The term fecal incontinence describes the involuntary passage of stool from the rectum.

Fecal incontinence can result from trauma (eg, after surgical procedures involving the rectum), a neurologic disorder (eg, stroke, multiple sclerosis, diabetic neuropathy, dementia), inflammation, infection, radiation treatment, fecal impaction, pelvic floor relaxation, laxative abuse, medications, or advancing age (ie, weakness or loss of anal or rectal muscle tone). It is an embarrassing and socially incapacitating problem that requires a many-tiered approach to treatment and much adaptation on the patients part.

Patients may have minor soiling, occasional urgency and loss of control, or complete incontinence. ` Patients may also experience poor control of flatus, diarrhea, or constipation.
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The nurse takes a thorough health history, including information about previous surgical procedures, chronic illnesses, bowel habits and problems, and current medication regimen. The nurse also completes an examination of the rectal area.

The nurse initiates a bowel-training program that involves setting a schedule to establish bowel regularity. The goal is to assist the patient to achieve fecal continence. If this is not possible, the goal should be to manage the problem so the person can have predictable, planned elimination Sometimes, it is necessary to use suppositories to stimulate the anal reflex. After the patient has achieved a regular schedule, the suppository can be discontinued.

Fecal incontinence can also cause problems with perineal skin integrity. Maintaining skin integrity is a priority, especially in the debilitated or elderly patient. Incontinence briefs, although helpful in containing the fecal material, allow for increased skin contact with the feces and may cause excoriation of the skin. The nurse encourages and teaches meticulous skin hygiene.