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Fecal incontinence in the elderly.
Felix W Leung1, Satish S C Rao
1Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at UCLA and Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, 111G, 16111 Plummer Street, North Hills, CA 91343, USA.
Gastroenterology Clinics of North America
|August 25, 2009
Summary
Fecal incontinence is common in older adults, especially in nursing homes. Management focuses on underlying causes, but dementia and immobility can persist despite treatment.
Area of Science:
- Geriatrics
- Gastroenterology
- Urology
Background:
- Fecal incontinence affects up to 20% of community-dwelling adults and over 50% of nursing home residents.
- Institutionalization, immobility, and physical restraints are significant risk factors for fecal incontinence in the elderly.
- Underlying causes include diarrhea, constipation, and fecal impaction, often exacerbated by diet or medications.
Purpose of the Study:
- To review the management of fecal incontinence in community-dwelling adults and nursing home residents.
- To highlight the association between constipation, stool retention, and fecal incontinence in institutionalized elderly individuals.
- To discuss diagnostic and therapeutic options for refractory cases.
Main Methods:
- Review of existing literature on fecal incontinence management.
- Discussion of anorectal physiologic testing findings in nursing home residents.
- Exploration of treatment modalities including conservative measures, biofeedback, and sacral nerve stimulation.
Main Results:
- Anorectal physiologic testing reveals a high prevalence of impaired sphincter function, decreased rectal sensation, and sphincter dyssynergia in incontinent nursing home residents.
- Constipation and stool retention are strongly associated with fecal incontinence in this population.
- Absorbent pads and undergarments offer symptomatic relief.
Conclusions:
- Effective management requires addressing underlying causes like constipation and impaction.
- Biofeedback and sacral nerve stimulation are viable options for refractory fecal incontinence before considering surgical interventions like colostomy.
- Dementia and immobility due to health issues or restraints can lead to persistent incontinence in nursing home residents despite optimal management.
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