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Faecal incontinence in older people

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Faecal incontinence in older people

What is faecal incontinence?

Faecal incontinence is the inability to control the passage of faeces. Normally, the bowel acts as a reservoir for faeces, which is prevented from leaking by a ring of muscle around the back passage or anus, known as the sphincter muscle. Faeces is also supported by muscles in the pelvis. People experiencing faecal incontinence may have little or no control over these muscles.

What are the causes of faecal incontinence?

Faecal incontinence usually occurs because the anal sphincter does not work properly. This may be due to damage to these muscles or to damage to the nerves supplying them, which help them to contract and aid sensation. If an elderly person does not feel the need to defaecate, it can lead to incontinence. There are several other causes of faecal incontinence, however, including:

  • Constipation.
  • Faecal impaction.
  • Diarrhoea.
  • Excessive use of laxatives and enemas.
  • Medications.
  • Neurological disorders (ie. those which result in damage to the brain or nerves).
  • Reduced mobility.

Other causes:

  • Diabetes.
  • Diverticulitis.
  • Bowel cancer.
  • Proctitis.
  • Rectal prolapse.
  • Crohn’s disease.
  • Malabsorption syndrome.
  • Ischaemic colitis.

Constipation

Older people often experience constipation, or prolonged retention of faeces in the bowel, which can be a cause of faecal incontinence. Constipation may occur because they do not eat enough fibre-rich foods or drink enough fluids. It may also be due to reduced mobility and prolonged bed-rest, when the muscles of the bowel become less active and therefore less well able to expel faeces.

Faecal impaction

Chronic constipation can result in faecal impaction, where putty-like faeces partially obstructs the bowel. Subsequent cramping then causes the involuntary passage of liquid stools from higher up in the bowel.

Diarrhoea

Diarrhoea is the accelerated movement of faeces through the bowel, resulting in the passage of frequent, unformed stools. It may occur as a result of food poisoning, as a side-effect of another disorder such as irritable bowel syndrome, for example, or as a result of some medication, such as an antibiotic.

The older person may experience a very sudden desire to use the toilet, only to find that they are unable to get there in time, resulting in incontinence.

Excessive use of laxatives and enemas

Overuse of laxatives and enemas can cause the faeces to be too soft and to pass through the bowel too quickly, which may also catch the older person unawares and result in incontinence. Overuse of these products can also cause the bowel muscles to lose their tone or elasticity, causing constipation.

Medications

Certain medications such as iron can cause tummy upsets and constipation, and should be considered as a possible indirect cause of faecal incontinence.

Neurological disorders/Nerve damage

An injury to the brain or spinal cord may also mean that the brain is unable to send messages through the nerves to the bowel, or the nerves are unable to transmit them to the muscles of the bowel and anal sphincter. This is why older people who have had a stroke or other problem with their brain or spinal cord may experience faecal incontinence.

Some older people may also be confused or forgetful due to conditions which affect the brain, such as Alzheimer’s disease and other forms of senile dementia, which involve degeneration of the brain. This may be one of the reasons for incontinence if the older person does not remember to go to the toilet or forgets where it is located.

Reduced mobility

Older people tend to be less mobile and therefore may not be able to get to a toilet in time because they are physically unable to do so. Physical obstructions can also play a part in faecal incontinence. Sometimes they have difficulty getting around physical obstacles such as footrests, armchairs, etc.

How can faecal incontinence be managed at home?

One of the first steps is to assess how often the older person is incontinent during a 24-hour period. It is also important to examine possible causes for the incontinence by observing when it occurs. When this has been established the cause can then be treated, as in the case of constipation or diarrhoea, for example.

Bowel training

If faecal incontinence occurs at around the same time every day it should help if a schedule is developed to encourage and assist the older person to use the toilet regularly at this time.

If the person’s incontinence is irregular, it may help to establish a regular time for the older person to defaecate. It might help to carry out some of the following techniques to help do this:

  • Ask the person to take a warm drink about half an hour before using the bathroom.
  • Ensure that the older person is sitting comfortably on the toilet in privacy, with no distractions.
  • Encourage them to contract their abdominal muscles, lean forward and bear down.
  • It may help if they exert pressure on their abdomen by pushing down on it with their hand.
  • Abdominal massage can also help to stimulate the bowels to act.

If constipation is the cause of the incontinence:

Research has shown that treating constipation can reduce the amount of faecal incontinence significantly. It may help at the beginning to establish a pattern by using mild laxatives or suppositories or an enema, however these should not be relied on in the longer term as they are thought to contribute to the problem of incontinence.

Diet

Ensure that the person avoids constipation by eating lots of fibre-rich foods such as cereals and wholemeal bread, and by eating plenty of fruit and vegetables. Fluid intake should also be increased.

Exercise

Encouraging the older person to exercise as much as possible can help to maintain the muscle tone in the abdomen and reduce constipation.

Medications

Certain medications may cause side effects, such as diarrhoea or constipation, that can contribute to faecal incontinence. It may be possible to stop or swap some of these medications but such changes should only be undertaken on the advice of a doctor. There are several treatments that may be used to reduce diarrhoea. Again, it is advisable to speak to your doctor about the various options available. Laxatives and enemas may be used to alleviate constipation in the short term.

Other measures

  • Clothing — Often it can help if the person wears clothing that is easy to remove quickly, such as tracksuit bottoms. This is important especially as braces, belts and zippers can be awkward and cumbersome when the person is in a hurry to use the toilet.
  • Location of toilet — Practical issues such as the location of the toilet may also need to be considered. If the toilet is upstairs some people may not be able to climb steep stairs quickly to reach it in time. The toilet door and lock, along with other furniture and items, may also need to be examined as potential obstacles for the elderly person trying to make their way to the toilet.
  • Commode — Some people may be afraid to get out of bed at night to go to the toilet. It may help to locate a commode (night chair) beside the bed for night-time use. A night-light should also be provided.

What appliances are available to help cope with faecal incontinence?

In some cases incontinence cannot be cured. However, there are ways to make the sufferer more comfortable.

Pads and appliances

Pads and appliances — Various protective pads are available which can be worn by the person to protect their clothes. Some resemble nappies and can be held in place with underpants. With severe cases of incontinence, it can help to use two pads together.

Incontinent sheets are also available. These are paper sheets with a waterproof backing that can be placed over the bed-sheet to prevent faeces or urine seeping through and soiling or wetting the bed.

Some people find the use of rubber mattresses and rubber sheets helpful. These rubber sheets may be placed across the centre of the person’s bed and covered with a cloth sheet for comfort. If the cloth sheet gets soiled or wet, it can easily be removed and changed without having to remake the whole bed.

Personal hygiene

Following faecal incontinence it is important that the skin is thoroughly washed and dried and a protective waterproof ointment or cream is applied to the skin.

What does the future hold?

Remember, it is never too late to seek help. Many cases of incontinence can be cured or improved by treatment or training. If you or an older relative have an incontinence problem, contact your doctor or public health nurse.

Medical card holders who are 65-years or older are entitled to an assessment of their incontinence by a public health nurse, who will advise on the management of the incontinence and the most suitable products available from the health board.

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