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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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Diarrhea. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2009. 9 p.

This fact sheet describes diarrhea, a condition defined as one in which a person passes three or more loose, watery stools in a day. Acute diarrhea is a common problem that usually lasts 1 or 2 days and goes away without treatment. Prolonged diarrhea persisting for more than 2 days may be a sign of a more serious problem and poses the risk of dehydration. Chronic diarrhea may be a feature of a chronic disease. The fact sheet answers common questions about diarrhea, including its causes, symptoms, other symptoms that may accompany diarrhea, how to know when to see a doctor, treatment strategies, and how to prevent traveler’s diarrhea. Diarrhea can be dangerous if a person becomes dehydrated. The causes of diarrhea include viral, bacterial, and parasitic infections; food intolerance; reactions to medicine; intestinal diseases; and functional bowel disorders. Treatment involves replacing lost fluid and electrolytes. Depending on the cause of the problem, a person might need medication to stop the diarrhea or treat an infection. Children may need an oral rehydration solution to replace lost fluid and electrolytes. Readers are advised to call a health care provider if the person with diarrhea has severe pain in the abdomen or rectum, a fever of 102 degrees or higher, blood in the stool, signs of dehydration, or diarrhea for more than 3 days. The fact sheet includes a brief description of current research in this area. Readers are referred to online publications and two resource organizations: the American Gastroenterological Association at 301–654–2055 or www.gastro.org and the International Foundation for Functional Gastrointestinal Disorders at 1–888–964–2001 or www.iffgd.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). 2 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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Short Bowel Syndrome. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2009. 10 p.

This fact sheet describes short bowel syndrome, defined as a group of problems related to poor absorption of nutrients that typically occurs in people who have had half or more of their small intestine removed. People with short bowel syndrome cannot absorb enough water, vitamins, and other nutrients from food to sustain life. The fact sheet answers common questions about short bowel syndrome, including its causes, signs and symptoms, treatment strategies, and intestinal adaptation. Diarrhea is the main symptom of short bowel syndrome and can lead to dehydration, malnutrition, and weight loss. Treatment may involve use of oral rehydration solutions, parenteral nutrition, enteral nutrition, and medications. Intestinal transplantation may be an option for some patients. The fact sheet includes a brief description of current research in this area. Readers are referred to two resource organizations: the Crohn’s and Colitis Foundation of America at 1–800–932–2423 or www.ccfa.org and the Oley Foundation at 1–800–776–OLEY or www.oley.org for more information. 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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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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Celiac Disease and the Colon. Practical Gastroenterology. 32(9): 40-45. September 2008.

This article explores the impact of celiac disease on the colon. The author defines celiac disease as an autoimmune enteropathy of the proximal small intestine, triggered by dietary exposure to gluten, a protein of wheat, barley, and rye. Serologic testing for celiac-related autoantibodies has facilitated diagnosis considerably, but diagnosis is still confirmed with intestinal biopsy. The author explores the associations between celiac disease and both inflammatory bowel disease (IBD) and microscopic colitis. One section reviews the likelihood of colon neoplasia in patients with celiac disease. Another section considers the use of diagnosing celiac disease during colonoscopy, determining that celiac disease cannot be excluded by ileal biopsy. One table helps physicians understand the significance of colon pathology, including microscopic colitis, inflammatory bowel disease, and colon neoplasia, in patients with celiac disease. The author recommends that physicians should consider additional pathology in patients who fail to respond to, or who later relapse despite, dietary gluten exclusion. Recurrent diarrhea and anemia in particular should prompt colonoscopy. 2 tables. 34 references.

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Celiac Disease. Bethesda, MD: American College of Gastroenterology. 2008. 6 p.

This fact sheet provides basic information about celiac disease and its diagnosis. Designed to help increase health care providers’ and patients’ index of suspicion about the disease, the fact sheet describes how the intestine reacts to gluten, the epidemiology of celiac disease, the primary symptoms, diagnostic tests used to confirm the presence of the disease, and treatment with a gluten-free diet. A final section considers the complications of celiac disease, all of which can be avoided by following a gluten-free diet. The most common symptoms of celiac disease include abdominal pain, bloating and gas, diarrhea, stools that may float or smell unusually bad, weight loss, poor growth or weight loss in children, and anemia. Other symptoms or complications include weakness, tiredness, low vitamin levels, bone and joint pains, osteoporosis, and a chronic skin rash. Diagnostic tests used include blood tests and an endoscopic biopsy of the small bowel. The fact sheet includes a brief list of grains that contain gluten and must be avoided, as well as a list of frequently overlooked foods that often contain gluten. A full-color illustration of the intestinal villi is included. A list of 10 websites that have more information concludes the fact sheet. 4 figures.

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Clinical Features of Malabsorptive Disorders, Small-Bowel Diseases, and Bacterial Overgrowth Syndromes. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 117-134. Price: $99.95.

This chapter on the clinical features of malabsorptive disorders, small-bowel diseases, and bacterial overgrowth syndromes 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. The first section of the chapter covers malabsorptive disorders and diarrhea, including carbohydrate malabsorption, fat malabsorption, protein malabsorption, diarrhea, intestinal resections, and short bowel disorders. The next section focuses on small bowel diseases, including celiac disease, Whipple’s disease, tropical sprue, eosinophilic gastroenteritis, intestinal lymphangiectasia, and amyloidosis. The last section on bacterial overgrowth syndromes describes small intestinal bacterial overgrowth (SIBO) and its risk factors, complications, diagnosis, and treatment. Malabsorption is considered a defect in the mucosal absorption of nutrients, while maldigestion is a defect in the hydrolysis of nutrients. Both conditions imply disordered physiologic mechanisms in the gastrointestinal system. The chapter is illustrated with full-color drawings and photographs. 7 figures. 8 tables. 9 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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