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Fecal Incontinence
Loss of bowel control; the accidental loss of feces.
The Anal Bag: A Modern Approach to Fecal Incontinence Management
In the past 30 years, colostomy and urostomy bags have dramatically improved the quality of life of ostomy patients. However, the anatomical characteristics and physiological motility of the pelvic floor have hampered the development of suitable disposable containers that can be applied directly to the anus. Use of a recently developed anal bag that insulates the anus and peri-anal area and collects stool was evaluated in two inpatient care settings in Italy from 1994 to 2004. The study included four nurses and eight physicians (four gastroenterologists, two cardiologists, and two gerontologists) involved in the care of 120 patients (65 men, 55 women, ages 45 to 96 years). The study population consisted of patients who were elderly and bedridden (47), had pressure ulcers (15), were affected by fecal incontinence or bedridden in intensive care (10), had coronary problems (10), and were receiving high-dose chemotherapy (10); patients who had undergone anorectal surgery (28) were added to the study to evaluate the anal bag for postoperative use to prevent contamination and contain exudate and fluid. Study participants were divided into groups based on length of anal bag use (3 days, 1 week, or 4 months or more). Objective evaluation at each bag change included skin reactions to the adhesive. Study participants? feelings and perceptions as well as nurse and physician evaluations of the anal bag were assessed using questionnaires and four-point rating scales. No adverse reactions to the product were observed and none of the high-risk patients developed a pressure ulcer. The majority of patients (91, 76%) tolerated the bag well and reported it was not painful to remove or apply (102, 85%). Nurses and physicians all considered the device easy to use and appreciated its potential to prevent contamination and cross-contamination. This device may help improve the management of fecal incontinence and prevent complications. KEYWORDS: fecal incontinence, bedridden patients, patient hygiene, faecis isolatio, anal bag
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Fecal Incontinence in Acutely and Critically Ill Patients: Options in Management
Fecal incontinence presents a major challenge in the comprehensive nursing care of acutely and critically ill patients. When manifested as diarrhea, the effects of fecal incontinence can range from mild (superficial skin irritation) to profound (severe perineal dermatitis, dehydration, electrolyte imbalance, and sepsis). Fecal incontinence has many etiologies and risk factors. These include damage to the anal sphincter or pelvic floor, liquid stool consistency, abnormal colonic transport, and decreased intestinal capacity. To avoid or minimize complications, the cause of diarrhea should be addressed, fecal leakage prevented, stool contained, and skin integrity preserved. Management options addressing these goals include diet, pharmacological therapy, and the use of containment products. Management options and their respective advantages and disadvantages are presented with a special focus on safety issues. Diverse approaches are safe only if they are knowledgeably selected, carefully instituted, and constantly monitored for their effects on patient outcomes. Research to identify which options work best in selected clinical situations and which combinations of therapies are most effective is needed. KEYWORDS: fecal incontinence, diarrhea, critical illness
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Correlating the Fecal Incontinence Quality-of-Life Score and the SF-36 to a Proposed Ostomy Function Index in Patients with a Stoma
Quality of life is affected by the creation of a stoma. To assess the validity of the Ostomy Function Index in patients with a stoma, a prospective survey was conducted from July 2000 to September 2001 among patients participating in local United Ostomy Association chapters (N = 99; 55 with a colostomy and 44 with an ileostomy). The Short Form 36 general health survey, Fecal Incontinence Quality of Life Scale, and the proposed Cleveland Clinic Florida Ostomy Function Index were used to assess general health and stoma function in patients with an ostomy. The average proposed function index score (7 = excellent function, 35 = poor function) was 11.97 (range 7 to 22). The proposed function Index correlated with the Fecal Incontinence Quality of Life Scale and the physical and mental component scales of the SF-36 (P <0.05). The correlation between the proposed function index and the Fecal Incontinence Quality of Life Scale was stronger in colostomy than in ileostomy patients. With the exception of the SF-36 role-emotional domain in ileostomy patients, the function index correlated with all SF-36 scales (P <0.05) in both patient groups. The results of this study suggest that ostomy function is variable and correlates with quality of life and that the Fecal Incontinence Quality of Life Scale offers a limited assessment of quality of life in colostomy patients. The Cleveland Clinic Florida Ostomy Function Index offers an objective assessment of ostomy function that reflects on quality of life. Additional studies to refine measurement of quality of life in stoma patients are warranted. KEYWORDS: fecal incontinence, ileostomy, colostomy; quality of life, ostomy
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The Last Taboos ? Urinary and Fecal Incontinence
Urinary and Fecal Incontinence - Diane K. Newman, RNC, MSN, CRNP, FAAN This issue continues the OWM tradition of focusing the December articles on incontinence and features the work of incontinence specialists, including several of my colleagues. My article reviews the CMS Tag F 315 on urinary incontinence and catheters. ” I hope you find these articles ...
