Clinical Assessment and Differential Diagnosis of Fecal Incontinence and Its Severity
Assessment and diagnosis of fecal incontinence by the advanced practice nurse involve critical thinking in the process of differential diagnosis of fecal incontinence. Fecal incontinence is a stigmatized condition that requires the advanced practice nurse to approach the patient from a perspective of cultural competence, demonstrating respect and acknowledgment of the sensitive nature of the concern. History taking starts with symptom assessment, as well as gathering a comprehensive health history. The use of a standardized symptom assessment instrument, particularly one that includes quality of life, can be helpful. The physical examination includes abdominal examination, vaginal examination in women, assessment of pelvic muscles in both women and men, and rectal examination. Arriving at the differential diagnosis must take into account the data gathered in the history and physical exam, as well as consideration of the breadth of potential causes, including red flag symptoms and signs. Laboratory investigations for specific conditions that may contribute to fecal incontinence may include tests for suspected hypo- and hyperthyroidism, diabetes, celiac disease, colorectal cancer screening, and infection. Diagnostic imaging to further evaluate fecal incontinence may be ordered by the advanced practice nurse or be accessed through referral.
KeywordsAssessment History taking Rectal examination Pelvic floor Differential diagnosis
- 1.Jarvis C. Physical examination and health assessment. Elsevier Health Sciences: St. Louis; 2016.Google Scholar
- 2.Stanhope M, Lancaster J. Public health nursing: population-centered health care in the community. 8th ed. Elsevier Mosby: Maryland Heights, MO; 2012.Google Scholar
- 4.The Simon Foundation for Continence. First International Conference on Stigma in Healthcare. http://simonfoundation.org/1st-conference-stigma-healthcare/.
- 5.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
- 6.Daines J, Baumann L, Scheibel P. Advanced health assessment and clinical diagnosis in primary care. 4th ed. St. Louis, MI: Elsevier Mosby; 2012.Google Scholar
- 7.Rhoads J, Petersen SW. Advanced health assessment and diagnostic reasoning. Burlington, MA: Jones & Bartlett Learning; 2016.Google Scholar
- 16.Bliss DZ, Larson SJ, Burr JK, Savik K. Reliability of a stool consistency classification system. J Wound Ostomy Cont Nurs. 2001;28(6):305–13.Google Scholar
- 18.Riss P, Koch M. Evaluation of pelvic organ prolapse. In: Principles and practice of urogynaecology. New Delhi: Springer India; 2015. p. 107–14.Google Scholar
- 22.Cannon JA. Evaluation, diagnosis, and medical management of rectal prolapse. Clin Colon Rectal Surg. 2017;30(01):016–21.Google Scholar
- 24.Birnbaum E, editor. Surgical anatomy of the colon, rectum, and anus. Cham: Springer International; 2017.Google Scholar
- 26.Weinstein A, Pinto-Powell R. Introductory clinical reasoning curriculum. MedEdPortal. 2016.; https://doi.org/10.15766/mep_2374-8265.10370