication, but relevant causes, particularly fecal impaction and conditions requiring specific treatment, should be considered before treatment begins.

Pelvic floor rehabilitation and biofeedback may help selected patients, although effectiveness varies according to the underlying mechanism and individual circumstances. Specialist assessment, including anorectal physiological testing or imaging, may be appropriate when symptoms remain significant despite conservative management.

Advanced treatments, including sacral neuromodulation or selected surgical procedures, may be considered for carefully assessed patients. Their suitability depends on expected benefits, risks, functional status, patient preferences, specialist expertise and the availability and regulatory status of the relevant interventions in Viet Nam.

For many older people, meaningful improvement may be possible through less invasive measures, particularly when treatable contributors are recognized early.

The NICE quality standard on fecal incontinence emphasizes that adults in higher-risk groups should be asked sensitively about bowel control problems and offered appropriate assessment and individualized management. This matters because people may otherwise remain silent about symptoms that could be improved.

Absorbent products can help people manage leakage while assessment or treatment is underway, and some individuals may need them over the longer term. However, providing these products should not automatically replace evaluation of treatable causes. Their use should reflect the person's needs, preferences and skin condition.

Fecal incontinence should not simply be accepted as permanent or untreatable because someone is older.

Toileting Support Is Also About Independence and Dignity

Few aspects of personal care involve as much vulnerability as needing assistance with bowel movements or cleaning after an episode of incontinence.

For someone who has managed independently for decades, asking a relative or care worker for help may be emotionally difficult. Some older people stop attending social activities because they fear having an accident. Others deliberately reduce food or fluid intake in an attempt to control bowel movements, potentially creating additional health problems.

These experiences show why bowel care cannot be reduced to a hygiene task. It involves personal autonomy, confidence and the ability to participate in ordinary life.

Respectful care begins with communication. Healthcare professionals and caregivers should explain the assistance being offered, use neutral and nonjudgmental language, and involve the person in decisions to the greatest extent possible. Privacy during toileting, cleaning and changing absorbent products should be protected.

Where possible, the older person should be encouraged to perform the parts of personal care they can still manage independently. Someone who needs assistance transferring to the toilet may still be able to manage clothing or personal hygiene. Supporting these abilities can preserve confidence and reduce unnecessary dependence.

The physical environment is equally important. An older person may recognize the urge to defecate but be unable to reach the toilet because of weakness, poor balance, arthritis or inaccessible facilities. A toilet may be too far from the bedroom, reached by steps or difficult to use without assistance.

Practical adjustments can make a substantial difference. Suitable grab bars, stable toilet seating, clear pathways, appropriate lighting and bedside commodes may improve access when properly assessed and installed. Some people benefit from toileting opportunities offered at predictable times, particularly after meals or when their usual bowel pattern suggests that assistance may be helpful.

These arrangements should remain individualized. A rigid institutional schedule may be convenient for staff but fail to reflect the person's actual needs or preferences. Delayed responses to toileting requests can also undermine continence and confidence, even when the medical treatment itself is appropriate.

Skin protection requires attention, particularly for people who experience repeated leakage or depend on others for hygiene. Prolonged exposure to stool and moisture can contribute to irritation and incontinence-associated dermatitis. Prompt, gentle cleansing, appropriate skin protection, hand hygiene and safe handling of soiled materials should be part of routine care.

For people living with dementia, changes in behavior may sometimes reflect constipation, discomfort, urgency or an unmet toileting need. Caregivers should consider these possibilities rather than automatically interpreting agitation or repeated requests for assistance as behavioral problems.

Good toileting support is not simply about keeping clothing and bedding clean. It is about helping the person remain comfortable, safe and as independent as possible while protecting privacy and dignity.

Bowel Care Must Work Across Hospitals, Homes and Long-Term Care

The causes and consequences of bowel problems may change as an older person moves between care settings.

During hospitalization, acute illness, surgery, opioid analgesics, reduced mobility and changes in meals or fluid intake can quickly disrupt bowel function. A patient who normally manages toileting independently may suddenly require assistance because of pain, weakness or temporary functional limitations. Constipation may interfere with comfort and rehabilitation, while urgent attempts to reach the toilet without help can create a risk of falling.

Hospital teams should recognize patients at increased risk, review relevant medications and ensure that clinically significant bowel changes receive appropriate assessment. When a bowel regimen is indicated, its effectiveness and adverse effects should be monitored. Access to timely toileting assistance also matters because appropriate medical treatment may still fail to protect continence when the patient cannot reach or use the toilet safely.

At home, the main challenge is often maintaining a realistic care plan with the support available. Family members may notice changes in bowel habits but be uncertain about warning signs, appropriate treatments or when professional assessment is necessary. Some may purchase laxatives, use previous prescriptions or try enemas without understanding the underlying problem.

