Fecal Incontinence in the Elderly
Fecal Incontinence in the Elderly
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DOI：
10.1016/j.gtc.2009.06.007
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发表时间：
2009-09-01
影响因子：
3.7
通讯作者：
Rao, Satish S. C.
中科院分区：
文献类型：
--
作者：
Leung, Felix W.;Rao, Satish S. C.
大便失禁影响高达20%的社区居住成年人和超过50%的养老院居民，并且是养老院中老年人的主要危险因素之一。机构化本身就是一个风险因素（例如，由于身体限制而无法移动）。管理应侧重于识别和治疗根本原因，如节食药物引起的腹泻，便秘和粪便嵌塞。使用吸水垫和特殊内衣是有用的。对疗养院居民进行的肛门直肠生理学测试揭示了便秘、大便潴留和大便失禁之间的联系。肛门括约肌功能受损（大便失禁的危险因素），直肠感觉下降，和肛门括约肌协同失调（便秘和嵌塞的危险因素）被发现在一个高比例的失禁疗养院居民。生物反馈和骶神经刺激可能对难治性患者有用，在社区居住的成年人结肠造口术前应考虑。尽管适当的管理，疗养院居民可能仍然失禁，因为痴呆症和健康或约束相关的不动。
Fecal incontinence affects up to 20% of community-dwelling adults and more than 50% of nursing home residents, and is one of the major risk factors for elderly persons in the nursing home. Institutionalization itself is a risk factor (eg, immobility due to physical restraints). Management should focus on identifying and treating underlying causes, such as dietor medication induced diarrhea, constipation, and fecal impaction. Use of absorbent pads and special undergarments is useful. Anorectal physiologic testing of nursing home residents has revealed an association between constipation, stool retention, and fecal incontinence. Impaired sphincter function (risk factor for fecal incontinence), decreased rectal sensation, and sphincter dyssynergia (risk factor for constipation and impaction) are found in a high proportion of incontinent nursing home residents. Biofeedback and sacral nerve stimulation may be useful in refractory patients and should be considered before colostomy in community-dwelling adults. Despite appropriate management, nursing home residents may remain incontinent because of dementia and health or restraint related immobility.