Faecal Incontinence and Constipation Flashcards
What is faecal incontinence?
Involuntary passage of flatus or faeces through the anal canal. Also associated with excreting in a socially unacceptable place due to behavioural problems or reduced mobility.
Why is faecal incontinence such a large issue in elderly patients?
Severe carer strain
Very common reason for care home admission
Give 3 risk factors for faecal incontinence
>80 years old Severe mental or physical disability Living in a care home Long-term hospital placement Limited ability/mobility
Describe the physiology of normal faecal continence
Passage of stool into rectum
Rectum distends and internal sphincter temporarily relaxes
Anal transition zone is richly innervated and sends information to the CNS on the volume and consistency of stool
Higher centre assesses if situation is socially acceptable
If socially acceptable- external sphincter relaxes
If socially unacceptable- external sphincter contracts and urge is resisted.
Depends on functioning sphincters, stool consistency, transit of colonic contents, rectal reservoir function and anorectal sensation.
Give 3 potential causes of Faecal incontinence
Structural anorectal abnormalities (rectal prolapse, sphincter trauma)
Neurological abnormalities (MS, stroke, pudendal neuropathy)
Alterations in stool consistency
Overflow constipation
Cognitive/behavioural dysfunction
General disability
Idiopathic
How is faecal incontinence managed conservatively?
Increase fibre Decrease natural laxatives Make sure there is easy access to toilets Open bowels regularly Disposable pads Skin care advice Odour control Emotional support
How is faecal incontinence managed if due to loose stools?
Loperamide
Codeine
Amitriptyline
Reduce rectal motor activity
How is faecal incontinence managed if due to overflow constipation?
Enemas or oral laxatives
Retrograde irrigation
How is faecal incontinence managed if due to neurological causes?
Establish a routine
Sacral nerve stimulation
How is faecal incontinence managed if due to external sphincter dysfunction?
Pelvic floor exercises
Electrical stimulation
Neosphincter
How is faecal incontinence managed if due to internal sphincter dysfunction?
Pelvic floor exercises
Sphincter bulking
How is faecal incontinence managed if due to behavioural dysfunction?
Regular toileting
What is the definition of constipation?
<1 stool passed every 3 days
Hard consistency of stool
May have feeling of incomplete evacuation
How is constipation diagnosed?
Bristol stool chart
Bowel monitoring
Can be seen on abdominal x-ray or CT
Give 4 causes of constipation
Dehydration Pelvic floor weakness Neurological cause Psychological/embarrassment Medication induced- codeine, antacids, antispasmodics, anticholinergics, verapamil, diuretics, antihypertensives.
