Development and evaluation of a protocol to manage fecal incontinence in the patient with cancer

Fecal incontinence is an important yet often overlooked clinical problem in the care of patients with cancer. This paper presents a protocol for the assessment and management of this distressing symptom. The objective of the protocol is to regulate bowel motion, thereby minimizing fecal incontinence and improving patients' physical functioning, self-esteem, dignity, and quality of life. A comprehensive assessment addressing the patient's physical status, previous elimination routines, dietary habits, and medications provides the foundation for successful management. Components of the intervention include dietary modification, pharmacotherapy with laxatives and suppositories, and attention to routines that capitalize on the normal, involuntary gastrointestinal reflexes. Promotion of normal bowel elimination patterns, positioning, and comprehensive patient teaching and support are also critical components of the intervention. Our experience with this protocol and the outcomes achieved in a small series of patients are discussed.