![]() 9 If a primary neurological cause is suspected, lower limb or more extensive neurological examination may be warranted. Inspection and DRE can accurately detect larger external sphincter defects, 18 and may identify complications, such as perianal dermatitis. Loss of visible sphincter constriction after stroking the perianal area (anal wink reflex) can result from damage to the S2–4 nerve roots or the pudendal nerve. Digital rectal examination (DRE) remains necessary to assess for rectal stool loading, rectal prolapse, deficient anal tone and significant pelvic floor descent. Investigation of faecal incontinence in RACĪctive case finding may be necessary, and primary neurological causes, such as spinal cord injury, should be ruled out. 12 In the RAC population, use of patient restraints has been identified as a significant risk factor, even when correcting for the reason for restraint application. 16 Moving into RAC can increase the risk of faecal incontinence. 12 The major risk factor for faecal incontinence is age up to 21.7% people with this condition are 80 years or older. There is some limited evidence in the RAC population that men may be at higher risk of faecal incontinence. 15 Lower spinal cord dysfunction has been hypothesised as a cause of faecal impaction in older adults. 14 Faecal impaction has been found in up to 42% of patients admitted into a geriatric ward. In the presence of impaction, faecal incontinence may be caused by an altered anorectal angle, low anal pressures and decreased anorectal sensation. 13 Faecal impaction – the presence of hard, immovable stool in the rectum following chronic constipation – may be more definitively linked. However, research has inconsistently associated constipation with faecal incontinence 12 and has failed to associate constipation treatment with reduced faecal incontinence episodes. 3Ĭonstipation is common in older adults and may manifest as overflow incontinence. ![]() 11 Deficiencies in activities of daily living, such as feeding, dressing and toilet use, have been correlated with increased risk of faecal incontinence. ![]() Additionally, patients who require significant hands-on mobility assistance may be reluctant to call for help when necessary. 10 Stroke and other causes of impaired mobility also contribute to constipation risk. 9 Parkinson’s disease slows gut transit time and contributes to constipation risk. Dementia can impair mobility and diminish voiding awareness and inhibitory control. 8 Major cognitive and neurological diseases that are common in older age can contribute to faecal incontinence. 7Īetiology of faecal incontinence in older adults in RACįaecal incontinence can occur with alterations to stool consistency or delivery, diminished rectal compliance, altered anorectal sensation or abnormal sphincter function. Even in ideal circumstances, invasive interventions have only been moderately successful. Invasive management options may not be suitable and are poorly researched in this patient group, who are likely to have coexisting pathologies that lower the odds of a successful outcome. Discussion of invasive management strategies is outside the scope of this article. The objective of this article is to describe the suggested initial investigation and management of faecal incontinence in older adults residing in RAC. 6ĭespite the significantly higher prevalence of faecal incontinence in RAC, limited research has been conducted into effective interventions that are specific to this environment. 2 North American studies have found a similar prevalence of up to 50% in RAC. 5 Limited Australian and New Zealand prevalence data indicate a general rate of 12–13% in older adults and up to 50% in residential aged care (RAC). 4 Severe faecal incontinence is also an independent predictor of mortality. Faecal incontinence can be a marker of increased frailty 3 and remains persistently underdiagnosed. The most common frequency measure was ‘leakage of liquid and/or solid stool at least once per month over the past 12 months’. 1 However, a recent review 2 identified significant heterogeneity in the definitions commonly used in the literature to define and measure significant faecal incontinence. The International Continence Society defines faecal incontinence as ‘the involuntary loss of liquid or solid stool that is a social or hygienic problem’.
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