Faecal incontinence Resources

The first article in this two-part series looking at faecal incontinence (FI) outlined its effect on people’s quality of life, highlighted its prevalence, explained the different definitions
available and summarised the anatomy and physiology of the lower intestinal tract (Yates, 2023). Here, part two concentrates on the multiple causes/risks of FI, the knowledge and skills r equired to complete a basic assessment and initiate conservative therapies, including the role of medication and pelvic floor rehabilitation, and also discusses management options for FI.

Faecal incontinence (FI) is the term describing the inability to control the bowels (International Continence Society [ICS], 2015). This can include the uncontrolled passage of solid or liquid stool, or flatus (wind) (Benezech et al, 2016) through the anal canal. It is recognised as a symptom rather than a diagnosis (National Institute for Health and Care Excellence [NICE], 2014) and is the result of complex interactions of many contributing factors. This series of two articles will look at this taboo condition, how it affects quality of life, highlight the anatomy and physiology which affects bowel control and then discuss conditions and contributing factors that make individuals prone to the
symptoms of FI.

Faecal incontinence (FI), always has an underlying cause (Harari, 2009). It is defined as any involuntary loss of faeces that is a social or hygiene problem (National Institute for Health and Care Excellence [NICE], 2007).

Urinary and faecal incontinence are common in the older population, yet incontinence is not a normal part of ageing. Dementia can impact upon a person’s ability to remain continent, yet incontinence is unlikely to be a symptom of dementia until the latter stages of disease progression. There is a misconception that nothing can be done if a person with dementia experiences episodes of incontinence. However, many people with dementia often experience functional incontinence caused by immobility, communication difficulties, disorientation, or the inability to find the toilet, which can all be alleviated if the right support and advice is available. Improving the identification, assessment and management of continence issues can not only enable people with dementia to maintain their dignity and improve their health, but also their sense of wellbeing and quality of life. There is also the possibility to improve relationships, reduce carer burden, and reduce the risk of a premature transition into a residential care setting. This fourth paper in the series explores some of the issues relating to dementia and continence and the impact as experienced by our two case studies, Dhriti Singh and Gregory Brewin.

Functional bowel disorders such as faecal incontinence and constipation are relatively common conditions, which have a significant negative impact on patients. This can often affect the social, psychological and financial areas of life, as well as leading patients to become isolated due in part to the social taboo surrounding bowel issues (Lukacz et al, 2011; Holroyd, 2015a). Constipation can affect up to 25% of the population at some point in their lifetimes (Belsey et al, 2010), and it is a condition that crosses all genders, ages and cultures, although it is more prevalent in the very young or older adults (Holroyd, 2015b).

This article aims to explore the perception that treatment of sacral pressure ulcers is costly and time-consuming, especially when faced with faecally incontinent patients with loose stool.  The authors’ tissue viability service used a faecal management system to prevent faeces from coming into contact with the wound bed for 12 weeks, while simultaneously allowing a conventional dressing to perform to its maximum ability. A total cost and wound-healing comparison was carried out in two community patients who were faecally incontinent and bed-bound. One patient was managed with a faecal management system and the other with incontinence pads. The authors found that although the purchase of the faecal management system was initially costly, the frequency of dressing change was reduced, the patient felt more comfortable and fewer visits from the community nurses were necessary. Also, faster healing rates were demonstrated by reductions in wound size. This technique requires further studies with a larger sample size to ascertain its true benefits, particularly around wound healing.