Nursing care plan for Bowel Incontinence

Bowel Incontinence

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Bowel Incontinence: Change in normal bowel habits characterized by involuntary passage of stool.

The nursing diagnosis bowel incontinence, also known as fecal incontinence, is the inability to control bowel movements, causing stool to leak unexpectedly from the rectum. It may occur as a result of damage to nerves or muscles and other structures associated with normal elimination or as a result of diseases that change the normal function of defecation.

Common factors that lead to bowel incontinence are an injury to rectal, anal, or nerve tissue from trauma, childbirth, radiation, or surgery. Infection with resultant diarrhea or neurological diseases such as stroke, multiple sclerosis, and diabetes mellitus can also result in bowel incontinence. Bowel incontinence may also occur in older patients with dementia and may also occur with age.

t is vital for nurses to learn and understand the cause of bowel incontinence because its treatment depends on the cause. Moreover, loss of bowel continence is an uncomfortable situation that should be given attention and importance to avoid social isolation. Appropriate management such as reestablishing a continent bowel elimination pattern and preventing loss of skin integrity may influence the condition of the patient and may aid in regaining an individual’s self-esteem.

Related Factors

Here are some factors that may be related to the nursing diagnosis of Bowel Incontinence that you can use for your nursing care plan:

Neuromuscular problems:

• - Dementia
• - Diabetes Mellitus
• - Lower motor nerve trauma
• - Multiple sclerosis
• - Muscular dystrophy
• - Myasthenia gravis
• - Spinal cord injury
• - Stroke

Musculoskeletal problems:

• - Damage to sphincters
• - Fecal impaction
• - Hyperosmolar food or fluid intake
• - Immobility
• - Infection
• - Lack of accessible toileting facilities
• - Long-term laxative use
• - Nerve trauma
• - Pelvic floor relaxation
• - Physical disability
• - Postoperative injuries
• - Radiation to pelvis

Defining Characteristics

Bowel Incontinence is characterized by the following signs and symptoms:

• - Fecal seepage (undesired leakage of stool after a bowel movement with otherwise normal continence and evacuation)
• - Urge incontinence (discharge of feces and flatus in spite of active attempts to retain these contents)
• - Passive incontinence (involuntary passage of feces and flatus without any awareness)
• - Encopresis (a term used mostly for fecal incontinence in children)

Goals and Outcomes

The following are the common goals and expected outcomes for Bowel Incontinence nursing diagnosis:

• - Patient is continent of stool or reports decreased episodes of bowel incontinence.
• - Patient participates in a daily bowel program until a bowel pattern develops.
• - Patient evacuates a soft, formed stool.
• - Patient verbalizes feelings of self-control regarding bowel movements.
• - Patient verbalizes ways on how to keep bowel movements regular by naming what foods to eat and how much fluids to intake.

Nursing Assessment for Bowel Incontinence

Gather your subjective and objective data with these nursing assessment guide for the nursing diagnosis Bowel Incontinence:

Assessment	Rationale
Identify the cause of incontinence.	This information serves as baseline data and provides direction for subsequent interventions. Other patients have more than one contributing factors.
Assess the patient’s normal bowel elimination pattern.	Every individual has a unique bowel elimination pattern. What’s “normal” for one person may not be normal for another; some have two bowel movements per day, whereas others may have a bowel movement infrequently as every third or fourth day. Most people feel the urge to defecate soon after the first oral intake of the day such as coffee or breakfast; this is a result of the gastrocolic reflex.
Determine the course of medications or treatments that may contribute to bowel incontinence.	Uncontrollable explosive diarrhea may be the result of hyperosmolar tube feedings, bowel preparation agents, pelvic and abdominal irradiation, some chemotherapeutic agents, and certain antibiotic agents.
Perform manual checkup for fecal impaction.	Liquid stool may leak past the impaction when the patient has hard, dry stool that cannot be expelled normally.
Assist in preparing the patient for several tests.	These procedures are performed to determine the causes of bowel incontinence. Tests include flexible sigmoidoscopy, barium enema, colonoscopy, and anal manometry (study to determine the function of rectal sphincters).
Assess the use of diapers, sanitary napkins, incontinence briefs, fecal collection devices, and underpads.	Patients or caregivers may use well-known products such as sanitary napkins to collect fecal material and for protection from bowel leaks, especially at night.
Evaluate the ability of the patient to go to the bathroom independently.	Rearranging the environment can prevent soiling accidents that can happen with the patient’s inability to get to the bathroom.
Assess fluid and fiber intake.	Fiber and fluid are great for normalizing bowel function.
Evaluate the extent to which the patient’s daily activities are modified by bowel incontinence.	The fear of uncontrolled bowel elimination may result in social isolation. Individuals with bowel incontinence are likely to experience soiling of clothing and embarrassment.
Assess perineal skin integrity.	Stool can create chemical sensitivity to the skin, which may be worsened by the use of diapers, incontinence briefs, and underpads.
Evaluate the surroundings for the availability of an accessible toilet facility.	Lacking access to toileting facilities at home, in the work setting, in the shopping mall, and the like can intensify the incontinence experience.

