Last updated on May 17th, 2022 at 06:59 am
Bowel Incontinence Nursing Care Plans Diagnosis and Interventions
Bowel Incontinence NCLEX Review and Nursing Care Plans
The digestive system may vary from 18-21 feet long, starting from the mouth all the way to the anus; however, the “bowel” only consists of the small and large intestines (or also known as the “colon”), which takes up more than a quarter of the total length of the digestive system.
The bowel, or intestine main purpose is to digest food, more specifically, the small bowel absorbs most of the nutrients while the large intestines absorbs all the liquid, turning indigestible matter to stool.
Our stools often reflect our diet, however changes to our “regular” bowel movements may indicate something more serious. What “regular” bowel movements are may differ from one person to another.
Some articles express that two bowel movements per day is sufficient as there are several factors that may affect one’s bowel movements. If the patient or family reports several incontinence episodes, if left untreated may cause bowel incontinence (BI).
Bowel incontinence is the lack of control of one’s bowel movement and involuntary passage of stool. These may come in four forms: solid or liquid stool, gas and mucus.
More often than not, these are treatable if diagnosed early, however due to the nature of the disease, many are reluctant to seek appropriate management due to fear of embarrassment. Progression of this disease may start with disruption of everyday tasks, increased dependency leading to its severity which may become an irreversible disability.
Causes of Bowel Incontinence
Here are some of the contributing factors of bowel incontinence (BI):
- Trauma to the colon (rectum, and anus; or any nerves around those areas) and pelvic area, this includes surgery, radiology, chemotherapeutic agents, and childbirth which can cause loss in muscle tone.
- Crohn’s disease and other inflammatory bowel diseases
- Prolonged constipation or loose stools, as any blockage or constant loose stool may weaken muscles and nerves.
- Hemorrhoids
- Spinal cord injury or neurological disorders, defects that affect nerves in control of bowel movements. These are located from the lumbar to sacral column.
- Other diseases that have resulted from infections that affects the gastrointestinal tract
Related Factors to Bowel Incontinence
Aside from the causes stated, age has been associated with incontinence and involuntary loss of stools among the institutionalized. There have been reports that extreme emotions or stress may also interfere with one’s ability to control their bowels.
Other risk factors may include certain and abuse of medications, lack of muscle coordination or sarcopenia due to lack of physical activity, frailty, and sudden change in hormone levels. It has also been observed that people suffering from fecal incontinence may also have comorbidities such as an enlarged prostate.
Urinary tract infections may occur especially if liquid stool travels into the urinary tract.
Signs and Symptoms of Bowel Incontinence
As there are many possible factors that may affect one’s bowel movements, there are signs and symptoms one should be aware of:
- Involuntary Leakage – occurs when one is unaware/unknowingly he/she has excreted. One loss the ability to control their bowel commitment, leakage may become more common. These range from sudden, uncontrollable urges to completely unaware passing.
- Frequency – one may experience fecal incontinence, especially when the patient is experiencing diarrhea, however it is a concern if it’s becoming more frequent. This will be gradual, thus once the patient notices a pattern it’s better to seek immediate consultation.
- Accompanying bowel problems – other bowel problems may present along or ahead from bowel incontinence, prolonged constipation, bloating, or diarrhea are usual symptoms of bowel incontinence.
- Changes in the bowel pattern – sudden changes in color, smell, consistency, size and even its density may provide additional information about the patient’s health.
- Disturbance of daily activities – if any of the above has been affecting daily routine, and ability to socialize, this deserves immediate intervention to avoid progression.
There are several ways treating or managing bowel incontinence, these may range from changes in diet, reorientation of bowel control, medications or surgery
Bowel Incontinence Nursing Diagnosis
Bowel Incontinence Nursing Care Plan 1
Nursing Diagnosis: Bowel Incontinence related to autonomic neuropathy secondary to Diabetes Mellitus, as evidenced by the patient’s decreased appetite, and increased inability to control bladder and bowel.
Desired Outcomes
- The patient will be educated in the importance of early intervention and treatment/management of bowel incontinence.
- The patient and family will abide with the discussed prompted voiding program.
