Caring for a patient with fecal incontinence is challenging. Patients that are morbidly obese present an additional challenge because of the difficulty in turning them frequently to perform perineal care. Mrs. B is a thirty-four year old African-American female who underwent gastric bypass surgery at a major medical center. Because of her multiple co-morbidities, postoperatively she was ventilated for several weeks in the ICU. Three days after her gastric bypass surgery, she developed diarrhea. The frequent turning and hygiene measures necessitated by the diarrhea were difficult because of her fluctuating vital signs, difficulty in turning her because of her size, and her discomfort with turning. Barrier creams and rectal pouches were ineffective. Due to her size, comfort, and risk for skin breakdown, the Bowel Management System* was initiated. The Bowel Management System is a catheter system designed to collect fecal effluent. It can remain in place for 29 days. Daily maintenance of the catheter includes irrigation, and assessing tubing for kinks. This patient required the catheter for 4½ weeks and so used two systems. Her perineal skin remained intact. Her comfort was maximized. Turning the patient was more regulated reducing the potential for staff injuries. Linen changes were minimized adding to staff satisfaction. Patients on prolonged ventilation often develop gastrointestinal, urinary or respiratory infections. However, this patient although being at increased risk for these infections did not develop any infections. By preserving perineal skin integrity and promoting efficient use of nursing time, the Bowel Management System allows the nurse to focus attention on other clinical interventions to optimize patient outcomes.* Bowel Management System is made by Zassi Medical Evolutions