Anti aging guide

Faecal Incontinence and Bowel Problem in Old Age



Why faecal incontinence is a disaster for the patient and his carers?

Faecal incontinence is a disaster for both the patient and his immediate carers. However, if the patient if aware of the problem it is likely that a treatable cause will be found. If the problem has an incurable cause, it will be least be possible for such a patient to cooperate with his carers so that the inconvenience and distress are minimized. In such circumstances a method of management can be devised which retains some degree of predictability concerning the patient’s bowel habits.

The most difficult patients to look after are those who have no insight into their bowel problem, usually due to severe widespread brain damage. Patients with dementia form the largest segment of this group; a few lose their social veneer as a consequence of a tumour situated at the front of the brain. It is at least comforting that patients are usually unaware of the distress and unpleasantness associated with their lack of bowel control. The suffering tends to be entirely on the side of onlookers and helpers. When incontinence takes the form of uncontrolled watery diarrhoea, which is lost almost continuously, it is essential that a search is made for severe constipation. This paradox is difficult for a layman to accept; however, when a patient with reduced powers of awareness becomes very constipated a large, hard stool may be acting as a blockage to the bowel. Motions higher up may then liquify, and ooze past the obstruction to run unhindered from the anus. Removal of the blockage (an unpleasant procedure for all concerned) and correction of the stool consistency help attempts to regain bowel control.

Patients who have persistent faecal incontinence and are aware of their problem are likely to have either a neurological condition affecting the spinal cord, such as severe trauma, a growth, or a degenerative condition. Alternatively they may have a local destructive lesion affecting the normal opening and closing mechanisms of the lower end of the bowel. A growth or gross laxity of the muscles so that the bowel can prolapse or turn inside out are the most likely explanations. Both are easily detected by simply examination and can be corrected by surgical operation.

Transient faecal incontinence
Many transient episodes of incontinence are unfortunate accidents, with the patient literally being caught short. Even fit young people may have such embarrassing accidents if they suffer from an excessively explosive attack of diarrhoea. In older and frailer people the diarrhoea is equally troublesome even when not explosive, particularly when the patient’s speed and mobility are hindered by painful arthritis or clumsiness due to a stroke. The awkward combination of loose motions, slow locomotion, and a distant toilet may be more than many disabled people can manage. In these cases attention to their walking and the location of their toilet is as important as consideration of possible causes for the loose motions.

If uncertainty about control remains after proper deliberation has been paid to all aspects of continence, then other methods of management must be contemplated. Special padded pants are available and can avoid much embarrassment and unpleasantness, but they should only be used as a last measure of defence.

Posted by Carol Hudgens - May 17, 2012 at 6:26 am