[Treatment for fecal incontinence in patients with anorectal malformations. Introduction of a therapeutic approach]. / Therapie der Inkontinenz am Beispiel anorektaler Fehlbildungen Vorstellung eines Behandlungskonzepts.

UNLABELLED: Fecal incontinence is a serious problem that may lead to social segregation and psychological problems. Patients with anorectal malformations frequently suffer fecal incontinence even with an excellent anatomic repair. In these patients an effective management program with enemas can improve their quality of life. We want to present our experience with bowel management and anorectal irrigation as treatment for stool incontinence. MATERIAL AND METHODS: Patients who presented with soiling regardless of the type of anomaly were included in the study. The diagnostic program comprised a careful clinical history, physical examination, exact classification of the malformation and stool protocol. All patients suffering from true fecal incontinence were included in a bowel management program. These patients received oral polyethylenglykol to evacuate stool impaction. Than anorectal irrigation was initiated and repeated every 24 or 48 hours. Patients were controlled for soiling, time needed for irrigation and time interval between irrigations 6 and 12 months after start oftherapy. RESULTS: 40 patients aged 4 to 54 with a mean age of 15,95 years were evaluated. 12 months after start of therapy 32 patients were free of symptoms of soiling. 6 patients were soiling occasionally once or twice per week. 2 patients did not follow the therapeutic regime and therefore did not show an improved condition concerning soiling in the long run. The average time needed for irrigation was 45 minutes, irrigations where done every 24 hours in 12 patients. 25 patients irrigated twice every 48 and 72 hours to achieve a constant seven day rhythm. One patient irrigated every five days. DISCUSSION: Patients born with anorectal malformation and suffering from stool incontinece can be kept clean of stool if they are subjected to an adequate treatment.

Digital removal of faeces.

Defecation is essential to enable us to eliminate waste and keep our bowels functioning. In some individuals, defecation is not possible without an intervention. This might be oral medication, such as laxatives to soften the stool and propel the faeces round the colon, or digital removal of faeces (DRF) by a competent health professional on a regular basis. This article considers who needs DRF, who can carry it out, the ethical and legal implications, and the importance of appropriate bowel care being carried out in all care settings.

Profundizando en el conocimiento sobre el manejo del dispositivo para control de la eliminación fecal en el paciente crítico / To go in-depth in the knowledge of the device to control fecal elimination in the critical patient

OBJETIVO: Describir las características generales del paciente y del uso del dispositivo. Conocer presión del globo de retención (PGR) y factores relacionados. Identificar incidencia de fuga, recolocación y lesión perineal asociada al dispositivo (LAD) y factores relacionados. MATERIAL Y MÉTODOS: Estudio observacional analítico longitudinal realizado en UCI polivalente, de junio a diciembre de 2010. La muestra incluyó portadores de Flexi-Seal ®. Se valoraron: características de pacientes y de uso del dispositivo, PGR, fuga y cantidad, recolocación y motivo, LAD, sedoanalgesia en perfusión(SAP), relajación en perfusión, posición, tipo sonda, modalidad ventilatoria(MV), presión intraabdominal(PIA), presión media intratorácica(PMI), PEEP, Glasgow, color-aspecto, consistencia y volumen de heces. Significación p < 0,05. RESULTADOS: Se incluyeron 21 pacientes, 52% varones, edad 54 ± 17años con 30 episodios de inserción, Flexi-Seal-Signal ® un 33%, permanencia 10 ± 8días, principal indicacion «diarrea más lesión piel» en un 33%, retirada «intolerancia y/o expulsión espontánea» en un 30%. PGR mediana (Me) = 40; RI (61-19) cmH2O. Factores asociados significativamente a mayor PGR: ausencia de SAP, decúbito prono, fuga, recolocación, Flexi-Seal ® convencional, MV, menor PEEP y PMI, color-aspecto y mayor PIA. Densidad de incidencia de fuga, recolocación y LAD 43, 30 y 2 casos/100días de sonda, respectivamente. Factores de riesgo de fuga y recolocación: mayor PGR, Glasgow y volumen de heces, menor PIA, MV, modalidad asistida-espontánea OR 2,5; IC (1,6-3,8) y OR 1,7 (1,1-2,7), ausencia SAP OR 3,3 (2,2-5,1) y OR 2,4 (1,5-3,8), relajación en perfusión OR 2,4 (1,4-3,9) y OR 1,8 (1,1-3,1), Flexi-Seal ® convencional OR 2,7 (1,7-4,1) y OR 2 (1,2-3,3), respectivamente. Factores de riesgo de fuga: color-aspecto, decúbito supino, menor PMI y PEEP. CONCLUSIONES: Monitorizar la PGR puede alertar sobre la aparición de fuga y necesidad de recolocación. Conocer los factores asociados a la PGR, fuga y recolocación permitirá desarrollar estrategias para descender su elevada incidencia, como puede ser la disminución de la PGR reduciendo el volumen de hinchado

