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The dangers of faecal incontinence in the at-risk patient
Faecal incontinence can have serious consequences for a patient's skin, quality of life and dignity. Clinicians and support workers need to be aware of the impact faecal incontinence can have on individual patients. This article identifies the negative effects of faecal incontinence in relation to morbidity, quality of life and health economics.
INTRODUCTION When faecal incontinence occurs tissue can deteriorate rapidly. Bliss et al[1]
reported
onset of incontinence-associated dermatitis (IAD) at between six and 42 days after onset (median 13 days). All clinicians and support workers need to
be aware of the impact faecal incontinence can have on individual patients. Early recognition of at-risk patients, prevention strategies and treatment may prevent tissue breakdown. It is, therefore, important for clinicians to be aware of the possible causes of faecal incontinence and to understand the physiological changes that may occur.
THE CAUSES OF FAECAL INCONTINENCE Clostridium difficile is the most significant cause of hospital-acquired diarrhoea and is responsible for considerable morbidity and mortality. Patients with C. difficile-associated diarrhoea may also experience faecal
incontinence[2] . Other important causes of faecal incontinence are outlined in Table 1.
WHO IS AT RISK Faecal incontinence is a common and debilitating condition with prevalence varying between care settings. The reported prevalence of faecal incontinence is 18% to 37% in patients in acute/critical care settings[3,4]
prevalence of 46% was reported[5]
. In long-term care hospitals a with
prevalence of between 40% and 79% in residential and nursing homes[1,6]
. Faecal
incontinence can occur as an acute episode, eg after commencing antibiotic therapy or during an exacerbation of inflammatory bowel disease, or as part of a chronic condition, eg in the presence of anal sphincter damage or a neurological condition. It affects all age groups but is most commonly seen in the elderly population[7]
critical care settings[8]
and in patients managed in .
Anal sphincter damage or weakness: obstetric trauma to anal sphincter muscles; surgery, eg lateral sphincterotomy; haemorroidectomy; anal stretch
Neurological conditions: spinal cord injury; multiple sclerosis; Parkinson’s disease; spina bifida; stroke
Impaction with overflow: frail or immobile patients; cognitive impairment, eg dementia; immobility/physical disability
Ano-rectal pathology: rectal prolapse; congenital abnormalities; anal/recto-vaginal fistula
Diarrhoea/intestinal hurry: Chron’s disease; ulcerative colitis Drugs, eg antibiotics
Table 1. Causes of faecal incontinence. References
1. Bliss DZ, Zehrer C, Savik K, Thayer D, Smith G. Incontinence associated skin damage in nursing home residents: a secondary analysis of a prospective multicenter study. Ostomy Wound Manage 2006; 52(12): 46–55
2. All Wales Guidelines for Faecal Management Systems. 2010. Available at: http://
welshwoundnetwork.org/ dmdocuments/all_wales- faecal_systems.pdf (accessed 12 September, 2012)
3. Bliss DZ, Johnson S, Savik K, Calbots CR, Gerding DN. Faecal incontinence in hospitalised patients who are acutely ill. Nurse Res 2000; 49(2):101–08
4. Bayon Garcia C, Binks R, De Luca E, Dierkes C, Franci A, Gallart E, Niederalt G, Wyncoll D. Prevalence, management and clinical challenges associated with acute faecal incontinence in the ICU and critical care settings: The FIRST™ cross sectional descriptive study. Intensive Critical Care Nursing 2012; 28(4): 242–50
5. Borrie MJ, Davidson HA. Incontinence in institutions: cost and contributing factors. CMAJ 1992; 1992 147(3): 322–28
6. Bale S, Tebble N, Jones V, Price P. The benefits of implementing a new skin care protocol in nursing homes. J Wound Care 2004; 14(2): 44–50
7. Nix DH. Validity and reliability of the Perineal Assessment Tool. Ostomy Wound Manage 2002; 48(2): 43–49
Author: Janice Bianchi Teresa Segovia-Gómez
www.woundsinternational.com
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