Skip to main content
SpringerLink
Log in

Management of Fecal Incontinence in Older Adults in Long-Term Care

  • Chapter
  • First Online:
Management of Fecal Incontinence for the Advanced Practice Nurse

  • 690 Accesses

Abstract

Of all the health challenges frail elderly face, fecal incontinence is one of the most dreaded. Lack of knowledge within the field of fecal incontinence is evident. With life expectancy lengthening, the percentage of people who will require care in a nursing home will increase in the years to come. Nursing home patients are the most fragile of the older patients. Among this group, there are often problems connected with defecation, such as constipation, diarrhea, and fecal incontinence. Fecal incontinence is a complex problem. It is therefore necessary to have a broad approach to fecal incontinence, and it is important that nurses have high knowledge and advanced skills when it comes to meeting patients’ needs for assessment, care, and treatment. Fecal incontinence can lead to feelings of shame and embarrassment and to a downward spiral of psychological distress, dependency, and poor health. Loose stool, as well as hard stool, can be related to fecal incontinence. Urgency associated with bowel movements is also an important factor. The most important risk factors are functional incapacity, reduced cognitive function, diarrhea, constipation/impaction, stroke, some neurological diseases, diabetes, and comorbidity in general. The level of knowledge among health personnel on the value of good bowel care seems limited. There is at present a relatively limited evidence base from high-quality experimental trials of fecal incontinence, and it remains challenging to provide strong evidence for most interventions. Frail older people require a different care approach addressing the potential role of comorbid disease and current medications, in addition to the functional and cognitive impairment, and should take into account the degree of bother to the person. When appropriate, patient education is important to promote self-management and other coping mechanisms. An environment with physical or social obstacles may impair the ability to maintain continence. This is particularly relevant to individuals who have physical or mental disorders. Good care quality encompasses care personnel to acknowledge the problem of fecal incontinence compassionately. Healthcare personnel should be trained in identification and management of fecal incontinence in nursing home patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 44.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 59.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 59.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Chassagne P, Landrin I, Neveu C, Czernichow P, Bouaniche M, Doucet J, et al. Fecal incontinence in the institutionalized elderly: incidence, risk factors, and prognosis. Am J Med. 1999;106(2):185–90.

    Article  CAS  PubMed  Google Scholar 

  2. Wagg A, Chen LK, Johnson T II, Kirschner-Hermanns R, Kuchel G, Markland A, et al. Incontinence in frail older persons. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed. Bristol: International Continence Society; 2017. p. 1309–441.

    Google Scholar 

  3. Saga S, Vinsnes AG, Morkved S, Norton C, Seim A. Prevalence and correlates of fecal incontinence among nursing home residents: a population-based cross-sectional study. BMC Geriatr. 2013;13:87.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Vinsnes AG, Nakrem S, Harkless GE, Seim A. Quality of care in Norwegian nursing homes–typology of family perceptions. J Clin Nurs. 2012;21(1–2):243–54.

    Article  PubMed  Google Scholar 

  5. Davies S, Nolan M. ‘Making it better’: self-perceived roles of family caregivers of older people living in care homes: a qualitative study. Int J Nurs Stud. 2006;43(3):281–91.

    Article  PubMed  Google Scholar 

  6. Nakrem S, Vinsnes AG, Harkless GE, Paulsen B, Seim A. Nursing sensitive quality indicators for nursing home care: international review of literature, policy and practice. Int J Nurs Stud. 2009;46:848–57.

    Article  PubMed  Google Scholar 

  7. Bliss DZ, Mellgren A, Whitehead WE, Chiarioni G, Emmanuel A, Santoro G, et al. Assessment and conservative management of faecal incontinence and quality of life in adults. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 5th ed. The Netherlands: ICUD-EAU; 2013. p. 1444–85.

    Google Scholar 

  8. Norton C, Whitehead W, Bliss DZ, Harari D, Lang J. Conservative and pharmacological management of faecal incontinence in adults. In: Abrams P, Khoury S, Wein A, editors. Incontinence. 4th ed. Paris: International Continence Society; 2009. p. 1321–86.

    Google Scholar 

  9. Akpan A, Gosney MA, Barrett J. Factors contributing to fecal incontinence in older people and outcome of routine management in home, hospital and nursing home settings. Clin Interv Aging. 2007;2(1):139–45.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Johanson JF, Irizarry F, Doughty A. Risk factors for fecal incontinence in a nursing home population. J Clin Gastroenterol. 1997;24(3):156–60.

    Article  CAS  PubMed  Google Scholar 

  11. Blekken LE, Vinsnes AG, Gjeilo KH, Norton C, Mørkved S, Salvesen Ø, et al. Exploring faecal incontinence in nursing home patients: a cross-sectional study of prevalence and associations derived from the Residents Assessment Instrument for Long-Term Care Facilities. J Adv Nurs. 2016;72(7):1579–91.

    Article  PubMed  Google Scholar 

  12. Nelson R, Furner S, Jesudason V. Fecal incontinence in Wisconsin nursing homes: prevalence and associations. Dis Colon Rectum. 1998;41:1226–9.

