What is happening to bowel?

BOWEL INCONTINENCE

M.Indumathi,M.sc-1st yearMed-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 FEATURESBOWEL INCONTINENCE

DiarrheaAbdominal pain Lower back painBloating

Stomach cramp Loss of appetiteInsomniaEmotional effects

(Vorvick, 2011)

What are the symptoms

ManagementPharmacologic interventions

sulfasalazine for UCSteroid enemas for radiation proctitisCholestyramine for diarrhea from

malabsorption of bile saltsBulk forming laxatives-psyllium in

metamucil.Motility agents:

Loperamide Lomotil (atropine/diphenoxylate

Surgical Procedures

SphincteroplastyProlapse RepairArtificial Anal SphincterBulking agent Sacral Nerve StimulationColostomy

State any two surgical

management

NURSING DIAGNOSIS

1

23

Nursing management

Perineal exercises to strengthen musclesAnal PlugBiofeedbackSensory trainingMuscle trainingCure or improvement in 70-80%Results tend to be long-lasting

Cont… Dietary changes

Fiber supplementationDrink lots of waterAvoid foods which exacerbate IBS or diarrhea states

Caffeine, spice, cured meat, grease, artificial sweetners

Bowel managementPlanned defectation (timing, use of gastrocolic reflex)Enemas