- The patient will maintain or improve skin integrity around the anal area.
| Nursing Interventions for Bowel Incontinence | Rationale |
| Educate the patient about signs and symptoms of bowel incontinence, and possible complications if left untreated | Shame is often a reason why most patients decide to delay consultation with their doctors until it affects their usual activities. |
| Encourage the patient to allow early intervention, and practice awareness | Due to the decreasing sensation in the area, it’s important that the patient takes proactive measures in regularly checking himself for any leakage; especially ones that he was unaware of. |
| Advise the patient and family to consult with a dietician to properly manage his hyperglycemia | Diet change is often the first intervention for patients with observed bowel incontinence. Improved fiber intake may help alleviate BI, and prevent further complications. |
| Monitor the patient’s weight | Increased weight may further increase pressure on other nerves in the pelvic area that is related to bowel elimination |
| Educate the patient and family the importance of skin care and maintaining moisture around the anus to prevent drying | Increased washing can cause dryness in the area, creating cracks around the area, allowing infections caused by microorganisms to enter. |
| Maintain after-care washing. Assess perineal skin integrity. | As part of maintaining the skin-barrier, the patient should practice after-care with warm water, followed by a gentle cleanser (no-alcohol), and proper drying. If dryness is still observed, one may opt to use over-the-counter ointments to help. |
Nursing Evaluation
- The patient has notified the family of signs of bowel incontinence and has consulted with a dietician.
- The family has shared difficulty in assisting the patient with cleaning as the patient is adamant in maintaining his independence.
- The patient still displays hesitancy in fully discussing his condition and sharing these details with his family.
Bowel Incontinence Nursing Care Plan 2
Nursing Diagnosis: Bowel Incontinence related to neurogenic bladder secondary to Spina Bifida as evidenced by constant dribbling of soft stool due poor anal sphincter control.
Desired Outcomes
- The patient will cooperate with the bowel training by maintaining a daily bowel program.
- The family will be able to perform the same training at home as prescribed.
- The patient will have a discernable pattern of bowel training.
| Nursing Interventions for Bowel Incontinence | Rationale |
| Nurse should evaluate the severity of the condition and prepare a bowel training aligned with the discussed rehabilitation plan with the family by utilizing a bowel and bladder log | Better care and treatment plan specific to the patient’s need ill help lessen strain among caregivers in managing bowel incontinence, improving overall outcome |
| Educate the family about the importance of adhering to a bowel control regimen | To create a habit, it’s important to maintain consistency. Sharing the importance of maintaining the training to the family will help the patient to grow awareness in keeping herself clean. |
| Demonstrate prescribed bowel training | Family should be aware of the proper handling of a child with spinal bifida. Especially around the excision site, as it makes the patient vulnerable to complications. |
| Educate and demonstrate the proper changing of diapers | The patient should be changed as often as possible, and as quick as possible once it appears soiled. It’s important to maintain good hygiene to protect the skin barrier in the area. |
| With excessive cleaning due to drippings, parents should also be taught how to maintain moisture in the area. | Ensure products are safe for children, and alcohol-free. The parents may opt to buy a moisture barrier creams during changing diapers. |
Nursing Evaluation
- The patient’s parent/caregiver monitored any difficulty in maintaining the bowel routine at home.
- The parent has decided to consult with a dermatologist to assist with the increased drying in the area due to frequent washing.
- The parent has requested for a modified bowel training, one that involves the use of suppositories, and possibility of sacral nerve stimulation.
Bowel Incontinence Nursing Care Plan 3
Nursing Diagnosis: Progressive Bowel Incontinence related to decreased mental capacity, sensation, and mobility secondary to moderate stage Alzheimer’s disease as evidenced by frequent sudden excretion of loose stool without awareness/sensation.
Desired Outcomes
- The patient remains comfortable and is treated with dignity.
