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Management of Fecal Incontinence in Adults with Neurogenic Bowel Dysfunction

  • Tamara Dickinson
  • Sharon Eustice
  • Nikki Cotterill
Chapter
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Abstract

Neurogenic bowel dysfunction can be classified according to the location of the lesion or disease and can be seen in patients with any central nervous system benign or neoplastic pathology. In the case of spinal cord lesions or disease, the level of the lesion and its complete or incomplete cord damage will determine the type of neurogenic bowel dysfunction. The dysfunction seen in patients with multiple sclerosis is thought to be multifactorial and can be affected by medications, mobility, and comorbidities aside from the disease itself. This chapter explains the management of fecal incontinence in patients with neurogenic bowel dysfunction for the advanced practice continence nurse. It addresses initial conservative strategies that include optimizing stool consistency and scheduled toilet regimes and techniques to assist with stool evacuation. Secondary interventions to be considered including pelvic floor muscle training, biofeedback, anal plugs and transanal irrigation are also discussed. The chapter reviews the important role of quality of life and practicality in management plan for fecal incontinence developed by the advanced practice continence nurse for these patients.

Keywords

Neurogenic bowel Spinal cord injury Multiple sclerosis Transanal irrigation Bowel regimen 
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References

  1. 1.
    Roy C, Whetsell MV, Frederickson K. The Roy adaptation model and research. Nurs Sci Q. 2009;22(3):209–11.CrossRefPubMedGoogle Scholar
  2. 2.
    Gardiner A, Wallace E. Identifying patient problems and devising care pathways with the neurogenic bowel dysfunction score. Gastrointestinal Nurs. 2014;12(Suppl 2):S17–23.CrossRefGoogle Scholar
  3. 3.
    Solomons J, Woodward S. Digital removal of faeces in the bowel management of patients with spinal cord injury: a review. Br J Neurosci Nurs. 2013;9(5).  https://doi.org/10.12968/bjnn.2013.9.5.216.
  4. 4.
    Preziosi G, Raptis DA, Raeburn A, Thiruppathy K, Panicker J, Emmanuel A. Gut dysfunction in patients with multiple sclerosis and the role of spinal cord involvement in the disease. Eur J Gastroenterol Hepatol. 2013;25(9):1044–50.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Apostolidis A, Drake D, Emmanuel A, Gajewski J, Hamid R, Heesakkers J, et al. Neurologic urinary and faecal incontinence. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed. Bristol, UK: International Continence Society; 2017. p. 1093–308.Google Scholar
  6. 6.
    Cotterill N, Madersbacher H, Wyndaele JJ, Apostolidis A, Drake M, Gajewski J, et al. Neurogenic bowel dysfunction: Clinical management recommendations of the neurologic incontinence committee. Presented at the proceedings of the 5th International Consultation on Incontinence. Paris, FR, 2013.Google Scholar
  7. 7.
    Beeckman D, Cottenden A, Fader M, Buckley B, Kitson-Reynolds E, Moore K, et al. Management using continence products. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed. Bristol, UK: International Continence Society; 2017. p. 2303–426.Google Scholar
  8. 8.
    Emmanuel A. Managing neurogenic bowel dysfunction. Clin Rehabil. 2010;24(6):483–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Krassioukov A, Eng JJ, Claxton G, Sakakibara BM, Shum S. Neurogenic bowel management after spinal cord injury: a systematic review of the evidence. Spinal Cord. 2010;48(10):718–33.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Coggrave M, Ash D, Adcock C. Guidelines for management of neurogenic bowel dysfunction in individuals with central neurological conditions. Multidisciplinary Association of Spinal Cord Injury Professionals. 2012.Google Scholar
  11. 11.
    Wyndaele JJ, Kovindha A, Madersbacher H, Radziszewski P, Ruffion A, Schurch B, et al. Neurologic urinary and fecal incontinence. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 4th ed. Plymouth: Health Publication Ltd; 2009. p. 793–960.Google Scholar
  12. 12.
    Bliss DZ, Mimura T, Berghmans B, Bharucha A, Chiaroni 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, UK: International Continence Society; 2017. p. 1993–2086.Google Scholar
  13. 13.
    Dumoulin C, Adewuyi T, Booth J, Bradley C, Burgio K, Hagen S, et al. Adult conservative management. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed. Bristol, UK: International Continence Society; 2017. p. 1443–628.Google Scholar
  14. 14.
    Apostolidis A, Drake D, Emmanuel A, Gajewski J, Hamid R, Heesakkers J, et al. Algorithms for faecal incontinence in neurological patients. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed. Bristol, UK: International Continence Society; 2017. p. 2597–600.Google Scholar
  15. 15.
