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Bowel Dysfunction and Its Relationship to Urinary Incontinence. IN: Newman, D.K.; Wein, A.J. Managing and Treating Urinary Incontinence. 2nd ed. Baltimore, MD: Health Professions Press, Inc. 2009. pp 129-174.

This chapter on bowel dysfunction and its relationship to urinary incontinence is from a book that provides a comprehensive review of the problem of urinary incontinence (UI) and overactive bladder (OAB) for health care providers of all disciplines—nurses, doctors, allied health professionals—who practice in primary care and who provide services to adults in acute care, rehabilitation centers, home care, and long-term care settings. This chapter reviews the most common bowel disorders that older adults with UI may experience: fecal (anal) incontinence (FI), chronic constipation, fecal impaction, and diarrhea. Clinicians are encouraged to develop a knowledge of the anatomy and physiology of the lower rectum in relation to the normal bowel; awareness of common bowel disorders seen in older adults; knowledge of stool type by history and physical examination; the ability to discuss constipation, FI, and fecal impaction management options with their patients; and a knowledge of evidence-based practice and relevant literature. Bowel regularity or irregularity has an impact on the bladder and its ability to empty. The chapter describes factors that contribute to bowel dysfunction, including insufficient dietary fiber, hemorrhoids, rectal surgery, poor fluid intake, ignoring the defecation urge, pregnancy, medications, chronic diseases, lack of physical activity, laxative abuse, and travel. Treatment options can address many of these factors. 7 figures. 2 tables. 83 references.

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Managing and Treating Urinary Incontinence: Patient and Provider Tools and Forms. IN: Newman, D.K.; Wein, A.J. Managing and Treating Urinary Incontinence. 2nd ed. Baltimore, MD: Health Professions Press, Inc. 2009. [CD-ROM].

This CD-ROM contains a wealth of support materials designed to accompany a book that provides a comprehensive review of the problem of urinary incontinence (UI) and overactive bladder (OAB) for health care providers of all disciplines—nurses, doctors, allied health professionals—who practice in primary care and who provide services to adults in acute care, rehabilitation centers, home care, and long-term care settings. The CD-ROM has three sections: patient care plans, patient education tools, and assessment forms. Nursing care plans are provided for patients with altered patterns of urinary elimination, detrusor activity, stress UI due to decreased outlet resistance, urinary retention related to chronically overfilled bladder with loss of sensation, functional incontinence related to decreased physical or cognitive capability, impaired skin integrity related to urinary and/or bowel incontinence, urinary tract infection, constipation, bowel incontinence related to decreased rectal tone, and diarrhea related to laxative and medication use or bacterial infection. The patient education section provides fact sheets about urinary incontinence, preventing bladder infections, the bladder and voiding, the role of caffeine, how food and drink affect the bladder, bladder training, exercising the pelvic floor muscles, stopping urine leaks, doing a pad test, ways to prevent bladder problems during the night, helping the bladder empty, how to prevent postvoid dribble, the side effects of treatment for overactive bladder, using a catheter for men, using a catheter for women, the care and use of an indwelling or Foley catheter, how to use an external “condom” catheter, how to care for the catheter drainage bag, using a pessary for pelvic organ prolapse, using topical estrogen, tips for keeping the bowels moving, and self care for painful bladder syndrome, also known as interstitial cystitis. The final section of the CD provides 11 assessment forms: incontinence patient profile, past medical history, pelvic floor muscle strength assessment, daily voiding and incontinence record, voiding frequency–volume and incontinence chart, bowel disorders profile, daily bowel record, treatment findings and recommendations, pelvic floor muscle exercise prescription, initial consultation for long-term care patients, and bladder and bowel diary for assessment of bladder function in long-term care patients.

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Irritable Bowel Syndrome: An Approach to Treating Patients. Digestive Health Matters. 17(1): 4-7. Spring 2008.

