Management of Fecal Incontinence for the Advanced Practice Nurse Under the auspices of the International Continence Society Donna Z. Bliss Editor 123123 Management of Fecal Incontinence for the Advanced Practice Nurse Donna Z. Bliss Editor Management of Fecal Incontinence for the Advanced Practice Nurse Under the auspices of the International Continence Society Editor Donna Z. Bliss School of Nursing University of Minnesota School of Nursing Minneapolis MN, USA ISBN 978-3-319-90703-1 ISBN 978-3-319-90704-8 (eBook) https://doi.org/10.1007/978-3-319-90704-8 Library of Congress Control Number: 2018948667 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature. The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword In the 45 years since the start of the International Continence Society, continence nursing has come a long way, from virtual invisibility to leadership in services and care for people living with incontinence. Yet even within the continence field, fecal incontinence has remained poorly visible, with considerably less research and development of interventions and services than for urinary incontinence. Nurses who specialize in continence care are not always advanced practitioners in manag- ing fecal incontinence. This book aims to change this. The size of the problem of fecal incontinence is huge, both in numbers of people affected and in its life-limiting effects, which literally ruins lives. There can be few, if any, more embarrassing and humiliating symptoms, with leaked feces and bowel function a taboo across nearly all cultures. This is true across diverse patient groups and ages. Prevalence is 50% and above among frail older adults in care homes. In people with bowel disorders such as inflammatory bowel disease, fecal inconti- nence affects at least one quarter. After surgery for colorectal cancer or radiotherapy for pelvic cancers, fecal incontinence often prevents a return to normal life even if the cancer is cured. All too often the symptom is accepted, even expected, by nurses and patients alike. Medical developments have focused largely on the anal sphincter which we can visualize and measure its quality, function, and sensation. Yet results of surgical approaches, such as anal sphincter repair, have remained often disappointing, espe- cially in the long term. Newer developments, such as sacral nerve stimulation, sphincter bulking, and implanting stem cells, while promising, have yet to pass the test of time and become generalized in use beyond pioneering centers, and it is known that results in generic practice are always less impressive than initial results that enthusiasts suggest. Tackling fecal incontinence is undoubtedly a task for a multidisciplinary team. Gastroenterologists, colorectal surgeons, radiologists, physiotherapists, dietitians as well as nurses all have important roles on such a team. Devising a referral and care pathway is important to ensure coordination and effective use of resources. But many colleagues have a limited range of options for fecal incontinence. Interventions tend to focus on the anatomy and function rather than the whole person. Both medi- cations and surgery are poorly developed and inappropriate or ineffective for many patients. Specific products are few and have limited uses. v vi Foreword Within a multidisciplinary team, nurses are often best placed to help patients both improve symptoms and to enhance coping skills, thereby improving quality of life. Nurses are often in the closest contact with patients who trust nurses in reveal- ing intimate issues or discussing symptoms they have told nobody else about. Nurses offer the combination of empathetic listening, holistic assessment, and prac- tical techniques that are needed. We are also likely to be in a position to coordinate the team and help the patient navigate the care system. However, achieving optimal care for fecal incontinence is far more than just using common sense and generic knowledge. We are starting to develop a body of specialist knowledge and skills to enable us to make a real difference to people with fecal incontinence. We also have techniques from related nursing areas of ostomy and bladder management and skin care which can be adapted and applied. This book is a treasure trove of information and techniques to help with this. Yet we still have a long way to go to find effective strategies and nursing inter- ventions across the full range of patients who experience fecal incontinence. Public awareness is limited, and unlike urinary incontinence, commercial interests have been slow to recognize the opportunity and develop products. The research base for our practice remains woefully inadequate compared with the massive scale of the problem. We are starting to understand the complexity of the physical, psychologi- cal, and social underpinnings and consequences of fecal incontinence. But we have yet to find the best ways to improve nursing assessment and management of the many different patients who present to us. And we are a very long way from identi- fying all those who need our help. This book is a major contribution to advanced nursing knowledge on fecal incon- tinence, pulling together in one place the current state of the art for assessing and managing its symptoms. It will help us to progress and speak the same language, fostering our debates and common understanding. I commend all nurses who are, or aspire to be, advanced nurse practitioners in this much neglected field. I wish I had this book when I started to work with these patients. King’s College London, London, UK Christine Norton About this Book The aim of this book is to serve as a resource to advanced practice nurses interested in evidence-based management of fecal incontinence. An international group of nurses and physician colleagues who are expert in the management of fecal incon- tinence collaborated in offering their expertise for this book. Notably, the International Continence Society (ICS) has provided its endorsement of the book. The book represents the current evidence and best practices for the management of fecal incontinence across different patient groups. The authors aimed to provide the essential knowledge and practice guidance needed by the advanced practice nurse to diagnose and manage fecal incontinence in various clinical settings and patient groups. They identified and shared exemplars from different countries and developed case studies to highlight the information discussed. Chapter 12 explains common surgeries to treat fecal incontinence for the advanced practice nurse fol- lowing patients who receive surgical intervention. Chapter 13 summarizes the treat- ment of incontinence-associated skin damage (i.e., dermatitis and pressure injury), and Chapter 14 addresses the management of fecal incontinence in the presence of urinary incontinence. In addition, the authors determined that clarifying the roles of the generalist, specialist, and advanced practice nurse in continence care would be beneficial in providing a contextual framework for this book. In so doing, they acknowledged the various levels of nurses involved in continence care and the important contributions to care made by each. Chapter 2 proposes a conceptualiza- tion of these roles and organizes necessary competencies by role. I would like to express my sincerest gratitude to all the authors who generously shared their expertise, collaborated on writing teams, and wrote chapters to produce this outstanding book. I would also like to thank the student assistants from the University of Minnesota: Megan Cavanaugh, Elise Gannon, and Haeyeon Lee who assisted in formatting all chapters and references and enabled us to meet our dead- lines. We appreciate the review of the ICS members in assisting us to produce the highest quality product. Those reviewers are Veronika Geng, Master in Health Science/Nursing Science, RN, Head of the Advisory Centre for Nutrition and Digestion for spinal cord injured people in the Manfred-Sauer-Foundation, Germany; Joanne Hoyle, Adult Specialist Nurse, Bladder and Bowel UK; ÖZGE ÖZ, Research Assistant and PhD student, Ondokuz Mayis