    Article  CAS  PubMed  Google Scholar 

  13. Kinnunen O. Study of constipation in a geriatric hospital, day hospital, old people’s home and at home. Aging Clin Exp Res. 1991;3(2):161–70.

    Article  CAS  Google Scholar 

  14. Rey E, Barcelo M, Cebrián MJJ, Alvarez-Sanchez A, Diaz-Rubio M, Rocha AL. A nation-wide study of prevalence and risk factors for fecal impaction in nursing homes. PLoS One. 2014;9(8):e105281.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Aslan E, Beji NK, Erkan HA, Yalcin O, Gungor F. The prevalence of and the related factors for urinary and fecal incontinence among older residing in nursing homes. J Clin Nurs. 2009;18(23):3290–8.

    Article  PubMed  Google Scholar 

  16. Nelson RL, Furner SE. Risk factors for the development of fecal and urinary incontinence in Wisconsin nursing home residents. Maturitas. 2005;52:26–31.

    Article  PubMed  Google Scholar 

  17. Brocklehurst J, Dickinson E, Windsor J. Laxatives and faecal incontinence in long-term care. Nurs Stand. 1999;13(52):32–6.

    Article  CAS  PubMed  Google Scholar 

  18. Borrie MJ, Davidson HA. Incontinence in institutions: costs and contributing factors. Can Med Assoc J. 1992;147(3):322–8.

    CAS  Google Scholar 

  19. Wang J, Kane RL, Eberly LE, Virnig BA, Chang L-H. The effects of resident and nursing home characteristics on activities of daily living. J Gerontol A Biomed Sci Med Sci. 2009;64(4):473–80.

    Article  Google Scholar 

  20. Saga S. Understanding faecal incontinence in nursing home patients. Doctoral Thesis at Norwegian University of Science and Technology, Trondheim. 2014.

    Google Scholar 

  21. Bliss DZ, Gurvich OV, Eberly LE, Harms S. Time to and predictors of dual incontinence in older nursing home admissions. Neurourol Urodyn. 2018;37:229–36.

    Article  PubMed  Google Scholar 

  22. Mangnall J, Taylor P, Thomas S, Watterson L. Continence problems in care homes: auditing assessment and treatment. Nurs Older People. 2006;18(2):20–3.

    Article  PubMed  Google Scholar 

  23. Thekkinkattil DK, Lim M, Finan PJ, Sagar PM, Burke D. Awareness of investigations and treatment of faecal incontinence among the general practitioners: a postal questionnaire survey. Color Dis. 2008;10(3):263–7.

    Article  CAS  Google Scholar 

  24. Bliss DZ, Mimura T, Berghmans B, Bharucha A, Chiarioni G, Emmanuel A, et al. Assessment and conservative management of faecal incontinence and quality of life in adults. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed. Bristol: International Continence Society; 2017. p. 1993–2085.

    Google Scholar 

  25. Roe B, Flanagan L, Jack B, Barrett J, Chung A, Shaw C, et al. Systematic review of the management of incontinence and promotion of continence in older people in care homes: descriptive studies with urinary incontinence as primary focus. J Adv Nurs. 2011;67(2):228–50.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rodriguez NA, Sackley CM, Badger FJ. Exploring the facets of continence care: a continence survey of care homes for older people in Birmingham. J Clin Nurs. 2007;16(5):954–62.

    Article  PubMed  Google Scholar 

  27. Harrington C, Carrillo H, Dowdell M, Tang PP, Blank BW. Nursing facilities, staffing, residents and facility deficiencies, 2005 through 2010. San Francisco: University of California; 2011.

    Google Scholar 

  28. Ouslander JG. Effects of prompted voiding on fecal continence among nursing home residents. J Am Geriatr Soc. 1996;44(4):424–8.

    Article  CAS  PubMed  Google Scholar 

  29. Chassagne P. Does treatment of constipation improve faecal incontinence in institutionalized elderly patients? Age Ageing. 2000;29(2):159–64.

    Article  CAS  PubMed  Google Scholar 

  30. Schnelle JF, Leung FW, Rao SS, Beuscher L, Keeler E, Clift JW, et al. A controlled trial of an intervention to improve urinary and fecal incontinence and constipation. J Am Geriatr Soc. 2010;58(8):1504–11.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Goodman C, Davies SL, Norton C, Fader M, Morris J, Wells M, et al. Can district nurses and care home staff improve bowel care for older people using a clinical benchmarking tool? Br J Community Nurs. 2013;18(12):580–7.

    Article  PubMed  Google Scholar 

  32. Norton C, Cody JD. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev. 2012:1–38.

    Google Scholar 

  33. Lauti M, Scott D, Thompson-Fawcett MW. Fibre supplementation in addition to loperamide for faecal incontinence in adults: a randomized trial. Color Dis. 2008;10(6):553–62.

    Article  CAS  Google Scholar 

  34. Abrams P, Andersson KE, Apostolidis A, Birder L, Bliss DZ, Brubaker L, et al. Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvis organ prolapse, and faecal incontinence. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed. Bristol: International Continence Society; 2017. p. 2549–619.

