HELLO I AM:

Amazing Argie T. Marpuri

FECAL INCONTENCE
 FECAL INCONTENCE

Involuntary passage of stool from the rectum.

Recurrent uncontrolled passage of faecal material in an
individual with a developmental age of at least 4 years.
 NORMAL CONTINENCE

Interaction of anal function:

Rectal compliance
Sphincter function
Anorectal sensation
Stool consistency
Stool volume
Mental allertness
 INCONTENCENCE - TYPES

Sensory
Patient not aware of it
Neurophatic, rectal prolapse
Motor
patient not aware, but cannot prevent
Urgency
Radiation, IBD
Poor reservoir
Soiling
Ana scarring, impaction
 FUNCTIONAL

Impaired rectal reservoir

Ulcerative colitis/Crohns disease
Radiation
Reduced Rectal Reservoir
Low colorectal anastomosis or coloanal anastomosis
Diarrhoea/diarrhe
Overflow
 SPHINCTER DEFECT

Congenital
Imperforate anus
Spina bifida
Trauma
Obstetric
Fistulotomy
Haemorrhoidctomy
Sphincterotomy
Anal stretch
Disease
Tumor
Rectal prolapse
TRAUMA

WOWNESS! Its
FABULOUS! Oh
wait my chin
hurts a bit
 OBSTETRIC INJURY

Sphincter injury on EUS

35% primips
44% multips
Up to 80% after forceps
Pudental neuropathy
May be asymtomatic worsen with time
 Neurological
Pudendal neuropathy
Diabetes
Degenerative
Spinal cord injury
idiopathic
 ASSESSMENT - HISTORY

Details of incontinence
Frequency
Nature solid, liquid & gas
Associated symptoms- blood, mucus etc
Previous anorectal trauma
Previous surgery
Obstetric history (episiotomy, tear, laceration, forceps)
Comprehensive drug history
Continence scores
CONTINENCE SCORING SYSTEM
 EXAMINATION

Underwear, pads
General physical
Perineal deformity, scars
Perineal descent
Prolapse
Rectal exam
Resting + squeeze pressure
Perineal sensation
 INVESTIGATION

Colonoscopy
Manometry
EUS
MRI
PNTML
ENDOANAL ULTRASONOGRAPHY
 MRI

multi-planar capability
Higher inherent
Contrast resolution than EUS
Not operator dependent
More expensive
IAS hyperintense, EAS hypointense
Good for EAS atrophy
 MANOMETRY

Sphincter
Resting pressure (>40mmHg)
Squeeze pressure (>100 mmHg)
Sphincter asymmetry
Rectal balloon
Sensation
Compliance
Capacity
RAIR
 CONSERVATIVE MANAGEMENT

After stool consistency (bulking agents,

loperamide)
Sphincter exercises
Biofeedback (70% improvement in symptoms)
Enema programme
Topical phenylephrin
Increase resting sphincter tone
Improve continence
 SURGICAL OPTIONS

Sphincter repair
Injectable agents
Sacral nerve stimulation
Dynamic graciloplasty
Artificial sphincter
Stoma
ACE
 ANTERIOR SPHINCTER REPAIR

EAS defect
Overlapping vs direct
apposition
80% improved
Function deteriorates with
time
 INJECTABLE AGENTS

IAS pathology
Silicone biomaterial
Submucosal vs
intersphincteric
Approx 50 to 70% gain
>50% improvement
 SACRAL NERVE STIMULATION

Weak but intact sphincter

Mechanism poorly
understood
2 stages
PNE trial electrode 2/52,
diary
Permanent implant

Good results up to 90%

report improvement
 DYNAMIC GRACILOPLASTY

Severe sphincter injury,

congenital malformations
Convert fast-twitch muscle to
slow twitch
Variable results (35 to 85%
continence)
Congenital malformations do
worse
Complications in 50% (30%
infection)
 ARTIFICIAL BOWEL SPHINCTER

Good results with

successful implant
High complications
rates
Infection (up to 50%)
Erosion
Pain
Not recommended for
routine use
Only in cases of severe
sphincter injury,
malformation or loss.
 STOMA

not without complication

Parastomal hernia
Mucus leakage
Diversion colitis
MANAGEMENT OF FECAL
INCONTINENCE
 NURSING ASSESSMENT

Obtain history of congenital defect, trauma

and disease
 NURSING DIAGNOSIS

Bowel incontinence related to inability to

control defecation
Bowel incontinence related to lack of voluntary
sphincter control
Bowel incontinence related to
 PATIENT EDUCATION AND
HEALTH MAINTENANCE

Teach the client and family to perform a bowel

stimulated program or other strategies to manage fecal
incontenence
Teach the client about common dietary sources of fiber
as well as supplemental fiber or bulking agents as
indicated
IF YOU WANT TO GO FAST, GO ALONE.
IF YOU WANT TO GO FAR, GO
TOGETHER.
FIN