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Fecal Incontinence

Symptoms

Diarrhea, soft stools, and unintended release of gas are commonly associated with FI. Individuals suffering from chronic fecal incontinence may experience few to frequent “accidents”. The individual may begin to wear protective padding, choose darker clothing to camouflage accidents, and begin “toilet mapping”᠆ the practice of plotting nearby restrooms when traveling.11

Complications

Physically, fecal incontinence frequently leads to a condition called Incontinence Associated Dermatitis (IAD)--skin irritation and inflammation of the surrounding skin caused by frequent contact with stool.13 Itching and burning are common symptoms of IAD. Chronic irritation, frequent bathing and the use of cleansers can lead to the erosion of the protective layers of the skin, leading to an increased risk of developing bacterial and fungal infections.2, 7

IAD is a common problem in hospitalized acute care and critical care patients. Studies show that the overall prevalence of fecal incontinence is 17.6% and the associated rate of skin injury among those that are incontinent is up to 42.5%. Patients with fecal incontinence are 22 times more likely to develop skin ulcerations than continent patients.7

Fecal incontinence can also have serious psychological and social complications. Those afflicted often suffer emotions such as anger, anxiety, depression and frustration due to their lack of bowel control and potential for embarrassment.9, 16, 14 Individuals may feel overwhelmed from their constant need for awareness and care to prevent an accident or to resolve one. Social isolation, lack of travel and sexual decline are frequently associated with FI. Many also find it difficult to retain employment leading to financial hardship. This is further compounded by the cost of protective garments and increased water consumption due to frequent bathing and laundering.16

Diagnosis

Despite the physical, social and emotional issues associated with fecal incontinence, it is important to speak openly about your symptoms with your healthcare professional in order to properly direct your treatment.

Your primary care physician may choose to refer you to a bowel conditions specialist such as a gastroenterologist, proctologist or colorectal surgeon. During your medical appointment, your physician will discuss your symptoms with you and perform a medical history assessment and physical examination including a neurological exam and may order diagnostic testing.1

Your doctor may further rely on one or more diagnostic tests to make the correct diagnosis. These tests may include:14, 1

  • Anal manometry that measures the tone and function of anal sphincter muscles, and the sensitivity of the nerves of the rectum and their ability to respond to reflexes

  • MRI barium studies to see how the rectum and anus perform during defecation (defecography)

  • Anal Electromyography or EMG testing to see if the nerves supplying the anal muscles are functioning normally


References

  1. Arnold-Long, M. (2010). Fecal incontinence: an overview of the causes, treatments, and interventions to address bowel incontinence in the elderly. Long-Term Living: For The Continuing Care Professional, 59(10), 50-53.
  2. Beeckman, D. (2017). A decade of research on Incontinence-Associated Dermatitis (IAD): Evidence, knowledge gaps and next steps. Journal Of Tissue Viability, 26(1), 47-56. doi:10.1016/j.jtv.2016.02.004
  3. Black, P. (2011). Procedures for patients with a colostomy. Practice Nursing, 22(3), 121-124.
  4. Bleier, J. S., & Kann, B. R. (2013). Surgical management of fecal incontinence. Gastroenterology Clinics Of North America, 42(4), 815-836. doi:10.1016/j.gtc.2013.09.006
  5. García, C. B., Binks, R., Luca, E. D., Dierkes, C., Franci, A., Gallart, E., . . . Gibot, S. (2013). Expert Recommendations for Managing Acute Faecal Incontinence with Diarrhoea in the Intensive Care Unit. Journal of the Intensive Care Society, 14(4_suppl), 1-9. doi:10.1177/17511437130144s201
  6. Gump, K., & Schmelzer, M. (2016). Gaining Control Over Fecal Incontinence. MEDSURG Nursing, 25(2), 97-102.
  7. Junkin, J., & Selekof, J. L. (2007). Prevalence of incontinence and associated skin injury in the acute care inpatient. Journal of Wound Ostomy & Continence Nursing, 34(3), 260-269.
  8. Kim, T., Chae, G., Chung, S. S., Sands, D. R., Speranza, J. R., Weiss, E. G., & ... Wexner, S. D. (2007). Faecal incontinence in male patients. Colorectal Disease: The Official Journal Of The Association Of Coloproctology Of Great Britain And Ireland, 10(2), 124-130.
  9. Koloski, N., Jones, M., Kalantar, J., Weltman, M., Zaguirre, J., & Talley, N. (2012). Psychological impact and risk factors associated with new onset fecal incontinence. Journal Of Psychosomatic Research, 73(6), 464-468. doi:10.1016/j.jpsychores.2012.07.013
  10. McNevin, M. (2010). Overview of pelvic floor disorders. Surgical Clinics Of North America, 90(1), 195-205. doi:10.1016/j.suc.2009.10.003
  11. Ness, W. (2012). Faecal incontinence: causes, assessment and management. Nursing Standard, 26(42), 52-60.
  12. Owen Price, R., & Bradley, R. (2013). ASSESSING AND TREATING FAECAL INCONTINENCE. Nursing Older People, 25(7), 16-23. doi:10.7748/nop2013.09.25.7.16.e484
  13. Voegeli, D. (2016). Incontinence-associated dermatitis: new insights into an old problem. British Journal Of Nursing, 25(5), 256-262. doi:10.12968/bjon.2016.25.5.256
  14. Wald, A. (2007). Clinical practice. Fecal incontinence in adults. New England Journal Of Medicine, 356(16), 1648-1696
  15. Whitehead, W. E., Borrud, L., Goode, P. S., Meikle, S., Mueller, E. R., Tuteja, A., & ... Ye, W. (2009). Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology, 137(2), 1-14. doi:10.1053/j.gastro.2009.04.054
  16. Wilson, M. (2007). Bowel care. The impact of faecal incontinence on the quality of life. British Journal Of Nursing, 16(4), 204-207.
  17. Woodward, S. (2012). Management options for faecal incontinence. Nursing & Residential Care, 14(5), 224-229.