Faecal Incontinence + Constipation Flashcards
Most common cause of faecal incontinence
Faecal impaction with overflow diarrhoea
Causes of faecal incontinence
- faecal impaction with overflow diarrhoea (most common)
- neurogenic dysfunction e.g MS, post stroke, spinal cord ingury
- rectal prolapse
- damage to anal sphincter muscles (often from childbirth or surgery)
- haemorrhoids
What is faecal incontinence?
Inability to control bowel movements > involuntary leakage of stool
What is involved in assessment of faecal incontinence?
- per rectum assessment
- rectum + prostate exam
- anal tone
- sensation
- visual inspection
- stool sample if in rectum
Treatment of faecal incontinence
- increasing fibre intake e
- reduce caffeine + alcohol
- pelvic floor exercises
- anti-diarrhoeal drugs / laxatives depending on cause
- bowel management programs: regular use of enemas or suppositories
What is faecal loading?
Accumulation of a large amount of hardened stool in the rectum or colon
What is faecal impaction?
Severe case of faecal loading where a large, hard mass of stool becomes stuck in the rectum or colon, obstructing normal bowel movements
Complications of faecal impaction + constipation
- stercoral perforation
- ischaemic bowel
- urinary retention
- rectal damage/anal fissures (due to straining)
- falls risk
What is stercoral perforation?
Life threatening condition where a hole forms in the wall of the colon or rectum due to pressure from impacted stool
What is constipation?
Difficulty in passing stools (strainnig), infrequent bowel movements (<3 per week), passing hard/dry stools
Management of constipation/faecal impaction
- enemas for rectal loading
- stool softeners e.g. liquid paraffin, docusate sodium
- stimulants e.g. senna
- osmotic laxatives e.g. lactose, macrogol
- manual evacuation (if severe + risk of perforation)
- increase dietary fibre + fluid intake
- toilet routine + positioning
examples of faecal softeners
liquid paraffin
docusate sodium
arachis oil enema
Examples of osmotic laxatives
lactulose
macrogol
Examples of stimulant laxatives
senna
bisacodyl
sodium picosulfate
glycerol suppositories
Bristol stool chart
- type 1: separate hard lumps (like nuts) that are hard to pass
- type 2: sausage shaped but lumpy
- type 3: sausage shaped but with cracks
- type 4: sausage shaped but smooth + soft
- type 5: soft blobs with clear cut edges
- type 6: fluffy pieces with ragged edges
- type 7: watery, no solid pieces
What do the types indicate in the Bristol stool chart?
- type 1-2: constipation
- type 3-4: ideal stools
- type 5-7: diarrhoea + urgency
What can cause diarrhoea?
- drugs e.g. domperidone, metoclopramide
- infection e.g. cholera, salmonella
- toxins
- radiotherapy
- anxiety
What should be done in a person with chronic diarrhoea?
- exclude all underlying causes by bowel imaging + stool culture
- remove all potentially causative medications
- exclude faecal impaction
- investigate red flag symptoms e.g. weight loss, blood, new change in bowel habit
- dietary review
Treatment of diarrhoea
- treat the cause (if one)
- treat any complications e.g. oral rehydration/IV fluids
- opioids e.g. codeine, loperamide
- antimuscarinics
How do opioids work in treatment of diarrhoea?
acts of u + delta receptors to slow movement in GI tract by reducing muscular contractions > allows more time for water absorption
How does loperamide work in treatment of diarrhoea?
- specific to u receptors in myenteric plexus
- decreases tone of longitudinal + circular muscle
- reduces peristaltic but increases segmental contractions
- decreases colonic mass movement by suppressing gastrocolic reflex
Pharmacological treatment of chronic diarrhoea in older people
loperamide
.
Avoid opioids
What needs to be considered before giving arachis oil?
It is made of peanut oil
Peanut allergies
