STUDY - Technical - New Dacian's Medicine
Fecal
incontinence (Classical / Allopathic Medicine)
Fecal
incontinence, the involuntary passage of feces, follows loss
or impairment of external anal sphincter control. It can
result from various GI, neurologic, and psychological
disorders; the effects of certain drugs; and surgery. In some
patients, it may even be a purposeful manipulative behavior.
Fecal incontinence
may be temporary or permanent; its onset may be gradual, as in
dementia, or sudden, as in spinal cord trauma. Although
usually not a sign of severe illness, it can greatly affect
the patient's physical and psychological well-being.
HISTORY:
Ask the patient (or the patient's family) with fecal incontinence about its onset, duration, and severity and about any discernible pattern - for example, at night or with diarrhea.
Ask the patient (or the patient's family) to describe the frequency, consistency, and volume of stools passed within the last 24 hours.
Review the patient's medical history for GI, neurologic, and psychological disorders.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient (or the patient's family) with fecal incontinence about its onset, duration, and severity and about any discernible pattern - for example, at night or with diarrhea.
Ask the patient (or the patient's family) to describe the frequency, consistency, and volume of stools passed within the last 24 hours.
Review the patient's medical history for GI, neurologic, and psychological disorders.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
If you suspect a brain or spinal cord lesion, perform a complete neurologic examination.
If a GI disturbance seems likely, inspect the abdomen for distention, auscultate for bowel sounds, and percuss and palpate for a mass. Inspect the anal area for signs of excoriation or infection.
If not contraindicated, check for fecal impaction, which may be associated with incontinence.
Obtain a stool sample. Note its consistency, color, and odor. Send the specimen for testing, as appropriate.
If you suspect a brain or spinal cord lesion, perform a complete neurologic examination.
If a GI disturbance seems likely, inspect the abdomen for distention, auscultate for bowel sounds, and percuss and palpate for a mass. Inspect the anal area for signs of excoriation or infection.
If not contraindicated, check for fecal impaction, which may be associated with incontinence.
Obtain a stool sample. Note its consistency, color, and odor. Send the specimen for testing, as appropriate.
Bowel retraining
tips
You can help the patient control fecal incontinence by instituting a bowel retraining program. Here's how:
Begin by establishing a specific time for defecation. A typical schedule is once per day or once every other day after a meal, usually breakfast. However, be flexible when establishing a schedule, and consider the patient's normal habits and preferences.
If necessary, help ensure regularity by administering a suppository, either glycerin or bisacodyl, about 30 minutes before the scheduled defecation time. Avoid the routine use of enemas or laxatives because they can cause dependence.
Provide privacy and a relaxed environment to encourage regularity. If “accidents” occur, assure the patient that they're normal and don't mean that he has failed in the program.
Adjust the patient's diet to provide adequate bulk and fiber; encourage him to eat more raw fruits and vegetables and whole grains. Ensure a fluid intake of at least 1 qt (1 L)/day.
If appropriate, encourage the patient to exercise regularly to help stimulate peristalsis.
Be sure to keep accurate intake and elimination records.
You can help the patient control fecal incontinence by instituting a bowel retraining program. Here's how:
Begin by establishing a specific time for defecation. A typical schedule is once per day or once every other day after a meal, usually breakfast. However, be flexible when establishing a schedule, and consider the patient's normal habits and preferences.
If necessary, help ensure regularity by administering a suppository, either glycerin or bisacodyl, about 30 minutes before the scheduled defecation time. Avoid the routine use of enemas or laxatives because they can cause dependence.
Provide privacy and a relaxed environment to encourage regularity. If “accidents” occur, assure the patient that they're normal and don't mean that he has failed in the program.
Adjust the patient's diet to provide adequate bulk and fiber; encourage him to eat more raw fruits and vegetables and whole grains. Ensure a fluid intake of at least 1 qt (1 L)/day.
If appropriate, encourage the patient to exercise regularly to help stimulate peristalsis.
Be sure to keep accurate intake and elimination records.
SPECIAL
CONSIDERATIONS:
While caring for the patient, maintain proper hygienic care, including control of foul odors.
While caring for the patient, maintain proper hygienic care, including control of foul odors.
PEDIATRIC
POINTERS:
Fecal incontinence is normal in infants and may occur temporarily in young children who experience stress-related psychological regression or a physical illness associated with diarrhea. It can also result from myelomeningocele.
Fecal incontinence is normal in infants and may occur temporarily in young children who experience stress-related psychological regression or a physical illness associated with diarrhea. It can also result from myelomeningocele.
AGING ISSUES:
Age-related changes affecting smooth-muscle cells of the colon may change GI motility and lead to fecal incontinence. However, before age is determined to be the cause, pathology must be ruled out.
Fecal incontinence is an important factor when long-term care is considered for an elderly patient.
Leakage of liquid fecal material is especially common in males.
Age-related changes affecting smooth-muscle cells of the colon may change GI motility and lead to fecal incontinence. However, before age is determined to be the cause, pathology must be ruled out.
Fecal incontinence is an important factor when long-term care is considered for an elderly patient.
Leakage of liquid fecal material is especially common in males.
PATIENT
COUNSELING:
Provide emotional support to decrease the feeling of embarrassment the patient may be experiencing. If the patient has intermittent or temporary incontinence, teach Kegel exercises to strengthen abdominal and perirectal muscles. If the patient has chronic incontinence but is neurologically capable of undergoing bowel retraining, institute a retraining program. (See Bowel retraining tips.)
Provide emotional support to decrease the feeling of embarrassment the patient may be experiencing. If the patient has intermittent or temporary incontinence, teach Kegel exercises to strengthen abdominal and perirectal muscles. If the patient has chronic incontinence but is neurologically capable of undergoing bowel retraining, institute a retraining program. (See Bowel retraining tips.)
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)