Severe Constipation with Impaction
Few things are as disturbing to patients and caregivers alike as an inability to control bowel movements and remain continent. It is not an aging change, but it is a problem that is associated with many age-related health problems. Because of the difficulties in providing nursing care for an incontinent patient, the development of this problem is often the underlying cause for nursing home placement. Patients thrive best in their own home environment; therefore, every effort should be made to restore continence or manage incontinence. Physicians divide incontinence into three varieties based on cause. The treatment varies with each of these causes.
- Overflow incontinence occurs when a patient has suffered constipation, which permits the development of a fecal impaction. A fecal impaction is a hard mass of feces that collects just above the outlet and is too large to pass. The patient loses the ability to discriminate between gas, fluids, and feces, and therefore leakage occurs. Over- flow incontinence is managed by removal of the impaction and prevention of its recurrence.
- Anorectal incontinence occurs when there has been damage to the nerves that supply impulses to the rectum and anus. This causes the rectal sphincter, the muscle that keeps the anus closed, to weaken, and the anus may actually gape open. Exercise and retraining of these muscles may help to restore continence, but surgery is needed in some situations.
- Neurologic incontinence occurs when there is central nervous system difficulty, such as stroke or dementia. Careful timing of meals and visits to the commode permits avoidance of an episode of incontinence. Occasionally, laxatives or suppositories are used to adjust the timing of bowel movements. The use of drugs should be under the direction of a physician. The goal is to restore a normal pattern, not to adjust the timing of bowel movements to the convenience of a caregiver.
- Patients thrive best in their own home environment; thus, every effort should be undertaken to restore or manage incontinence.
- Symptomatic incontinence occurs as a result of other intestinal tract diseases. These other problems are the focus of treatment, and their resolution often also resolves the incontinence.