title: A controlled trial of an intervention to improve urinary and fecal incontinence and constipation.
abstract: OBJECTIVE
  To evaluate effects of a multicomponent intervention on fecal incontinence (FI) and urinary incontinence (UI) outcomes.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Six nursing homes (NHs).
  
  
  METHODS
  One hundred twelve NH residents.
  
  
  METHODS
  Intervention subjects were offered toileting assistance, exercise, and choice of food and fluid snacks every 2 hours for 8 hours per day over 3 months.
  
  
  METHODS
  Frequency of UI and FI and rate of appropriate toileting as determined by direct checks from research staff. Anorectal assessments were completed on a subset of 29 residents.
  
  
  RESULTS
  The intervention significantly increased physical activity, frequency of toileting, and food and fluid intake. UI improved (P=.049), as did frequency of bowel movements (P<.001) and percentage of bowel movements (P<.001) in the toilet. The frequency of FI did not change. Eighty-nine percent of subjects who underwent anorectal testing showed a dyssynergic voiding pattern, which could explain the lack of efficacy of this intervention program alone on FI.
  
  
  CONCLUSIONS
  This multicomponent intervention significantly changed multiple risk factors associated with FI and increased bowel movements without decreasing FI. The dyssynergic voiding pattern and rectal hyposensitivity suggest that future interventions may have to be supplemented with bulking agents (fiber), biofeedback therapy, or both to improve bowel function.
authors.affiliation: Division of General Internal Medicine and Public Health, Center for Quality Aging, School of Medicine, Vanderbilt University, Nashville, Tennessee, USA. John.Schnelle@Vanderbilt.edu
authors.forename: John F
authors.initials: JF
authors.lastname: Schnelle
authors.forename: Felix W
authors.initials: FW
authors.lastname: Leung
authors.forename: Satish S C
authors.initials: SS
authors.lastname: Rao
authors.forename: Linda
authors.initials: L
authors.lastname: Beuscher
authors.forename: Emmett
authors.initials: E
authors.lastname: Keeler
authors.forename: Jack W
authors.initials: JW
authors.lastname: Clift
authors.forename: Sandra
authors.initials: S
authors.lastname: Simmons
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000502:physiology; D003248:Constipation / Q000451:nursing / Q000517:prevention & control*; D003672:Defecation; D004032:Diet; D015444:Exercise; D005242:Fecal Incontinence / Q000451:nursing / Q000517:prevention & control*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D008365:Manometry; D009735:Nursing Homes; D012007:Rectum / Q000502:physiology; D014160:Transducers, Pressure; D014549:Urinary Incontinence / Q000451:nursing / Q000517:prevention & control*; D014554:Urination