Bowel dysfunction is a common condition. A wide spectrum of symptoms is involved, such as chronic constipation and fecal incontinence (FI) among others. A recent study in a Dutch population showed that prevalence of FI is as high as 7.9% in the general population.
However, it is not always easy to find the reason behind FI or to decide which tests to perform on patients to find the right treatment solution. Even so, FI is a debilitating condition that affects quality of life and which needs to be addressed by the healthcare system. This month we include a review from a nurse’s perspective of the management of these patients.
On a positive note, new therapies are being tested. One pilot study investigating tibial nerve stimulation in a patient group with fecal incontinence showed promising results. Also, a device previously only used for colonic irrigation before surgery has been tested for chronic constipation, and irrigation seem to be a positive therapy for these patients. This has been shown before using the mobile bowel management therapy transanal irrigation (TAI), and this month the first clinical study with the first electronic TAI device (Navina Smart) has been published.
The study shows that perception, satisfaction and compliance with Navina Smart are regarded positively by patients. This gives hope for the future for patients with bowel dysfunction, as new advancing techniques develop and improve.
Summary of Publications
Short Term Evaluation of a Novel Eletronic Transanal Irrigation System in Patients with Neurogenic Bowel Dysfunction Previously Exposed to Transanal Irrigation Systems.
http://www.davidpublisher.org/Public/uploads/Contribute/5abde98e4536c.pdf
Author and Origin
Passananti V, Emmanuel A,Nordin M, Storrie J, Gripenland J, Astrom M and Hultling C.
UK and Sweden
Summary
A prospective study evaluating satisfaction, perception, safety, and compliance with Navina Smart. Included 28 patients with neurogenic bowel dysfunction who previously used transanal irrigation.
Conclusions
After 4 weeks, compliance was 68% and Navina Smart was shown to be safe, tolerable, and effective. Navina Smart was associated with an increase in the patients’ independence.
Comments
First prospective study of Navina Smart measuring compliance, satisfaction, perception, and safety.
See more details in Publication Highlight.
Colon Irrigation: Effective, Safe, and Well-Tolerated Alternative to Traditional Therapy in the Management of Refractory Chronic Constipation.
Author and Origin
Parekh PJ, Burleson D, Lubin C and Johnson DA.
US
Summary
A prospective study of the product HyGleaCare for high-volume colonic irrigation in 175 patients with refractory chronic constipation.
Conclusions
All patients in the study had a successful passage of stool while undergoing the high-volume colon irrigation procedure. However, patients need to visit the clinic to perform the procedure.
Comments
Prospective study of the effect on constipation of HyGleaCare, a high-volume irrigation chair.
Efficacy of Percutaneous Posterior Tibial Nerve Stimulation for the Management of Fecal Incontinence in Multiple Sclerosis: A Pilot Study.
https://www.ncbi.nlm.nih.gov/pubmed/29575432
Author and Origin
Sanagapalli S, Neilan L, Lo JYT, Anandan L, Liwanag J, Raeburn A, Athanasakos E, Zarate-Lopez N, Emmanuel A.
UK
Summary
A pilot study using percutaneous posterior tibial nerve stimulation in patients with multiple sclerosis (MS) who have fecal incontinence.
Conclusions
BResponders to the therapy (79%) tended to be more symptomatic at baseline and had greater improvements in bowel symptom score and quality of life.
Comments
Pilot study of percutaneous posterior tibial nerve stimulation in patients with MS.
Expert consensus document: Advances in the evaluation of anorectal function.
https://www.ncbi.nlm.nih.gov/pubmed/29636555
Author and Origin
Carrington EV, Scott SM, Bharucha A, Mion F, Remes-Troche JM, Malcolm A, Heinrich H, Fox M, Rao SS; International Anorectal Physiology Working Group and the International Working Group for Disorders
of Gastrointestinal Motility and Function.
Worldwide
Summary
An expert consensus evaluating current indications, study performance characteristics, clinical utility, strengths, and limitations of the most widely available tests of anorectal structure.
Conclusions
Several challenges are identified with testing concerning data acquisition and analysis of results. There is, however, an agreement that the tests are important to identify disease phenotypes and direct effective management.
Comments
Expert consensus review of tests to perform in patients with fecal incontinence.
Nursing management of patients with faecal incontinence.
https://www.ncbi.nlm.nih.gov/pubmed/29687686
Author and Origin
Barrie M.
UK
Summary
A review of managing patients with fecal incontinence from a nurse perspective. An overview of causes, psychological effects, and conservative and specialized management measures.
Conclusions
Fecal incontinence is distressing for most patients. Nurses should be able to assess the underlying causes, initiate conservative management, and provide practical advice to increase the patient’s quality of life.
Comments
Short review of fecal incontinence and treatment from a nurse perspective.
Subtypes and symptoms of fecal incontinence in the Dutch population: a cross-sectional study.
https://www.ncbi.nlm.nih.gov/pubmed/29705940
Author and Origin
van Meegdenburg M, Meinds R, Trzpis M and Broens P. The Netherlands
Summary
A cross-sectional internet survey on the prevalence and subtypes of fecal incontinence in 1259 Dutch respondents. Participants were defined as either healthy or having comorbidity before further analysis.
Conclusions
Prevalence of fecal incontinence in this cross-section group was 7.9%, and significantly higher in the comorbidity group (18%). Soiling with urge fecal incontinence was the most common subtype. Passive urge was the least common form.
Comments
A study reporting high prevalence of fecal incontinence.
This blog post is an extract of the Science Alert from May 2018 (76040-USX-20180514)