    Hung SL, Lin YH, Yang HY, Kao CC, Tung HY, Wei LH. Pelvic floor muscle exercise for fecal incontinence quality of life after coloanal anastomosis. J Clin Nurs. 2016;25(17-18):2658–68.CrossRefPubMedGoogle Scholar
  16. 16.
    Christensen P, Bazzocchi G, Coggrave M, Abel R, Hultling C, Krogh K, et al. A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients. Gastroenterology. 2006;131(3):738–47.CrossRefPubMedGoogle Scholar
  17. 17.
    Benezech A, Bouvier M, Vitton V. Faecal incontinence: current knowledges and perspectives. World J Gastrointest Pathophysiol. 2016;7(1):59–71.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Bazzocchi G, Giuberti R. Irrigation, lavage, colonic hydrotherapy: from beauty center to clinic? Tech Coloproctol. 2017;21(1):1–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Christensen P, Krogh K, Buntzen S, Payandeh F, Laurberg S. Long-term outcome and safety of transanal irrigation for constipation and fecal incontinence. Dis Colon Rectum. 2009;52(2):286–92.CrossRefPubMedGoogle Scholar
  20. 20.
    Memon S, Bissett IP. Rectal perforation following transanal irrigation. ANZ J Surg. 2016;86(5):412–3.CrossRefPubMedGoogle Scholar
  21. 21.
    Christensen P, Krogh K, Perrouin-Verbe B, Leder D, Bazzocchi G, Petersen Jakobsen B, et al. Global audit on bowel perforations related to transanal irrigation. Tech Coloproctol. 2016;20(2):109–15.CrossRefPubMedGoogle Scholar
  22. 22.
    Emmett C, Close H, Mason J, Taheri S, Stevens N, Eldridge S, et al. Low-volume versus high-volume initiated trans-anal irrigation therapy in adults with chronic constipation: study protocol for a randomised controlled trial. Trials. 2017;18(1):151. http://europepmc.org/articles/PMC5374566?pdf=render. doi.org/10.1186/s13063-017-1882-y CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Emmanuel AV, Krogh K, Bazzocchi G, Leroi AM, Bremers A, Leder D, et al. Consensus review of best practice of transanal irrigation in adults. Spinal Cord. 2013;51(10):732–8.CrossRefPubMedGoogle Scholar
  24. 24.
    The National Institute for Health and Care Excellence (NICE). Faecal incontinence in adults: Management 2007. Available from: https://www.nice.org.uk/guidance/cg49.
  25. 25.
    Bildstein C, Melchior C, Gourcerol G, Boueyre E, Bridoux V, Vérin E, et al. Predictive factors for compliance with transanal irrigation for the treatment of defecation disorders. World J Gastroenterol. 2017;23(11):2029–36.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Nafees B, Lloyd AJ, Ballinger RS, Emmanuel A. Managing neurogenic bowel dysfunction: what do patients prefer? A discrete choice experiment of patient preferences for transanal irrigation and standard bowel management. Patient Prefer Adherence. 2016;10:195–204. Available from: http://europepmc.org/articles/PMC4764299?pdf=render.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Emmanuel A. Review of the efficacy and safety of transanal irrigation for neurogenic bowel dysfunction. Spinal Cord. 2010;48(9):664–73.CrossRefPubMedGoogle Scholar
  28. 28.
    Passananti V, Wilton A, Preziosi G, Storrie JB, Emmanuel A. Long-term efficacy and safety of transanal irrigation in multiple sclerosis. Neurogastroenterol Motil. 2016;28(9):1349–55.CrossRefPubMedGoogle Scholar
  29. 29.
    Fourtassi M, Charvier K, Hajjioui A, Have L, Rode G. Transanal irrigations in the management of bowel dysfunction and disordered defecation after spinal cord injury. Ann Phys Rehabil Med. 2011;54:e309.CrossRefGoogle Scholar
  30. 30.
    Lloyd K. How transanal irrigation changed my life. Gastrointestinal Nurs. 2014;12(Sup2):S4–6.CrossRefGoogle Scholar
  31. 31.
    Juul T, Christensen P. Prospective evaluation of transanal irrigation for fecal incontinence and constipation. Tech Coloproctol. 2017;21(5):363–71.CrossRefPubMedGoogle Scholar
  32. 32.
  33. 33.
    Emmanuel A, Kumar G, Christensen P, Mealing S, Størling ZM, Andersen F, et al. Long-term cost-effectiveness of transanal irrigation in patients with neurogenic bowel dysfunction. PLoS One. 2016;11(8):e0159394. Available from: http://europepmc.org/abstract/MED/27557052.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Malouf A. Surgical treatment of faecal incontinence. In: Norton C, Chelvanayagam S, editors. Bowel continence nursing. 1st ed. Buckinghamshire: Beaconsfield Publishers Lts; 2004. p. 150–64.Google Scholar
  35. 35.
    Castro-Diaz D, Robinson D, Bosch R, Costantini E, Cotterill N, Espuna-Pons M, et al. Patient-reported outcome assessment. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed. Bristol, UK: International Continence Society; 2017. p. 541–670.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Tamara Dickinson
    • 1
  • Sharon Eustice
    • 2
  • Nikki Cotterill
    • 3
  1. 1.Radiation OncologySouthwestern Medical Center, Harold C. Simmons Comprehensive Cancer CenterDallasUSA
  2. 2.Cornwall Foundation TrustTruro Health Park, Infirmary HillTruroUK
  3. 3.Bristol Urological Institute (Learning and Research), Southmead Hospital, North Bristol NHS TrustBristolUK

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