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A Review of Perineal Skin Care Protocols and Skin Barrier Product Use
Perineal skin damage secondary to incontinence is painful, prevalent, and preventable. Skin care professionals consider regular application of skin protectants for patients with incontinence the standard of care for preventing perineal skin injury secondary to incontinence. Although protocols to improve care exist, the extent to which they are implemented and followed has not been documented. A study was conducted to ascertain the extent to which perineal skin care protocols are consistent with Wound, Ostomy and Continence Nurses Society Clinical Practice Guidelines and to estimate the level of compliance related to the use of protective perineal skin barriers. A convenience sample of 76 perineal skin care protocols was obtained from acute care (n = 55), long-term care (n = 9), and nondisclosed types of extended care facilities (n = 12). All protocol interventions were compared to the Wound, Ostomy and Continence Nurses guidelines. Healthcare Products Information Services data were used to obtain the total amount of skin protectants sold to US healthcare facilities in 2002. Skin protectant use was compared to previously published urinary and fecal (urofecal) incontinence prevalence data. All 76 protocols lacked one or more of the interventions considered important in perineal skin care. Although 75% of the protocols included the use of skin protectants, Healthcare Products Information Services data and urofecal prevalence data suggest underutilization of skin protectants; an estimated 10 cents per day versus an anticipated average cost of 23.5 cents per application is being spent. Further study is warranted and necessary to ensure the application of evidence-based protocols of care in practice. KEYWORDS: perineal, skin, wounds, incontinence, dermatitis
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Incontinence-Associated Skin Damage in Nursing Home Residents: A Secondary Analysis of a Prospective, Multicenter Study
More than half of the nursing home population is incontinent of urine or feces, presenting challenges to perineal skin health. To determine the occurrence and severity of skin damage in nursing home residents with incontinence, a secondary analysis of data collected from a multisite, open-label, quasi-experimental study of cost and efficacy of four regimens for preventing incontinence-associated dermatitis in nursing home residents was performed. Sixteen randomly selected nursing homes from across the US were included in the study. Participating nursing home residents were incontinent of urine and/or feces and free of skin damage. Of the 1,918 persons screened, 51% (n = 981) qualified for prospective surveillance. Perineal skin was assessed over a 6-week period; frequency, type, and severity of skin damage were observed. Skin damage developed after a median of 13 (range 6 to 42) days in 45 out of 981 residents (4.6%), of which 3.4% was determined to be incontinence-associated dermatitis. Some residents (14 out of 45, 31%) had incontinence-associated dermatitis or other skin damage in more than one area. This study is one of the first to report the characteristics of incontinence-associated dermatitis in a large sample of nursing home residents. The sample size and random selection of nursing homes impart generalizability to the findings. Incontinence-associated dermatitis is a risk in nursing home residents, especially those with fecal incontinence. These findings suggest that the rate and severity of incontinence-associated dermatitis are low with close monitoring and use of a defined skin care regimen that includes a pH-balanced cleanser and moisture barrier. KEYWORDS: skin damage, dermatitis, incontinence, pressure ulcer, skin treatment, moisture barrier, nursing home
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When Fiber is Not Enough: Current Thinking on Constipation Management
Constipation is a common disorder and many patients fail to respond to the simple constipation remedies of increased fiber and fluid intake. When secondary to other conditions, medications, or disease processes, the focus of constipation management is correction of causative factors. However, primary constipation - ie, constipation with no identifiable causative factor - is very common. Patients generally present with one of three patterns: constipation-predominant irritable bowel syndrome, slow transit constipation, or pelvic floor dysfunction resulting in dyssynergic defecation. Baseline evaluation for patients with chronic constipation includes a careful history, focused physical examination, and limited laboratory studies. Patients with dyssynergic defecation usually respond best to biofeedback therapy and pelvic muscle re-education. Constipation-predominant irritable bowel syndrome is best managed with dietary monitoring and modifications, fiber therapy, and education regarding self-monitoring and self-care. Patients with slow transit constipation may benefit from fiber therapy and increased activity, but most also will require laxative therapy. Current guidelines for prescribing laxatives suggest bulk agents as first line and osmotic agents as second line therapy. Stimulant laxatives should generally be reserved for PRN use. Current understanding about the etiology, pathology, and classification of different types of constipation are summarized and a stepwise approach to evaluation and management is presented.
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Guest Editorial: We are All Continence Nurses!
Practitioners in the past1 and current WOCN President Laurie McNichol2 support broadening the continence care perspective to embrace both continence restoration nursing and incontinence management. Clinicians in long-term care settings deal with continence issues on a daily basis because their patients are at high risk for urinary and fecal incontinence and urinary retention and fecal impaction. ...
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Prevention and Treatment of Perineal Skin Breakdown Due to Incontinence
For example, F-314 identifies moisture from incontinence as one of the risk factors that must be minimized to prevent pressure ulcers.14 F-315 guides surveyor evaluation of efforts regarding appropriate cleansing, rinsing, drying, and protective moisture barrier application to prevent skin breakdown from incontinence.15 Plan of Care The plan of care must be individualized for the patient with incontinence and should include the following components:&...
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An Ostomy Can Mean Continence
Fecal or urinary incontinence negatively affects quality of life ? The most common indications for surgical intervention in management of fecal incontinence include spinal cord injuries and inflammatory bowel disease.2 Continent surgical alternatives also are now available, such as the creation of an ileal-anal reservoir or a Koch pouch. Nurses caring for these ...
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