OBJECTIVE: To describe the general characteristics of the patient and device use. To know retention balloon pressure (RBP) and related factors. To identify rate of leakage incidence, relocation and perineal damage due to the device (PSD) and related risk factors. MATERIAL AND METHODS: An analytical observational, cross-sectional study conducted in a polyvalent ICU from June-December 2010 was performed. The sample included Flexi-Seal ® carriers. Variables evaluated were patient and device use characteristics, RBP, leakage and quantity, relocation and reason, PSD, sedoanalgesia infusion, neuromuscular block, patient position, Flexi-Seal type catheter, ventilatory mode (VM), intra-abdominal pressure (IAP), mean intrathoracic pressure (MITP), PEEP, Glasgow, color-aspect, fecal consistency and volume. Significance P < .05. RESULTS: Twenty-one patients were included, 52% male, aged 54 ± 17 with 30 insertion episodes, Flexi-Seal-Signal ® 33%, 10 ± 8 days permanency, main indication 33% «diarrhea and injured skin»," 30% device removal «intolerance and/or spontaneous expulsion». Median (Me) PGR = 40; RI (61-19) cmH2O. Factors associated to higher PGR: SCI absence, prone-decubitus position, leakage, relocation, conventional Flexi-Seal ®, MV, lower PEEP and IMP, Color-aspect, higher MITP. Leakage, relocation and PSD incidence density 43, 30 and 2 cases/100 days of catheter, respectively. Leakage and relocation risk factors: higher PGR, Glasgow and fecal volume, lower MITP, MV, assisted-spontaneous mode OR 2.5 CI (1.6-3.8) and OR 1.7(1.1-2.7), absence SCI OR 3.3 (2.2-5.1) and OR 2.4 (1.5-3.8), absence neuromuscular block OR 2.4 (1.4-3.9) and OR 1.8 (1.1-3.1), Flexi-Seal® conventional OR 2.7(1.7-4.1) and OR 2 (1.2-3.3), respectively. Leakage risk factors: color-aspect, supine position, lower IMP and PEEP. CONCLUSIONS: Monitoring RBP may alert us about leakage presence and relocation need. Knowing associated risk factors to RBP, leakage and relocation would help to develop strategies to reduce their high incidence rate such as decreasing RBP by reducing inflated volume

Revisión de conocimientos sobre alteraciones del ritmo intestinal y de eliminación fecal en el paciente crítico / Review of the knowledge on gastrointestinal motility disorders and stool elimination in the critical patient

Incorpora un sistema anual de autoevaluación y acreditación dentro de un Programa de Formación Continuada sobre la revisión de conocimientos para la atención de enfermería al paciente adulto en estado crítico. Uno de los objetivos de ENFERMERÍA INTENSIVA es que sirva como instrumento educativo y formativo en esta área y estimule el estudio continuado. Las personas interesadas en acceder a la obtención de los créditos de Formación Continuada, que a través de la SEEIUC otorga la Comisión Nacional de Formación Continuada, deberán remitir cumplimentada la hoja de respuestas adjunta (no se admiten fotocopias), dentro de los 2 meses siguientes a la aparición de cada número, a la Secretaría de la SEEIUC. Vicente Caballero, 17. 28007 Madrid (AU)

From fecal impaction to colon perforation.

The authors present the case of an elderly, nonverbal nursing home resident with dementia who developed fecal impaction, despite interventions such as enema. Subsequent stercoral perforation of the sigmoid colon resulted in peritonitis, sepsis, and death. The authors discuss colon perforation as a result of fecal impaction, as well as the difficulties of pain assessment and communication in patients with dementia.

Digital removal of faeces by acute sector nurses.

Gaye Kyle argues that nurses in the acute sector need education about the procedure for the manual removal of faeces.

A procedure for the digital removal of faeces.

This article describes the development of an evidence-based procedure for the digital removal of faeces (DRF) and the problems and barriers encountered--not least the absence of primary evidence. The procedure for DRF that evolved is based on the best evidence available. It sets out the criteria for performing DRF and directs the practitioner's actions, while still being adaptable to the individual patient's situation. It should help to ensure that nurses performing DRF do so within the remit of their professional and legal responsibilities, and that patients receive the most effective care grounded in the current state of knowledge.

Fecal impaction: a review.

TOPIC: Fecal impaction, a review of the literature. PURPOSE: To review the definition, diagnosis, causes, signs and symptoms, and treatment of fecal impaction. SOURCES: Published literature. CONCLUSIONS: While a great deal has been published on fecal impaction, there is limited research. Clarification of when constipation changes to impaction is ambiguous. Causes of fecal impaction are multiple, and people can be affected at all ages. Signs and symptoms of and problems associated with fecal impaction are varied. Research-based treatment of fecal impaction is very limited, and nonresearch based treatment varies. There is a need for additional research to clarify terminology, diagnosis, and interventions.