Fecal Management System (FMS)

What is the Fecal Management System?

Your loved one has a fecal management system (FMS). This is a soft, flexible tube placed in the rectum that collects stool into a sealed bag. It keeps stool away from the wound so the wound can heal.

Think of it like a catheter for stool — similar to how a urinary catheter drains urine into a bag.

The device is safe to use at home. Your loved one may already have other medical devices at home (such as a feeding tube, tracheostomy, or ventilator), and the FMS is managed in a similar way — with daily checks, routine care, and knowing when to call for help.

How the device works

• A soft silicone tube sits inside the rectum, held in place by a small water-filled balloon (or a soft seal, depending on the device type).
• Stool flows through the tube into a collection bag.
• The bag hangs below the level of the patient's body, like a urinary catheter bag.
• The device stays in place continuously and is replaced by a clinician every 29 days, or sooner if needed.

Your daily care checklist

Do these checks at least once a day. Twice a day is better.

1. Check the tube position

• Look at the tube where it comes out of the body. It should be at the same spot each day. Your nurse or clinician will mark the tube or tell you what depth to look for.
• If the tube has slipped out partway, do not push it back in. Call the wound care team.

2. Check the skin around the tube

• Look at the skin around the rectum where the tube enters. It should not be red, raw, or broken down.
• Apply barrier cream (zinc oxide or the cream provided) to the skin around the tube to protect it from moisture.

3. Empty the collection bag

• Empty the bag when it is about one-third to one-half full. Do not let it get completely full — a heavy bag can pull on the tube.
• To empty: put on gloves, open the drain spout at the bottom of the bag over a toilet or container, let it drain, close the spout, and clean the spout with an alcohol wipe.
• Write down how much stool you emptied, what color it was, and whether it was watery or thick. Share this with the wound care team at each visit.

4. Check the tube is secured

• The tube should be taped or strapped to the patient's thigh so it does not get pulled accidentally during repositioning, bathing, or transfers.
• If the tape is loose, replace it. Keep the tube gently looped — no kinks or sharp bends.

5. Check for leaking

• If stool is leaking around the tube (coming out around the tube instead of through it), this may mean the balloon has lost water or the tube has shifted.
• Do not try to fix this by adding more water to the balloon beyond what you were told. Call the wound care team.

Balloon checks

Balloon-type devices only (such as Flexi-Seal).

• The balloon is filled with water — never air. Your clinician will tell you the correct amount (usually about 40–45 mL).
• Check the balloon volume once a day: withdraw the water with a syringe through the balloon port, measure it, then put the same amount back in.
• If the balloon keeps losing water, the device may need to be replaced. Call the wound care team.

How to remove the device in an emergency

Only remove the device yourself if there is bleeding, or if the wound care team tells you to. Otherwise, leave removal and replacement to the clinician.

1. Put on gloves.
2. Find the balloon port on the tube (your clinician will show you which port this is during training).
3. Attach the syringe to the balloon port and pull back to remove all the water from the balloon. This is the most important step — never pull the tube out with the balloon still inflated, as this can injure the rectum.
4. Once the balloon is completely empty, gently and slowly slide the tube out.
5. If there is bleeding, hold a clean gauze pad gently against the area.
6. Call the wound care team or 911 as appropriate.

Irrigation (flushing the tube)

You only need to flush the tube if it gets clogged — stool stops flowing into the bag even though you know your loved one is having bowel movements.

1. Put on gloves.
2. Draw up 30–60 mL (about 1–2 ounces) of clean water or saline into a catheter-tip syringe.
3. Connect the syringe to the end of the tube (or the irrigation port, if there is one).
4. Push the water in slowly and gently. Do not force it.
5. Let the water and stool drain into the collection bag.
6. If the tube is still clogged after two tries, call the wound care team. The device may need to be replaced.

Do not use soap, bleach, or any cleaning solution — only clean water or saline.

Device replacement schedule

• The device is replaced every 29 days by a clinician (your wound care clinician or nurse). You do not replace the device yourself.
• If the device falls out or must be removed before the 29 days are up, protect the wound from stool by placing a clean pad or barrier dressing over the wound area, and call the wound care team to schedule reinsertion.
• After the device is removed, the clinician may wait a few hours before putting in a new one to give the rectal tissue a rest.

Supplies to keep at home

Make sure you always have these on hand:

• One backup FMS device (in case the current one needs to be replaced urgently)
• Extra collection bags
• Water-soluble lubricant (such as K-Y Jelly — never use petroleum jelly / Vaseline for insertion)
• Catheter-tip syringe (for balloon checks and irrigation)
• Barrier cream (zinc oxide or dimethicone-based)
• Clean gloves (non-sterile is fine)
• Gauze pads
• Tape or securement straps

If you are running low on any supplies, contact the wound care team or your medical supply company at least one week before you run out.

Supply company name:

Supply company phone:

Daily log

Use this log to track your daily checks, or keep a notebook. Bring it to each visit.