NCM 116 NB - CARE OF CLIENTS WITH PROBLEM IN NUTRITION AND GI, METABOLISM

AND ENDOCRINE, PERCEPTION

Fecal Incontinence
Definition
Fecal incontinence – also called anal incontinence – is the term used when bowel movements
cannot be controlled. Stool (feces/waste/poop) leaks out of the rectum when you don’t want it
too, which means not during planned bathroom breaks. This leakage occurs with or without your
knowledge. 
Predisposing Factors
A number of factors may increase your risk of developing fecal incontinence, including:
 Age. Although fecal incontinence can occur at any age, it's more common in adults over
65.
 Being female. Fecal incontinence can be a complication of childbirth. Recent research
has also found that women who take menopausal hormone replacement therapy have a
modest increased risk of fecal incontinence.
 Nerve damage. People who have long-standing diabetes, multiple sclerosis, or back
trauma from injury or surgery may be at risk of fecal incontinence, as these conditions can
damage nerves that help control defecation.
 Dementia. Fecal incontinence is often present in late-stage Alzheimer's disease and
dementia.
 Physical disability. Being physically disabled may make it difficult to reach a toilet in time.
An injury that caused a physical disability also may cause rectal nerve damage, leading to
fecal incontinence.

Precipitating factors

 Muscle damage. Injury to the rings of muscle at the end of the rectum (anal sphincter)
may make it difficult to hold stool back properly. This kind of damage can occur during
childbirth, especially if you have episiotomy or forceps are used during delivery.
 Diarrhea. Solid stool is easier to retain in the rectum than is loose stool, so the loose
stools of diarrhea can cause or worsen fecal incontinence.
 Surgery. Surgery to treat enlarged veins in the rectum or anus (hemorrhoids), as well
as more-complex operations involving the rectum and anus, can cause muscle and
nerve damage that leads to fecal incontinence.
 Hemorrhoids. When the veins in your rectum swell, causing hemorrhoids, this keeps
your anus from closing completely, which can allow stool to leak out.

Disease Process
When the normal anatomy or physiology that maintains the structure and function of the
anorectal unit is disrupted. Incontinence usually results from the interplay of multiple pathogenic
mechanisms and is rarely attributable to a single factor.

Signs and Symptoms

Bowel Incontinence is characterized by the following signs and symptoms:

 Fecal seepage (undesired leakage of stool after a bowel movement with otherwise

normal continence and evacuation)
 Urge incontinence (discharge of feces and flatus in spite of active attempts to retain
these contents)
 Passive incontinence (involuntary passage of feces and flatus without any awareness)
 Encopresis (a term used mostly for fecal incontinence in children)

Laboratory Tests and other Examination

A number of tests are available to help pinpoint the cause of fecal incontinence:
 Digital rectal exam. Your doctor inserts a gloved and lubricated finger into your
rectum to evaluate the strength of your sphincter muscles and to check for any
abnormalities in the rectal area. During the exam your doctor may ask you to bear
down, to check for rectal prolapse.
 Balloon expulsion test. A small balloon is inserted into the rectum and filled with
water. You'll then be asked to go to the toilet to expel the balloon. If it takes longer than
one to three minutes to do so, you likely have a defecation disorder.
 Anal manometry. A narrow, flexible tube is inserted into the anus and rectum. A small
balloon at the tip of the tube may be expanded. This test helps measure the tightness
of your anal sphincter and the sensitivity and functioning of your rectum.
 Colonoscopy. A flexible tube is inserted into your rectum to inspect the entire colon.
 Magnetic resonance imaging (MRI). An MRI can provide clear pictures of the
sphincter to determine if the muscles are intact and can also provide images during
defecation (defecography).

Complications

Complications of fecal incontinence may include:

 Emotional distress. The loss of dignity associated with losing control over one's
bodily functions can lead to embarrassment, shame, frustration and depression. It's
common for people with fecal incontinence to try to hide the problem or to avoid social
engagements.
 Skin irritation. The skin around the anus is delicate and sensitive. Repeated contact
with stool can lead to pain and itching, and potentially to sores (ulcers) that require
medical treatment.

Pharmacologic Management
Depending on the cause of fecal incontinence, options include:
 Anti-diarrheal drugs such as loperamide hydrochloride (Imodium A-D) and
diphenoxylate and atropine sulfate (Lomotil)
 Bulk laxatives such as methylcellulose (Citrucel) and psyllium (Metamucil), if chronic
constipation is causing your incontinence

Medical Management

 Colostomy (bowel diversion). This surgery diverts stool through an opening in the

abdomen. Doctors attach a special bag to this opening to collect the stool. Colostomy
is generally considered only after other treatments haven't been successful.

 Sphincteroplasty. This procedure repairs a damaged or weakened anal sphincter

that occurred during childbirth. Doctors identify an injured area of muscle and free its
edges from the surrounding tissue. 
Nursing Considerations
Diagnosis 1: Bowel Incontinence related to nerve damage as evidence by abdominal pain
Assessment

 Assess patient's level of anxiety.

 Assess degree to which patient's daily activities are altered by bowel incontinence.
 Assess perineal skin integrity.
Nursing Interventions

 Provide high-fiber diet under the direction of a dietitian, unless contraindicated.

 Perform manual check for fecal impaction.
 Ensure fluid intake of at least 3000 ml per day, unless contraindicated.
Dependent Nursing Interventions

 Encourage mobility or exercise if tolerated.

Expected Patient outcome:

 The patient will maintain or improve skin integrity around anal area

Diagnosis 2: Knowledge deficit

Assessment

 Assess the patient’s normal bowel elimination pattern.

  Assess the use of diapers, sanitary napkins, incontinence briefs, fecal collection devices,
and underpads.
 Evaluate the surroundings for the availability of an accessible toilet facility.
Nursing Interventions

 Provide a high-fiber diet under the direction of a registered dietician, unless

contraindicated.
 Encourage the intake of natural bulking agents to thicken stools, for example, foods such
as banana, rice, and yogurt.
 Educate the patient about proper hygiene and the use of soap and water and moisture
barrier containing zinc oxide or dimethicone.
 Educate the patient on the importance of establishing a regular schedule for bowel
elimination.
 Ensure fluid consumption of at least 3000 mL/day, unless contraindicated.

Expected Patient outcome:

 Patient is continent of stool or reports decreased episodes of bowel incontinence.
 Patient verbalizes feelings of self-control regarding bowel movements.
 Patient verbalizes ways on how to keep bowel movements regular by naming what foods
to eat and how much fluids to intake.

References:
Bowel Incontinence Nursing Care Plan - Nursing Diagnosis - Nurseslabs. (2022).
Retrieved 26 January 2022, from
https://nurseslabs.com/bowel-incontinence/#nursing_interventions_for_bowel_incontine
nce
Fecal incontinence. (2022). Retrieved 26 January 2022, from
https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/diagnosis-
treatment/drc-20351403
Bartlett LM, Sloots K, Nowak M, Ho YH. . Fecal Incontinence: Nonoperative Management
of Fecal Incontinence. (2022). Retrieved 26 January 2022, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780124/
Bowel Incontinence Nursing Care Plan - Nursing Diagnosis - Nurseslabs. (2022).
Retrieved 26 January 2022, from https://nurseslabs.com/bowel-incontinence/