Practical caregiver education should address recognition of important symptoms, safe toileting, prescribed treatment, suitable dietary and fluid support, and when to seek medical advice. Family members should not be expected to diagnose complex bowel disorders, independently adjust medications or undertake invasive procedures without appropriate professional guidance. Care plans should also consider their physical abilities, availability and emotional well-being.

Residential long-term care presents additional challenges because bowel management becomes part of everyday organizational routines. Residents may have different bowel patterns, levels of dependency, cognitive abilities and preferences. Staffing arrangements, environmental conditions and access to clinical assessment can influence whether problems are recognized and managed appropriately.

A resident who receives repeated laxatives without reassessment may develop loose stools or persistent discomfort. Another may depend on absorbent products because timely toileting assistance is unavailable. Someone living with dementia may experience significant constipation but be unable to describe it clearly.

Care providers should understand residents' usual bowel patterns, recognize important changes and ensure that toileting assistance and clinical review are available when needed. Medication regimens should have appropriate indications and review arrangements, while staff should know when apparent diarrhea may indicate fecal impaction rather than a primary diarrheal illness.

These practices require suitable staff competency, effective communication and access to professional support. However, improving bowel care does not necessarily mean introducing complex specialist services into every setting. It means recognizing which needs can be managed safely within the organization and which require additional clinical assessment or referral.

The same principle applies to rehabilitation and transitional care. Bowel problems should be managed in ways that support functional recovery, participation and independence rather than becoming an additional barrier to care.

Viet Nam's 2026 Professional Guidance Provides an Important Foundation

Bowel health is explicitly addressed in Viet Nam's current professional guidance on caring for older people at home and in the community.

Ministry of Health Decision No. 1976/QĐ-BYT, issued on 1 July 2026, provides guidance on several aspects of older-person care, including physical health, daily functioning and personal support. In its discussion of age-related digestive changes, the guidance identifies constipation and fecal incontinence as common bowel problems. It recognizes contributing factors such as physiological changes, medication use, inadequate fiber intake and limited physical activity.

The document encourages attention to suitable nutrition, adequate fluid intake and physical activity. It also recognizes the importance of supporting regular bowel habits among older people with cognitive difficulties.

Of particular relevance to care quality, Chapter IV includes practical guidance on assisting older people with elimination. It addresses toileting in bathrooms, at the bedside and through suitable equipment. The guidance emphasizes explaining the proposed activity, obtaining the older person's agreement, preparing appropriate equipment, ensuring safe positioning and maintaining hygiene.

These provisions are important because bowel care depends on both clinical assessment and reliable support with daily activities. A person may receive appropriate treatment for constipation yet continue to experience difficulty because they cannot access the toilet, require assistance with transfers or feel uncomfortable asking for help.

Circular No. 34/2026/TT-BYT, issued on 8 September 2026, provides additional implementation context within the National Target Programme on Health Care, Population and Development for 2026–2035, Phase I: 2026–2030. In relevant community-based older-person care activities, the Circular refers to Decision 1976 as professional guidance for training and care-related activities.

These documents provide a useful foundation for improving knowledge and practical care skills, but their scope should be interpreted carefully. Decision 1976 is not a comprehensive Vietnamese clinical practice guideline for chronic constipation, fecal incontinence, anorectal physiological testing or advanced gastrointestinal treatment. Circular 34 does not establish a separate nationwide bowel continence program or universal accreditation requirements for all long-term care facilities.

Vietnamese law also provides important protections within medical examination and treatment. Article 10 of the Law on Medical Examination and Treatment No. 15/2023/QH15, effective from 1 January 2024, addresses patients' rights to respect, protection of privacy and confidentiality, subject to the circumstances provided by law. These principles are particularly relevant when discussing sensitive bowel symptoms, performing intimate examinations or communicating personal health information.

The protection of identifiable care information also needs to be considered under applicable personal data protection requirements, including the Law on Personal Data Protection No. 91/2025/QH15, which took effect on 1 January 2026. The responsibilities of a particular organization depend on its activities and how personal information is collected, used, stored and shared.

The legal and professional requirements applicable to each service also depend on its nature, licensing status and relevant regulatory framework. International guidance from AGA, ACG, ASCRS, WGO and NICE should therefore be treated as evidence-based professional references rather than automatically binding Vietnamese legal requirements.

For Viet Nam, the practical opportunity is to translate existing professional guidance and relevant international evidence into better recognition of bowel problems, safer clinical management and more respectful personal care. This includes ensuring that healthcare professionals and caregivers understand when routine support is sufficient and when clinical reassessment or specialist referral is necessary.

Continuity of Bowel Care Requires More Than a Medication List

Bowel problems may persist or change when older people move between hospitals, rehabilitation services, homes and long-term care facilities.

