A controlled trial of an intervention to improve urinary and fecal incontinence and constipation.
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.
Schnelle
John F
JF
Division of General Internal Medicine and Public Health, Center for Quality Aging, School of Medicine, Vanderbilt University, Nashville, Tennessee, USA. John.Schnelle@Vanderbilt.edu
Leung
Felix W
FW
Rao
Satish S C
SS
Beuscher
Linda
L
Keeler
Emmett
E
Clift
Jack W
JW
Simmons
Sandra
S
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