First, a confession: initially the subject of this month’s CE, fecal incontinence, seemed so daunting that we considered lighter titles (“Don’t Pooh-Pooh Fecal Incontinence,” for one). But we decided against going that route, because we didn’t want to minimize the condition’s importance or its life-altering effects. Indeed, fecal incontinence has been called the “unvoiced symptom,” one so embarrassing that sufferers often fail to tell their health care providers about it—and one that many providers never ask about.
Fecal incontinence has been defined as the “involuntary loss of liquid or solid stool that is a social or hygienic problem.” As authors Donna Zimmaro Bliss and Christine Norton report, possible causes include cognitive or physical disability, impaired sensory or motor function, poor coordination of defecation processes, and loose stool consistency; in some cases the cause may be multifactorial or idiopathic. Although studies of nursing home residents have found prevalence rates of more than 40%, the condition is by no means limited to elderly or disabled people.
Quality-of-life issues. Bliss and Norton provide an overview of fecal incontinence and describe what the research thus far has revealed about its impact on patients’ quality of life. One study used a validated 29-item quality-of-life scale to quantify how the condition alters four aspects of quality of life: lifestyle, coping behavior, depression or self-perception, and embarrassment. That study found that people who had fecal incontinence scored significantly lower in all four categories than did people who had other gastrointestinal problems. And studies in women have found that fecal incontinence is associated with poor self-image and interferes with the desire for sex. (Bliss and Norton note that most research into the effects of fecal incontinence on quality of life has focused on women, although the condition can occur in either sex.)
Assessment and management. The authors then describe assessment and discuss various evidence-based, conservative management strategies. Conservative management is recommended when severity is determined on assessment to be mild to moderate; when there is no cure for the predisposing cause; or when no cause can be identified. Strategies include
- patient education
- diet counseling
- regular rectal emptying
- bowel training
- leakage containment
In short, fecal incontinence is almost certainly underreported and undertreated; it causes untold misery for those who have it; and there’s a lot nurses can do to help. Bliss and Norton emphasize the need for sensitivity: “Interactions with nurses should provide patients with a therapeutic climate that allows for a discussion of health and quality-of-life concerns that the patient may not feel safe discussing with anyone else.” Have you had patients with this condition, or have you suspected it? How have you addressed it with them? Let us know in the comments. —SF, senior editor