Abstract
Faecal incontinence (FI) is a symptom of an underlying problem and is defined as involuntary leakage or any involuntary loss of faeces (solid or liquid) that is a social or hygienic problem (National Institute for Health and Care Excellence), 2007). FI and/or urgency is thought to affect approximately 10% of adults in the UK (NICE, 2007) and this can have a devastating impact on quality of life. Prevalence increases with age and in some patient groups (Box 1).
Outside these groups, it is more common in women, where it is usually associated with obstetric injury to the pelvic floor. It is also a frequent complication of pelvic organ prolapse, colonic resection or anal surgery, pelvic radiotherapy and ingestion of some medications. FI is often more difficult to control if the patient has loose stool or diarrhoea (NICE, 2007).
Bowel continence requires an individual to sense when the rectum is filling, store the faecal material for a period of time and prevent unwanted leakage from the anus. Bowel continence is maintained by the closure of the internal and external anal sphincters and adequate functioning of the muscles of the pelvic floor (Woodward, 2012). Neurological disorders or trauma can result in faecal incontinence as the nervous supply to the muscles of the pelvic floor and anal sphincters is impaired. This may result in a lax anus and passive leakage, depending on the level of neurological damage (Norton and Chelvanayagam, 2004).
In some cases of faecal incontinence the pelvic floor and anal sphincter muscles are intact and functioning normally. Faecal incontinence can also occur as the result of other factors such as profuse diarrhoea, constipation and faecal impaction (which distends the anal sphincters) with faecal fluid overflow. Loss of motivation to maintain continence or cognitive decline can also result in FI (Norton and Chelvanayagam, 2004). In older people, chronic constipation has been shown to result in faecal impaction, faecal incontinence, and delirium for some patients, which may necessitate hospital admission (Tariq, 2007). Previous surgery, tumours or radiotherapy may reduce the capacity of the rectum to store faeces, cause mucosal damage and/or affect anal sphincter function (Woodward, 2012).
Outside these groups, it is more common in women, where it is usually associated with obstetric injury to the pelvic floor. It is also a frequent complication of pelvic organ prolapse, colonic resection or anal surgery, pelvic radiotherapy and ingestion of some medications. FI is often more difficult to control if the patient has loose stool or diarrhoea (NICE, 2007).
Bowel continence requires an individual to sense when the rectum is filling, store the faecal material for a period of time and prevent unwanted leakage from the anus. Bowel continence is maintained by the closure of the internal and external anal sphincters and adequate functioning of the muscles of the pelvic floor (Woodward, 2012). Neurological disorders or trauma can result in faecal incontinence as the nervous supply to the muscles of the pelvic floor and anal sphincters is impaired. This may result in a lax anus and passive leakage, depending on the level of neurological damage (Norton and Chelvanayagam, 2004).
In some cases of faecal incontinence the pelvic floor and anal sphincter muscles are intact and functioning normally. Faecal incontinence can also occur as the result of other factors such as profuse diarrhoea, constipation and faecal impaction (which distends the anal sphincters) with faecal fluid overflow. Loss of motivation to maintain continence or cognitive decline can also result in FI (Norton and Chelvanayagam, 2004). In older people, chronic constipation has been shown to result in faecal impaction, faecal incontinence, and delirium for some patients, which may necessitate hospital admission (Tariq, 2007). Previous surgery, tumours or radiotherapy may reduce the capacity of the rectum to store faeces, cause mucosal damage and/or affect anal sphincter function (Woodward, 2012).
| Original language | English |
|---|---|
| Pages (from-to) | 370-372 |
| Number of pages | 3 |
| Journal | British Journal of Nursing |
| Volume | 25 |
| Issue number | 7 |
| DOIs | |
| Publication status | E-pub ahead of print - 15 Apr 2016 |