Directions for Future Nursing Research on Fecal Incontinence

Incidence and Characteristics of Incontinence-Associated Dermatitis in Community-Dwelling Persons With Fecal Incontinence

PURPOSE

Little is known about the incidence and characteristics of incontinence-associated dermatitis (IAD) in community-living individuals with fecal incontinence. The primary aim of this study was to describe the incidence and characteristics of self-reported IAD among community-living individuals with fecal incontinence. The study also examined whether IAD was associated with older age, sex, presence of urinary incontinence, or fecal incontinence severity.

DESIGN

Secondary data analysis was performed using a prospective cohort design.

SUBJECTS AND SETTING

Data were drawn from community-living adults (n = 98) with fecal incontinence (76% female, 34% aged ≥65 years, 90% white) who participated in a study about dietary fiber supplementation and were free of IAD at the start. Thirty five percent also had urinary incontinence.

METHODS

Subjects assessed their skin for IAD daily for 52 days, reporting types of IAD damage (redness, rash/fungal infection, and skin loss), location of IAD, and symptoms. They reported fecal incontinence on a diary for the first and last 14 study days.

RESULTS

The incidence of IAD was 41% (40 of the 98). The fecal incontinence severity score for subjects developing IAD was 1.2 higher than those who never had IAD (P < .001). There was no significant association of IAD with age, sex, or dual fecal and urinary incontinence. Incontinence-associated dermatitis developed within 2 weeks and healed in approximately 1 week. The most common sign and symptom were redness (60% patients) and soreness (78% patients), respectively. Most subjects (85%) had IAD in one location.

CONCLUSIONS

Assessing for IAD in community-living patients with fecal incontinence is important as IAD is common and causes discomfort. The relatively mild severity of IAD offers WOC nurses the opportunity for improving patient outcomes by preventing and managing this problem.

Goals of fecal incontinence management identified by community-living incontinent adults

The purpose of this study was to identify goals of fecal incontinence (FI) management and their importance to community-living adults if complete continence would not be possible. Participants expressed their goals of FI management in a semistructured interview, selected others from 12 investigator-identified goals, and rated their importance. Five thematic categories emerged from the 114 participant-identified goal statements: Fecal Incontinence/Bowel Pattern, Lifestyle, Emotional Responses, Adverse Effects of Fecal Incontinence, and Self-Care Practices. Participants selected a median of seven investigator-identified goals (range = 2 to 12). Goals selected by the most participants were decreased number of leaks of stool and greater confidence in controlling fecal incontinence. These goals also had the highest importance along with decreased leakage of loose or liquid stool. The type and number of management goals identified by participants offer a toolbox of options from which to focus therapy when cure is not possible and promote patient satisfaction.

Raising awareness about fecal incontinence

There is a lack of awareness about fecal incontinence despite its prevalence and adverse impact on quality of life. Inadequate knowledge about fecal incontinence deters help-seeking, therapeutic consultation, and clinical research about effective prevention and management strategies. A systematic, evidenced-based approach to raise awareness of fecal incontinence is essential to forward progress and overcome multiple barriers. In this manuscript, strategies of this approach are prioritized and focus on increasing continence literacy and communication, emphasizing prevention and screening, disseminating evidenced-based management interventions, and promoting larger scale impact through effective partnerships.

Incontinence: assessment, diagnosis, and management in two rehabilitation units for older people

BACKGROUND

Incontinence of both bladder and bowel is a major health care problem and adversely affects the lives of many people living at home or in health service facilities. The prevalence and severity of incontinence is a global concern that has, in recent years, prompted investigation across several countries. Current approaches to continence care indicate an emphasis on safety and reduction of risk, rather than on detailed individualised assessment and management.

AIM

To show approaches to assessment, diagnosis, and management of urinary and faecal incontinence in two rehabilitation settings for older people in Ireland. The study forms part of a larger 2-year case study to identify the determinants of practice "context" that enable or hinder proactive approaches to promoting continence and the treatment of incontinence in rehabilitation settings for older people.

METHOD

The Royal College of Physicians Audit Scheme was used to record the assessment and management of urinary and faecal incontinence. This scheme also includes questions regarding resources available to enable effective continence management. Over 6 months, 220 patients who suffered from incontinence participated in two study sites: a 78-bed rehabilitation unit in Northern Ireland and an 80-bed rehabilitation unit in Southern Ireland.

RESULTS

Findings indicated that 60% of incontinent patients had urinary incontinence, 3% faecal incontinence, and 37% mixed urinary and faecal incontinence; however, a specific continence assessment and specific rationale for treatment decisions or continuation of care were lacking. The focus was on continence containment rather than on proactive management. The examination of resources available for continence promotion and management showed that even though guidelines for continence management were available to staff in one unit, there was a dearth of appropriate education or support for staff in continence care.

IMPLICATIONS FOR PRACTICE

Because incontinence remains an issue for older people and the clinical implications of sustained incontinence are multifaceted, strategies should focus on the development of practice towards evidence-based multidisciplinary approaches to continence promotion and management.