Someone may leave hospital with a laxative started during opioid treatment but without a clear review plan. Another person may return home after treatment for fecal impaction without adequate arrangements to prevent recurrence. A resident entering long-term care may have established bowel routines that are unfamiliar to the receiving staff.

If these details are not communicated, treatment may be continued unnecessarily, stopped prematurely or repeated despite previous failure. The next care team may also overlook practical issues such as assistance with transfers, safe toilet access or skin protection.

A useful transition record should identify clinically significant bowel symptoms, relevant diagnoses or suspected conditions, current treatments, important adverse effects, toileting assistance needs and follow-up responsibilities. When medication was introduced for a temporary problem, the indication and review arrangements should be clear.

Persistent constipation, suspected defecatory dysfunction, recurrent fecal impaction or significant fecal incontinence may require further assessment after discharge or transfer. These needs should not disappear from the care plan simply because the person has moved to another service.

Information sharing should remain proportionate to the person's care needs and comply with applicable confidentiality and personal data protection requirements. Sensitive bowel symptoms should be communicated discreetly to those who need the information to provide appropriate care.

Continuity is not achieved merely by transferring the same medication list. It requires ensuring that the next care team understands what the problem is, what has already been tried, what matters to the person and what needs to happen next.

Measuring Bowel Care Quality Means Looking Beyond Stool Frequency

Recording bowel movements can provide useful clinical information, but frequency alone does not demonstrate good care.

A person may have a bowel movement every day while experiencing painful straining or incomplete evacuation. Another may pass stool less frequently but remain comfortable and satisfied. Someone with fecal incontinence may report fewer accidents after treatment but develop excessive constipation or other adverse effects.

Meaningful outcomes should reflect the problem being treated and the person's experience. For constipation, relevant measures may include stool consistency, straining, ease of evacuation, abdominal discomfort and satisfaction with bowel function. For fecal incontinence, they may include leakage frequency, urgency, ability to reach the toilet, skin problems, distress and restrictions on everyday activities.

Clinical safety should also be considered. Services may review recurrent fecal impaction, treatment-related diarrhea, medication adverse effects and whether warning signs trigger timely assessment. In settings where older people require assistance, appropriate toileting support, respect for privacy and the person's own experience of care may be equally important.

Validated clinical instruments can support assessment when appropriate, but they should not replace individual preferences or the wider clinical picture. Someone with advanced dementia may require caregiver-supported or observational approaches, while a person who can communicate reliably should have the opportunity to describe their own symptoms and goals.

These are potential areas for local quality improvement, not a nationally mandated Vietnamese bowel-care indicator set. The choice of measures should depend on the service, patient population and purpose of evaluation.

Organizations should use information to identify problems and improve care rather than impose identical bowel frequency targets on everyone. Recording that a resident passed stool or used fewer absorbent products is not enough if the person remains uncomfortable, distressed or unable to participate in daily activities.

The more useful question is whether bowel care is improving comfort, safety, independence and quality of life.

From Bowel Management to Comfort, Independence and Dignity

For an older person, better bowel health may mean having a bowel movement without pain or excessive straining, being able to leave home without worrying about an accident, or reaching the toilet without unnecessary assistance.

For someone recovering from surgery, it may mean avoiding severe constipation while remaining able to participate in rehabilitation. For a person living with dementia, it may mean receiving timely, sensitive assistance when they cannot clearly communicate a need. For a resident in long-term care, it may mean having familiar routines respected and intimate care provided without embarrassment or loss of dignity.

These outcomes may seem modest compared with major medical treatments, but they can make a substantial difference to everyday life.

As Viet Nam continues to develop age-friendly, integrated and long-term care, bowel health should become a more consistent part of clinical assessment and daily support. This requires recognizing symptoms that older people may be reluctant to mention, distinguishing between different causes, selecting safe and appropriate treatment, and ensuring that care remains reliable when needs or settings change.

The quality of bowel care cannot be judged simply by how often someone passes stool or whether their clothing and bedding remain clean. It is reflected in whether care helps the person remain comfortable, safe and able to participate in activities that matter to them, while maintaining as much independence as possible.

Good bowel care is not only about preventing constipation or managing fecal incontinence. It is about recognizing a personal health need that can affect how older people live, recover, participate and maintain control over their everyday lives.

Protecting that control, wherever possible, is an important part of safe, dignified and person-centered care for older people.

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14. Ministry of Health of Viet Nam. Decision No. 1976/QĐ-BYT issuing professional guidance on care for older people at home and in the community. 1 July 2026.

15. Ministry of Health of Viet Nam. Circular No. 34/2026/TT-BYT guiding certain contents in the implementation of the National Target Programme on Health Care, Population and Development 2026–2035, Phase I: 2026–2030, within the state-management scope of the Ministry of Health. 8 September 2026.

16. National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. Adopted 9 January 2023; effective 1 January 2024.

17. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. Adopted 26 June 2025; effective 1 January 2026.