What is happening to bowel?

BOWEL
INCONTINENCE

M.Indumathi,M.sc-1st year
Med-surg Depart
WHAT IS ANATOMY &
PHYSIOLOGY
 DEFINITION

- Bowel Incontinence -
• Bowel incontinence is the inability
to control the bowel movements,
resulting in the involuntary
passage of stools
 Types
Urge bowel incontinence – sudden
need to defecate, with often fecal matter
is discharged from rectum despite
attempt to retain
Passive incontinence or soiling –
experience of no sensation before
leakage of stools
ETIOLOGY

Rectum problems
- constipation
- diarrhoea r/t infection or irritable bowel syndrome,
Crohn’s disease, ulcerative colitis causing the lack of
elasticity.

Sphincter muscles problem

- the muscles are weakened or damaged d/t
childbirth, complication of rectal surgery
Nerve damage
- decreased awareness of sensation of rectal
fullness
- r/t diabetes, multiple sclerosis, stroke, spinal
cord injuries.
Weakness of pelvic floor muscles –
puborectalis,rectal prolapse.

functional disability-physical or mobility

impairments affecting the toileting.
List any two
etiology
PATHOPHYSIOLOGY
Bowel function is controlled by few factors: anal sphincter
pressure, rectal storage capacity and rectal sensation.
Anything that interferes with these factors can result in
incontinence.

Fecal incontinence occur when there is direct trauma to the

sphincter muscles (internal and external) such as chronic
constipation or obstetric trauma.

The sphincter muscles stretched, weaken and not strong

enough to maintain the continence and stool will leak out.

Patients with impaired continence will also decreased thermal and

electrical sensitivity to stimuli.
 CLINICAL FEATURES
BOWEL INCONTINENCE

Diarrhea
Abdominal pain
Lower back pain
Bloating
Stomach cramp
Loss of appetite
Insomnia
Emotional effects
(Vorvick, 2011)
What are the symptoms
 Management
Pharmacologic interventions
 sulfasalazine for UC
Steroid enemas for radiation proctitis
Cholestyramine for diarrhea from
malabsorption of bile salts
Bulk forming laxatives-psyllium in
metamucil.
Motility agents:
Loperamide
Lomotil (atropine/diphenoxylate
Surgical Procedures
Sphincteroplasty
Prolapse Repair
Artificial Anal
Sphincter
Bulking agent
Sacral Nerve
Stimulation
Colostomy
State any two
surgical
management
NURSING DIAGNOSIS

1
2
3
 Nursing management

Perineal exercises to strengthen muscles

Anal Plug
Biofeedback
 Sensory training
 Muscle training
 Cure or improvement in 70-80%
 Results tend to be long-lasting
 Cont…
 Dietary changes
Fiber supplementation
Drink lots of water
Avoid foods which exacerbate IBS or diarrhea states
Caffeine, spice, cured meat, grease, artificial
sweetners
 Bowel management
Planned defectation (timing, use of gastrocolic reflex)
Enemas