The anal bag: a modern approach to fecal incontinence management

In the past 30 years, colostomy and urostomy bags have dramatically improved the quality of life of ostomy patients. However, the anatomical characteristics and physiological motility of the pelvic floor have hampered the development of suitable disposable containers that can be applied directly to the anus. Use of a recently developed anal bag that insulates the anus and peri-anal area and collects stool was evaluated in two inpatient care settings in Italy from 1994 to 2004. The study included four nurses and eight physicians (four gastroenterologists, two cardiologists, and two gerontologists) involved in the care of 120 patients (65 men, 55 women, ages 45 to 96 years). The study population consisted of patients who were elderly and bedridden (47), had pressure ulcers (15), were affected by fecal incontinence or bedridden in intensive care (10), had coronary problems (10), and were receiving high-dose chemotherapy (10); patients who had undergone anorectal surgery (28) were added to the study to evaluate the anal bag for postoperative use to prevent contamination and contain exudate and fluid. Study participants were divided into groups based on length of anal bag use (3 days, 1 week, or 4 months or more). Objective evaluation at each bag change included skin reactions to the adhesive. Study participants feelings and perceptions as well as nurse and physician evaluations of the anal bag were assessed using questionnaires and four-point rating scales. No adverse reactions to the product were observed and none of the high-risk patients developed a pressure ulcer. The majority of patients (91, 76%) tolerated the bag well and reported it was not painful to remove or apply (102, 85%). Nurses and physicians all considered the device easy to use and appreciated its potential to prevent contamination and cross-contamination. This device may help improve the management of fecal incontinence and prevent complications.