Nursing Interventions for Bowel Incontinence

The following are the therapeutic nursing interventions for Bowel Incontinence nursing diagnosis:

Nursing Interventions	Rationale
Provide a high-fiber diet under the direction of a registered dietician, unless contraindicated.	Insoluble type of fiber promotes the movement of material through the digestive system and increases stool bulk, so it can be of benefit to those who struggle with irregular stools. Bulky stool stimulates peristalsis and expulsion of stool from the bowel.
Ensure fluid consumption of at least 3000 mL/day, unless contraindicated.	This prevents impaction because a moist stool can move through the bowel more easily. If the patient has diarrhea, fluid therapy is vital for volume replacement.
Perform removal of fecal impaction manually, if necessary.	Presence of fecal impaction can interfere with the establishment of a regular bowel routine.
Keep bedside commode and assistive device on sight.	Immediate access to appropriate toileting facilities reduces unnecessary “accidents.”
Encourage the intake of natural bulking agents to thicken stools, for example, foods such as banana, rice, and yogurt.	These foods help provide bulk to the stool by absorbing fluids from the stool.
Assist patient for mobility or exercise, if tolerated.	Movement and exercise stimulate peristalsis and aid in bowel movement.
Create a bowel program.	Promoting regular time for bowel elimination prevents the bowel from emptying sporadically.
- Encourage bowel elimination at the same time each day.	Soon after breakfast is the best time because the gastrocolic reflex is stimulated by food or fluid intake.
- After breakfast or a warm drink, administer a suppository and perform digital stimulation every 10 to 15	For some cases, direct stimulation of the rectal sphincter and lower colon may be needed to initiate peristalsis.
- Place the patient in an upright position for defecation.	Sitting upright with feet flat on the floor promotes muscular movement that aids in defecation.
Discourage the use of pads, diapers, or collection devices for long-term management of bowel incontinence.	These products can be used on a short-term basis to prevent soiling but may irritate the skin in the long run.
Use fecal collection systems selectively over pads and diapers.	These devices allow for collection and disposal of stool without exposing the perianal skin to stool; odor and embarrassment are controlled because the stool is contained.
- External anal pouch	This consists of a bendable wafer which has an opening at its center. One side of the wafer adheres to the skin around the anus and the other side is connected to a collection bag.
- Intra anal stool bag	This is made of latex (20cm non-extended, 26cm extended) that is inserted into the anus and an adhesive attachment (10cm in diameter) applied around the anus to secure it in position.
- Rectal tubes and catheters	These are inserted into the rectum to direct loose stool into a collection bag. A balloon near the tip of the catheter (inside the body) can be inflated once the catheter is in position to block leakage of stool around the catheter and to prevent the tube from coming out throughout a bowel movement.
- Rectal trumpets	The trumpet is made up of a nasopharyngeal airway connected to a drainage bag. The flange (wide) end of the trumpet is inserted into the rectum. A trumpet is shorter than a rectal tube so there is less chance of damaging the lining of the rectum. The other narrow end of the trumpet can be connected to a drainage bag.
Wash the perineal area after each elimination with soap and water. Apply a moisture barrier ointment.	Any fecal material left on the skin may cause irritation, skin excoriation, and pain. This pain may result in fear of defecating and cause the patient to deny the urge to defecate. This may result in impaction and eventually bowel incontinence.
Educate the patient and caregiver the importance of fluid and fiber in maintaining soft, bulky stool.	This improves personal efficacy and can enhance compliance and participation with the therapeutic regimen.
Educate the caregiver the use of a fecal device, if necessary.	This may be challenging but the caregiver has the chance to learn to manage the device with appropriate guidance and feedback.
Educate the patient about proper hygiene and the use of soap and water and moisture barrier containing zinc oxide or dimethicone.	These prevent skin irritation and pain that may lead to fecal impaction and eventually bowel incontinence.
Educate the patient on the importance of establishing a regular schedule for bowel elimination.	Knowledge helps the patient and family understand the rationale for treatment and assists the patient in assuming responsibility for self-care later.

  References and Sources : nurseslabs.com