This article reprints an interview with Dr. Peter Whorwell, conducted in April 2007 at the 7th International Symposium on Functional Gastrointestinal Disorders, in which he discussed treatment options that are available to patients with irritable bowel syndrome (IBS). With limited IBS-targeted drugs available, the interview focused on how Dr. Whorwell approaches treatment of patients with IBS. Topics include changes in the medical treatment of IBS that have occurred in the last decade; how to find adequate care for IBS; the intake interview; the professional-patient relationship and its impact on delivery of health care; the need to tailor treatments to each individual patient; addressing individual symptoms of IBS such as diarrhea, constipation, pain, and food-related problems; the role of dietary fiber; medications used to treat the varying symptoms of IBS; the role of tricyclic antidepressants; how antidepressants can work for IBS symptoms at lower doses than when they are used for psychological problems; and the use of hypnotherapy for treating IBS. Throughout the article, Dr. Whorwell emphasizes that any and all treatment strategies require a long-term approach and that most patients will achieve improvements rather than a cure. One side bar reviews the problem of IBS in children and adolescents.

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Irritable Bowel Syndrome: Searching for Underlying Causes. Digestive Health Matters. 16(1): 24-25. Spring 2008.

This article summarizes some recent investigations that explore the underlying causes of irritable bowel syndrome (IBS), a functional gastrointestinal (GI) disorder characterized by changes in normal bowel function. The author focuses on the role of food and nutrients for gut function in IBS, as well as the link between different alterations of function and the symptom pattern of the patient. Topics include food sensitivity in IBS, the role of dietary fats, postprandial symptoms, gut sensitivity, gastrointestinal motility, the link between symptoms and contributing factors in IBS, diarrhea versus constipation as the primary symptoms of IBS, the lack of effective treatment options for IBS, the role of anxiety and psychological well-being, gender predominance, and inflammation and bacterial infections in patients with IBS. The author does not support widespread use of antibiotics for patients with IBS. The author concludes that IBS is a disorder with multiple contributing factors, which can complicate treatment approaches but may aid in understanding some of the difficulties in determining the causes of this condition.

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Appendicitis. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2008. 6 p.

This fact sheet describes appendicitis, defined as a painful swelling and infection of the appendix. The fact sheet answers common questions about the anatomy and function of the appendix, the causes of appendicitis, who gets appendicitis, the symptoms of appendicitis, how appendicitis is diagnosed, how appendicitis is treated, and what people should do if they think they have appendicitis. The appendix is a fingerlike pouch attached to the large intestine and located in the lower right area of the abdomen. Symptoms of appendicitis may include abdominal pain, loss of appetite, nausea, vomiting, constipation or diarrhea, inability to pass gas, low-grade fever, and abdominal swelling. A doctor can diagnose most cases of appendicitis by taking a person’s medical history and performing a physical examination. Sometimes laboratory and imaging tests are needed to confirm the diagnosis. Appendicitis is typically treated by removing the appendix. Appendicitis is a medical emergency that requires immediate care. The fact sheet includes a brief description of current research in this area. Readers are referred to three resource organizations: the American Academy of Family Physicians at 1–800–274–2237 or www.aafp.org, the American College of Surgeons at 1–800–621–4111 or www.facs.org, and the American Society of Colon and Rectal Surgeons at 847–290–9184 or www.fascrs.org. The document concludes with a summary of the activities of the National Digestive Diseases Information Clearinghouse (NDDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 1 figure.

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Appendix A: The Rome III Diagnostic Criteria for the Functional Gastrointestinal Disorders. IN: Drossman, D., ed. Understanding the Irritable Gut: The Functional Gastrointestinal Disorders. McLean, VA: Degnon Associates, Inc. 2008. pp 183-199.

This appendix is from a book that helps doctors and patients better understand functional gastrointestinal disorders (FGIDs), with text based on information developed by the Rome Foundation to identify, classify, and treat these disorders. This appendix presents the Rome criteria for the diagnoses of FGIDs; the criteria were developed by teams of experts to define patients for scientific study and help practicing doctors more precisely identify the disorders. The disorders covered include functional heartburn, functional chest pain of presumed esophageal origin, functional dysphagia, globus, functional dyspepsia, postprandial distress syndrome, epigastric pain syndrome, belching disorders, chronic idiopathic nausea, functional vomiting disorders, cyclic vomiting syndrome (CVS), rumination syndrome in adults, irritable bowel syndrome, functional bloating, functional constipation, functional diarrhea, functional abdominal pain syndrome (FAPS), functional gallbladder and Sphincter of Oddi disorders, functional fecal incontinence, functional anorectal pain, and functional defecation disorders. The diagnostic criteria for both childhood and adult FGIDs are included, although the remainder of the appendix only focuses on adult disorders. Readers are cautioned that the criteria are not meant for self-diagnosis and that a confident diagnosis can only be safely arrived at after a careful history and physical examination by a doctor. The diagnostic criteria are scheduled to be updated again in 2012.