- The family will be well-aware of the association between bowel incontinence and progression of Alzheimer’s.
| Nursing Interventions for Bowel Incontinence | Rationale |
| The family should be provided with counselling to help adjust to the additional roles/changes they may face. | Including the family as early as possible especially in cases where incontinence is observed to progress faster than anticipated. Counselling them of possible changes will lessen misunderstandings and aid in assisting the patient transition to assisted living. |
| Educate the family how to maintain respect when caring for the patient. | At this stage, patients will display difficulty in communication and recognition, which may contribute to their inability to request for assistance. They may display frustration and embarrassment—it’s important to reassure them that “it’s fine” or “normal” to not further aggravate their situation. |
| Remove or minimize as many stressors as possible. | Stress or extreme emotions may induce accidental excretion. |
| Put assistive devices (e.g., as safety rails etc.) and additional protective barriers in the patient’s area especially toward the toilet | Sometimes patients will still respond and act to their urges, although there might be mobility issues that may present danger to the patient when going to the bathroom. |
| Educate the family how to respectfully approach the patient when she soils herself. | The family should be taught that coercion in whatever form is highly discouraged. |
Nursing Evaluation
- The family has expressed difficulty in maintaining the patient’s hygiene cleanliness due to lack of communication from the patient.
- The family has resorted to hourly checking of the patient’s incontinence briefs, although this has been slowly responded with increasing aggression.
- The family has recently retrofitted the patient’s space to fit her needs and removed known stressors, this has led to fewer accidents.
Bowel Incontinence Nursing Care Plan 4
Nursing Diagnosis: Bowel Incontinence related to neurogenic bowel dysfunction secondary to Multiple Sclerosis as evidenced by constant reports of constipation, and report of blood seen in stool.
Desired Outcomes
- The patient will have fewer reports of constipation.
- The patient will report increased relief and improved quality of life.
| Nursing Interventions for Bowel Incontinence | Rationale |
| Introduce the patient to a dietitian. | The patient will benefit from a specialist consultation with the dietitian to help him/her commence a gluten-free diet. Diet often affects our digestion, especially among individuals who consume inadequate amounts of fiber and inadequate fluid intake will experience constipation which could lead to fecal impaction. |
| Review the patient’s medications. | Some medications may disrupt bowel movement, leaving him/ her constipated. These may be prescribed to be changed, or if not, lower in dosage. |
| Refer the patient to a physical therapist | Due to decreased mobility, the lack of exercise also contributed to poor bowel movement. |
| As a lifelong condition, the family should provide support and assistance whenever possible | Reported quality of life from the patient has been greatly affected since confirmation of diagnosis. Improving quality of life may also improve overall outcomes. |
| If possible, request for laxative for the patientProviding laxatives may help alleviate the frequency of constipation, therefore reducing the risk of incontinenceIf the patient continues to have deteriorated mental health, counselling with family is advisable. | The patient might have difficulty with adjusting with his recent diagnosis, and support from family may help him cope better. |
Nursing Evaluation
- The patient has expressed great relief from exercises provided by the physical therapist.
- The patient visited a physician and was able to adjust his medication; he is still awaiting results by his next consultation.
- Until the next visit, the physician has allowed him a laxative when he has constipation for more than five days.
- The patient had also consulted a dietician and is currently on a Mediterranean diet.
- Overall, the patient is having a more positive outlook on his current treatment plan.
Bowel Incontinence Nursing Care Plan 5
Nursing Diagnosis: Bowel Incontinence related to gluten sensitivity secondary to Celiac disease as evidenced by constant reports of constipation, and reported blood seen in stool.
Desired Outcomes
- The patient will adapt to a lifelong gluten-free diet.
- The patient will report increased relief and better quality of life.
| Nursing Interventions for Bowel Incontinence | Rationale |
| Introduce the patient to a dietician. | Diet often affects our digestion, especially among individuals who consume inadequate amounts of fiber and water will experience constipation more. |
| Review the patient’s medications. | Some medications may disrupt bowel movement, leaving him/her constipated. These may be prescribed to be changed, or if not, lower in dosage. |
| Refer the patient to a physical therapist. | Due to decreased mobility, the lack of exercise also contributed to poor bowel movement. |
| As a lifelong condition, the family should provide support and assistance whenever possible | Reported quality of life from the patient has been greatly affected since confirmation of diagnosis. Improving quality of life may also improve overall outcomes. |
| Create a sample weekly meal plan with the patient, considering his/her likes and dislikes. Include a list of allowed foods and foods to avoid for gluten-free diet. | A weekly meal plan can help the patient prepare him/herself to avoid unallowed foods like wheat, barley, and rye. |
Nursing Evaluation
- The patient started on a gluten-free diet and understands that this will be a lifelong diet for him/her.
- The patient will report increased relief of bowel incontinence and better quality of life.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.
