Impaired bowel continence

Domain 3. Elimination and exchange
Class 2. Gastrointestinal function
Diagnostic Code: 00319
Nanda label: Impaired bowel continence
Diagnostic focus: Continence

Nursing diagnosis impaired bowel continence is a broad term used to categorize problems a patient may have with managing their bowel functions. This can range from things like urgent and frequent need to go to the bathroom, to more severe and frequent episodes of diareah and/or constipation, or even complete incontinence in some cases. The general outcome of this diagnosis is improved bowel control and better management of one's defecation needs.

NANDA Nursing Diagnosis Definition

The NANDA International (NANDA-I), the leading international organization for defining and standardizing nursing diagnoses, suggests that for an individual to be diagnosed with impaired bowel continence, they must experience a decrease in their ability to control when and where they defecate three or more times within a week.

Defining Characteristics

Defining characteristics for impaired bowel continence can vary from patient to patient. Subjectively, patients might report experiences like:

• Recurrent abdominal pain or cramping
• A sense of urgency when needing to use the bathroom
• A feeling of incomplete bowel emptying
• Uneven stool consistency
• Inconsistent size and shape of stools
• Discomfort or difficulty when going to the bathroom
• Fear or anxiety regarding going to the bathroom

Objectively, healthcare professionals can observe indicators such as:

• Lack of coordination of abdominal and rectal muscles causing involuntary defecation
• Abnormal amount of loose stools or hard stools
• Weak pelvic floor muscles
• Unusual stool pattern or inconsistencies between bowel movements

Related Factors

Impaired bowel continence can be the result of both physical and psychological changes or disorders. Physical conditions can range from chronic inflammation and endometriosis to neurological diseases like multiple sclerosis and stroke. In addition, lifestyle factors like disease, medications, and poor diet can irritate the intestines, resulting in something called intestinal dysmotility. Psychological issues such as depression, situational stress, posttraumatic stress disorder, and other mental health disorders can also contribute to impaired bowel continence.

At Risk Populations

Populations at risk for impaired bowel continencne include individuals who are pregnant, elderly, chronically ill, or taking certain medications that may affect the bowels. Those with mental illness and people who have recently undergone abdominal surgery may also experience issues with their bowel function.

Associated Conditions

There are a number of conditions associated with impaired bowel continence, many of which are comorbid. Chronic diarrhea, constipation, fecal incontinence, fecal impaction,
intestinal obstruction, anal fissures, inflammatory bowel disease, irritable bowel syndrome, and diverticulitis are some of the most common.

Suggestions for Use

When treating someone with impaired bowel continence, the goal should be to restore balance to the intestinal tract by utilizing a combination of lifestyle changes, medications, and supportive therapies. Medical treatments should be tailored to the individual's underlying cause, while nurses and other healthcare professionals are mainly responsible for providing education and support regarding proper bowel habits and implications of poor bowel control. This can range from teaching correct posture during a bowel movement, to making healthy dietary recommendations and using verbal and non-verbal interventions to facilitate appropriate toileting behaviors.

Suggested Alternatives of NANDA Nursing Diagnosis

Depending on the underlying cause of impaired bowel continence, there are a few alternative NANDA nursing diagnoses that may be applied. In cases of infectious diseases that disrupt bowel function, Acute Diarrhea would be the appropriate diagnosis to use. For those affected by metabolic disorders or dehydration, Risk for Fluid Volume Deficit would be the best fit. And for cases in which anxiety or depression is contributing to the dysfunction, Anxiety or Depression is a suggested diagnosis.

Usage Tips

Nurses can use a variety of assessment and evaluation tools to inform the nursing process when caring for individuals with impaired bowel continence. To accurately measure and monitor patterns of defecation, nurses may use diaries, documentation and observation, or abdominal palpation. Obtaining detailed information regarding the client's history and physical exam can help to rule out underlying conditions and also guide diagnosis, prevention, and intervention.

NOC Outcomes

When treating patients with impaired bowel continence, nurses should aim to achieve the following NOC outcomes:

• Bowel Elimination: Ability of a patient to control automatic elimination processes in order to defecate independently at regular intervals.
• Bowel Continence: Ability to contain and withhold stool and gas for socially accepted periods of time, and evacuate at appropriate times.
• Bowel Status: Ability to maintain healthy bowel habits that ensure all nutritional needs are met.
• Bowel Management: Ability of a patient to properly control the consistency and volume of the stool.
• Hygiene Self Care: Ability of a patient to identify personal needs and to care for oneself appropriately.

Evaluation Objectives and Criteria

When evaluating a patient's progress in regards to improving their impaired bowel continence, nurses may use various criteria to measure success. These criteria include: frequency, consistency, timing, sensation, control, and communication. To evaluate a patient's frequency, for example, one could observe their daily bowel movements or use a diary or chart to log their habits. Consistency could be assessed based on the look and feel of the stool (i.e., hard or soft), while control could be monitored with regard to whether the patient is able to hold in their stool or restroom visits. Finally, communication could be measured by how well the patient is able to respond to questions about their toilet habits and overall understanding of the condition.

NIC Interventions

NIC interventions commonly used when treating impaired bowel continence include:

• Bowel Training: Educating the patient to establish regular toileting schedules and defecating behaviors.
• Fluid/Food Monitoring: Tracking and monitoring indicators such as fluid intake, diet, stool consistency, weight, and elimination pattern.
• Toileting Assistance: Assisting the patient with their toileting needs, including positioning, getting on and off the toilet, cleaning, and restocking supplies.
• Relaxation: Teaching the patient relaxation techniques to help them cope with fear or stress associated with the condition.
• Guided Imagery: Using guided imagery to help the patient stay focused and relaxed during defecation.
• Dietary Management: Providing detailed information about dietary restrictions and suggestions for maintaining healthy nutrition.
• Positioning: Assisting the patient in finding the most comfortable and effective position for their bowel movements.

Nursing Activities

When caring for someone with impaired bowel continence, nurses should engage in a variety of activities designed to provide physical and emotional support to the patient. This can include providing education regarding proper hygiene, providing assistance with toileting needs, implementing lifestyle changes, developing a support system, and providing therapeutic strategies such as relaxation techniques to reduce stress and performance anxiety.

Conclusion

Impaired bowel continence can be an uncomfortable and embarrassing issue for many patients, but it is manageable with the right interventions. Nurses are in a unique position to provide education, guidance, and emotional support for their clients to help them regain control over their bowels. With sufficient healthcare support, patients can improve their quality of life and achieve optimal bowel health.

FAQs

• What is impaired bowel continence? Impaired bowel continence is an issue related to a person’s inability to control when and where they defecate. It often results from physical and psychological changes or disorders and can range from more minor symptoms, like a sense of urgency to go to the bathroom, to more severe symptoms, like complete incontinence.
• What are the defining characteristics of impaired bowel continence? Defining characteristics for impaired bowel continence may include frequency of bathroom visits, abdominal pain or cramping, a sense of urgency, feeling of incomplete bowel emptying, abnormal stool consistency, inconsistent size and shape of stools, discomfort when going to the bathroom, or fear of going to the bathroom.
• What are some populations at risk for impaired bowel continence? People who are pregnant, elderly, chronically ill, on certain medications, mentally ill, or recently had abdominal surgery may be at risk for impaired bowel continence.
• What are some conditions associated with impaired bowel continence? Chronic diarrhea, constipation, fecal incontinence, fecal impaction, intestinal obstruction, anal fissures, inflammatory bowel disease, irritable bowel syndrome, and diverticulitis are some of the common conditions associated with impaired bowel continence.
• What are some interventions to consider when treating impaired bowel continence? Interventions for impaired bowel continence may include medication, lifestyle changes, education about proper toileting behaviors, relaxation techniques, dietary management, and assisted toileting.