bowel incontinence
TRANSCRIPT
What is happening to bowel?
BOWEL INCONTINENCE
M.Indumathi,M.sc-1st yearMed-surg Depart
WHAT IS ANATOMY & PHYSIOLOGY
DEFINITION
- Bowel Incontinence -
• Bowel incontinence is the inability to control the bowel movements, resulting in the involuntary passage of stools
Types Urge bowel incontinence – sudden need to defecate, with often fecal matter is discharged from rectum despite attempt to retain Passive incontinence or soiling – experience of no sensation before leakage of stools
ETIOLOGY
Rectum problems- constipation- diarrhoea r/t infection or irritable bowel syndrome, Crohn’s disease, ulcerative colitis causing the lack of elasticity.
Sphincter muscles problem- the muscles are weakened or damaged d/t childbirth, complication of rectal surgery
Nerve damage- decreased awareness of sensation of rectal fullness
- r/t diabetes, multiple sclerosis, stroke, spinal cord injuries.Weakness of pelvic floor muscles – puborectalis,rectal prolapse.
functional disability-physical or mobility impairments affecting the toileting.
List any two etiology
PATHOPHYSIOLOGY
Bowel function is controlled by few factors: anal sphincter pressure, rectal storage capacity and rectal sensation. Anything that interferes with these factors can result in incontinence.
Fecal incontinence occur when there is direct trauma to the sphincter muscles (internal and external) such as chronic constipation or obstetric trauma.
The sphincter muscles stretched, weaken and not strong enough to maintain the continence and stool will leak out.
Patients with impaired continence will also decreased thermal and electrical sensitivity to stimuli.
CLINICAL FEATURESBOWEL INCONTINENCE
DiarrheaAbdominal pain Lower back painBloating
Stomach cramp Loss of appetiteInsomniaEmotional effects
(Vorvick, 2011)
What are the symptoms
ManagementPharmacologic interventions
sulfasalazine for UCSteroid enemas for radiation proctitisCholestyramine for diarrhea from
malabsorption of bile saltsBulk forming laxatives-psyllium in
metamucil.Motility agents:
Loperamide Lomotil (atropine/diphenoxylate
Surgical Procedures
SphincteroplastyProlapse RepairArtificial Anal SphincterBulking agent Sacral Nerve StimulationColostomy
State any two surgical
management
NURSING DIAGNOSIS
1
23
Nursing management
Perineal exercises to strengthen musclesAnal PlugBiofeedbackSensory trainingMuscle trainingCure or improvement in 70-80%Results tend to be long-lasting
Cont… Dietary changes
Fiber supplementationDrink lots of waterAvoid foods which exacerbate IBS or diarrhea states
Caffeine, spice, cured meat, grease, artificial sweetners
Bowel managementPlanned defectation (timing, use of gastrocolic reflex)Enemas