    Google Scholar 

  35. Blekken LE. Faecal incontinence, constipation and laxative use: epidemiology and development of an implementation strategy for improving incontinence care in nursing homes. Doctoral Thesis at Norwegian University of Science and Technology, Trondheim. 2016.

    Google Scholar 

  36. Goodman C, Norton C, Buswell M, Russell B, Harari D, Harwood R, et al. Managing faecal incontinence in people with advanced dementia resident in care homes (FINCH) study: a realist synthesis of the evidence. Health Technol Assess. 2017;21(42):1–220.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ostaszkiewicz J. Reframing continence care in care-dependence. Geriatr Nurs. 2017;38:520–6.

    Article  PubMed  Google Scholar 

  38. Bliss DZ, Gurvich O, Savik K, Eberly L, Harms S, Wyman JF. Racial and ethnic disparities in time to cure of incontinence present at nursing home admission. J Health Dispar Res Pract. 2014;7(3):96–113.

    PubMed  PubMed Central  Google Scholar 

  39. Bliss DZ, Gurvich OV, Savik K, Harms S, Wyman JF, Mueller C, et al., editors. Racial and ethnic disparities in the management of incontinence of nursing home residents. J Wound Ostomy Continence Nurs. 2017;44(3S). https://doi.org/10.1097/WON.0000000000000331.

  40. Wyman JF, Bliss D.Z., Gurvich, O., Savik, K., Eberly, L.E., Harms, S., Mueller, C.A., Virnig, B. Racial and ethnic disparities in the time to dual incontinence and its treatment in older adults after nursing home admission. Ann Gerontol Geriatr Res 2017;4(1) 1047: 1–8.

    Google Scholar 

  41. Bliss DZ, Gurvich OV, Eberly LE, Savik K, Harms S, Wyman JF, et al. Racial disparities in primary prevention of incontinence among older adults at nursing home admission. Neurourol Urodyn. 2017;36:1124–30.

    Article  PubMed  Google Scholar 

  42. Chin MH, Clarke AR, Nocon RS, Casey AA, Goddu AP, Keesecker NM, et al. A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care. J Gen Intern Med. 2012;27(8):992–1000.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Smith DB. Eliminating the disparities in treatment: the link to healing a nation. J Healthc Manag. 2002;47(3):156–60.

    Article  PubMed  Google Scholar 

  44. Herdman T. Nursing diagnoses. Definition and classification (2012–2014). Chichester: Wiley-Blackwell/North America Nursing Diagnosis Associations International; 2012.

    Google Scholar 

  45. Butcher HK, Bulechek GM, Dochterman JM, Wagner C. Nursing interventions classification (NIC). 6th ed. St. Louis, MO: Mosby, Inc. Elsevier; 2013.

    Google Scholar 

  46. Grol R, Wensing M. Implementation of change in healthcare: a complex problem. Improving patient care. Hoboken, NJ: John Wiley & Sons, Ltd, 2013. p. 1–17.

    Google Scholar 

  47. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet. 2003;362(9391):1225–30.

    Article  PubMed  Google Scholar 

  48. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci. 2012;7(1):50.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Blekken LE, Vinsnes AG, Gjeilo KH, Mørkved S, Salvesen O, Norton C, et al. Effect of a multifaceted educational program for care staff concerning fecal incontinence in nursing home patients: study protocol of a cluster randomized controlled trial. Trials. 2015;16:69.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Blekken LE, Nakrem S, Gjeilo KH, Norton C, Morkved S, Vinsnes AG. Feasibility, acceptability, and adherence of two educational programs for care staff concerning nursing home patients’ fecal incontinence: a pilot study preceding a cluster-randomized controlled trial. Implement Sci. 2015;10:72.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Flodgren G, Parmelli E, Doumit G, Gattellari M, O’Brien MA, Grimshaw J, et al. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2011. https://doi.org/10.1002/14651858.CD000125.pub4

Download references

Author information

Authors and Affiliations

  1. Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

    Lene Elisabeth Blekken & Anne Guttormsen Vinsnes

  2. Norwegian University of Science and Technology (NTNU), Trondheim, Norway

    Kari Hanne Gjeilo

  3. St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway

    Kari Hanne Gjeilo

  4. University of Minnesota School of Nursing, Minneapolis, MN, USA

    Donna Z. Bliss

Authors
  1. Lene Elisabeth Blekken
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anne Guttormsen Vinsnes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kari Hanne Gjeilo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donna Z. Bliss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lene Elisabeth Blekken .

Editor information

Editors and Affiliations

  1. School of Nursing, University of Minnesota School of Nursing, Minneapolis, Minnesota, USA

    Donna Z. Bliss

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Blekken, L.E., Vinsnes, A.G., Gjeilo, K.H., Bliss, D.Z. (2018). Management of Fecal Incontinence in Older Adults in Long-Term Care. In: Bliss, D. (eds) Management of Fecal Incontinence for the Advanced Practice Nurse. Springer, Cham. https://doi.org/10.1007/978-3-319-90704-8_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90704-8_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90703-1

  • Online ISBN: 978-3-319-90704-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation