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Fecal Incontinence

Treatment

Fortunately, several treatment options exist to assist in improving bowel control and these options vary depending on the cause of the condition.

  • Dietary changes may assist in preventing diarrhea and constipation. Adjusting the amount of fiber, fluids and controlling the amount and type of food one eats can help with one’s stool quality and promote regularity in the timing of one’s stools.15, 11, 12, 6

  • Certain medications such as laxatives, antidiarrheal drugs, bulk laxatives or stool softeners can also treat bowel incontinence by treating fecal consistency.1, 11

  • Bowel training or developing a regular bowel movement schedule by going to the bathroom at specific times of the day can decrease the frequency of accidents.12

  • Biofeedback therapy may increase one’s sensation inside the rectum and promote sphincter muscle strength. The former uses a balloon inserted into the rectum allowing the individual to gradually increase their ability to sense that it is “time to go”. The latter uses sensors allowing the individual to gauge the strength of their sphincter contractions and exercise the muscles involved in controlling defecation.17

  • Stool Management Systems (SMS) can be used for those with little to no bowel control, and are used for bed bound patients with liquid stool. A catheter is inserted into the rectum and is held in place by an inflatable balloon. Stool is then diverted into an external drainage bag.6 These systems promote the preservation of skin integrity, reduce the development of incontinence associated dermatitis, and protect against infection.17

Surgical procedures may be able to treat some forms of FI often when past treatment options have been exhausted.

  • A sphincteroplasty repairs the anal sphincter in cases where a weakened sphincter muscle is the cause of FI. In this procedure doctors surgically overlap and tighten the associated muscles in order strengthen their force of contraction.4

  • The insertion of an artificial bowel sphincter is another surgical option. Surgeons insert a circular balloon cuff around the anal canal, attached to a control pump which is then placed in the labia or scrotum. Individuals squeeze the control pump to temporarily deflate the balloon and allow the passage of stool.4

  • A colostomy is a variety of procedures where a surgical opening is made in the abdomen connecting the colon to the outside in order to bypass the rectum. Waste is collected into a removable colostomy bag.3 This procedure is generally a last resort for bowel incontinent individuals.6


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.