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Colon: Questions and Answers. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 271-280.

This section of questions and answers is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. This section helps readers review seven chapters on the colon, including clinical aspects, therapy, extraintestinal manifestations and cancer, gastrointestinal infections, diverticular disease, colorectal neoplasms, irritable bowel syndrome (IBS), constipation, and disorders of the pelvic floor function. The section consists of 21 multiple choice questions, followed by annotated answers that explain each of the correct choices.

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Concerned About Constipation?.

This fact sheet from the National Institute on Aging provides basic information about constipation. Readers are reassured that there is no correct number of daily or weekly bowel movements and being “regular” is different for each person. The fact sheet lists recommended questions to help readers determine whether they might have a constipation problem. These questions consider symptoms such as bowel movements fewer than three times per week, difficulty passing stools, lumpy or hard stools, and a feeling of being blocked or of not having fully emptied the bowels. The fact sheet discusses the causes of constipation, including diet; using too many laxatives or enemas; lack of exercise; holding back bowel movements; some medical conditions; some medications; treatment approaches such as adding fiber to the diet, drinking adequate fluids, and getting enough physical activity; and how to know when to consult a health care provider about constipation concerns. Readers are referred to three resource organizations for more information: the National Digestive Diseases Information Clearinghouse (www.niddk.nih.gov or 1–800–891–5389), the National Library of Medicine Medline Plus (www.medlineplus.gov), and the National Institute on Aging Information Center (www.nia.nih.gov or 1–800–222–2225). Readers are encouraged to go online to NIHSeniorHealth (www.nihseniorhealth.gov), a senior-friendly website that has health information for older adults.

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Pediatric Anorectal Disorders. Gastroenterology Clinics of North America. 37(3): 709-730. September 2008.

This article about pediatric anorectal disorders is from a special issue of Gastroenterology Clinics of North America that presents updates on disorders of the pelvic floor and anorectum. The authors report on the clinical, physiopathologic, diagnostic, and therapeutic aspects of the most common anorectal disorders in children, including constipation and fecal incontinence. They focus on the differential diagnosis between organic and functional constipation. Other clinical conditions are discussed, such as atopy, neurologic diseases, and anorectal malformations, in which chronic constipation may be an important clinical manifestation. Anorectal disorders are common in children and are usually mild and short-lived if the child receives prompt and adequate attention during the early phase of the disorder. Altered stool frequency and altered behavior with defecation are common presenting symptoms in children who have anorectal disorders. These alterations may be affected by several factors such as diet, social habit, convenience, parents’ cultural beliefs, interrelationships with the family, and daily timing of activities. In addition, the authors encourage clinicians to consider the age and degree of psychosocial development of the child for both diagnostic and treatment approaches. 3 figures. 2 tables. 92 references.

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Constipation and Disorders of Pelvic Floor Function. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 257-270.

This chapter on constipation and disorders of pelvic floor function is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. In the section on constipation, the author reviews the salient aspects of colonic motor physiology and pathophysiology, including function, regional differences in colonic motor function, motor patterns, colonic contractile response to a meal, colonic relaxation, colocolonic inhibitory reflexes, and serotonin and the gut. Other topics covered in this section include the assessment of colonic transit, a definition of constipation, and the clinical assessment, classification, and management of constipation The next section reviews disorders of pelvic floor function, including functional defecatory disorders and fecal incontinence; the physiology of defecation; diagnostic tests that may be used to confirm the presence of functional defecatory disorders; anorectal manometry; treatment options for functional defecatory disorders; the definition and etiology of fecal incontinence; patient assessment and diagnostic tests used to confirm fecal incontinence; and treatment strategies. The author stresses the potential impact of functional defecatory disorders on quality of life, noting that much can be accomplished by regulating bowel habits in patients with diarrhea or constipation. Diarrhea should be managed by treatment of the underlying condition. Biofeedback may be useful for fecal incontinence. Scheduled rectal emptying with suppositories of enemas is often useful for fecal impaction and overflow incontinence. 6 figures. 3 tables.

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