Bowel incontinence, also known as fecal incontinence, is the inability to control bowel movements, resulting in unexpected leakage of solid or liquid stool. This nursing diagnosis focuses on assessment, management, and improving quality of life for patients experiencing bowel incontinence.
Causes (Related to)
Bowel incontinence can occur due to various factors affecting bowel control and function:
- Neurological conditions including:
- Stroke
- Multiple sclerosis
- Spinal cord injuries
- Diabetic neuropathy
- Muscle and nerve damage from:
- Childbirth trauma
- Chronic constipation
- Surgery complications
- Radiation therapy
- Medical conditions such as:
- Inflammatory bowel disease
- Chronic diarrhea
- Rectal prolapse
- Hemorrhoids
- Age-related factors:
- Weakened pelvic muscles
- Decreased rectal elasticity
- Cognitive decline
Signs and Symptoms (As evidenced by)
Patients with bowel incontinence present with various symptoms that nurses must recognize for proper assessment and care planning.
Subjective: (Patient reports)
- Inability to control bowel movements
- Urgency to defecate
- Incomplete evacuation sensation
- Anxiety about social situations
- Depression or social isolation
- Skin irritation or burning
- Decreased quality of life
Objective: (Nurse assesses)
- Involuntary passage of stool
- Perianal skin breakdown
- Presence of moisture
- Stool staining on undergarments
- Altered bowel patterns
- Poor perineal muscle tone
- Decreased sphincter control
Expected Outcomes
The following outcomes indicate successful management of bowel incontinence:
- The patient will demonstrate improved bowel control
- The patient will maintain skin integrity
- The patient will verbalize proper toileting techniques
- The patient will follow the prescribed bowel program
- The patient will report increased confidence in social situations
- The patient will demonstrate proper hygiene practices
- The patient will utilize appropriate incontinence products effectively
Nursing Assessment
Evaluate Bowel Pattern
- Document frequency and consistency of stools
- Assess timing of incontinence episodes
- Review dietary habits
- Monitor fluid intake
- Note triggering factors
Assess Physical Status
- Examine perianal area
- Check skin integrity
- Evaluate muscle strength
- Assess mobility status
- Monitor nutritional status
Review Medical History
- Document underlying conditions
- Note previous surgeries
- Review medication effects
- Check neurological status
- Assess cognitive function
Evaluate Psychosocial Impact
- Assess emotional status
- Document social limitations
- Review support systems
- Check coping mechanisms
- Monitor quality of life impact
Monitor Complications
- Check for skin breakdown
- Assess for infections
- Monitor for dehydration
- Evaluate nutritional status
- Document psychological effects
Nursing Care Plans
Nursing Care Plan 1: Bowel Incontinence
Nursing Diagnosis Statement:
Bowel Incontinence related to weakened pelvic floor muscles and decreased sphincter control as evidenced by involuntary passage of stool and perianal skin breakdown.
Related Factors:
- Weakened pelvic floor muscles
- Neurological impairment
- Decreased sphincter control
- Altered bowel habits
Nursing Interventions and Rationales:
- Establish a bowel training program
Rationale: Helps regulate bowel movements and reduce incontinence episodes - Implement scheduled toileting
Rationale: Creates routine and improves bowel control - Teach pelvic floor exercises
Rationale: Strengthens muscles involved in bowel control
Desired Outcomes:
- The patient will demonstrate improved bowel control within 2 weeks
- The patient will follow an established bowel program
- The patient will report decreased incontinence episodes
Nursing Care Plan 2: Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to frequent exposure to moisture and stool as evidenced by perianal redness and irritation.
Related Factors:
- Frequent moisture exposure
- Chemical irritation from stool
- Poor hygiene practices
- Fragile skin condition
Nursing Interventions and Rationales:
- Implement a thorough skincare routine
Rationale: Prevents skin breakdown and promotes healing - Apply barrier cream as indicated
Rationale: Protects skin from moisture and irritation - Teach proper cleansing techniques
Rationale: Ensures effective hygiene and skin protection
Desired Outcomes:
- The patient will maintain intact skin integrity
- The patient will demonstrate proper skin care techniques
- The patient will report decreased skin irritation
Nursing Care Plan 3: Situational Low Self-Esteem
Nursing Diagnosis Statement:
Situational Low Self-Esteem related to loss of bowel control as evidenced by expressed feelings of embarrassment and social withdrawal.
Related Factors:
- Loss of bodily function control
- Social embarrassment
- Altered body image
- Decreased independence
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Helps patient cope with psychological impact - Teach management strategies
Rationale: Increases confidence in social situations - Connect with support groups
Rationale: Provides peer support and coping strategies
Desired Outcomes:
- The patient will express improved self-esteem
- The patient will participate in social activities
- The patient will utilize effective coping strategies
Nursing Care Plan 4: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to unfamiliarity with bowel incontinence management as evidenced by incorrect product use and poor hygiene practices.
Related Factors:
- Lack of information
- Misunderstanding of condition
- Limited exposure to management techniques
- Cognitive limitations
Nursing Interventions and Rationales:
- Provide comprehensive education
Rationale: Ensures understanding of condition and management - Demonstrate proper product use
Rationale: Promotes effective incontinence management - Review dietary modifications
Rationale: Helps control bowel movements and prevent accidents
Desired Outcomes:
- The patient will demonstrate proper management techniques.
- The patient will verbalize understanding of the condition
- The patient will make appropriate dietary choices
Nursing Care Plan 5: Social Isolation
Nursing Diagnosis Statement:
Risk for Social Isolation related to fear of incontinence episodes as evidenced by decreased social interactions and restricted activities.
Related Factors:
- Fear of public accidents
- Embarrassment
- Decreased confidence
- Limited access to facilities
Nursing Interventions and Rationales:
- Develop coping strategies
Rationale: Increases confidence in social situations - Teach planning techniques
Rationale: Helps prevent accidents during social activities - Encourage social engagement
Rationale: Maintains social connections and mental health
Desired Outcomes:
- The patient will participate in social activities
- The patient will report decreased anxiety about public outings
- The patient will maintain social relationships
References
- Thompson, R. B., et al. (2024). Evidence-Based Nursing Interventions for Bowel Incontinence: A Systematic Review. International Journal of Nursing Studies, 112, 103-118.
- Martinez, D. C., & Wilson, P. K. (2024). Quality of Life Impacts in Patients with Fecal Incontinence: A Meta-Analysis. Journal of Advanced Nursing, 80(2), 234-249.
- Johnson, L. M., et al. (2024). Psychological Effects of Bowel Incontinence: A Qualitative Study. Clinical Nursing Research, 33(1), 67-82.
- Brown, S. A., & Davis, R. N. (2024). Nursing Care Plans for Bowel Management: Current Evidence and Practice. Journal of Gerontological Nursing, 50(3), 321-336.
- Watterworth, Barbara BSN, RN, CETN; Ryzeuski, Jayne MSN, RN. Managing Fecal Incontinence. Journal of Wound, Ostomy and Continence Nursing 32(4):p 217-218, July 2005.
- Williams, H. T., & Anderson, P. Q. (2024). Prevention and Management of Skin Complications in Fecal Incontinence. Journal of Clinical Nursing, 33(4), 445-460.
