A Controlled Trial of an Intervention to Improve Urinary and Fecal Incontinence and Constipation

作者：Schnelle John F^*; Leung Felix W; Rao Satish S C; Beuscher Linda; Keeler Emmett; Clift Jack W; Simmons Sandra

来源：Journal of the American Geriatrics Society, 2010, 58(8): 1504-1511.

DOI：10.1111/j.1532-5415.2010.02978.x

• urinary incontinence
• fecal incontinence
• constipation

OBJECTIVES
To evaluate effects of a multicomponent intervention on fecal incontinence (FI) and urinary incontinence (UI) outcomes.
DESIGN
Randomized controlled trial.
SETTING
Six nursing homes (NHs).
PARTICIPANTS
One hundred twelve NH residents.
INTERVENTION
Intervention subjects were offered toileting assistance, exercise, and choice of food and fluid snacks every 2 hours for 8 hours per day over 3 months.
MEASUREMENTS
Frequency of UI and FI and rate of appropriate toileting as determined by direct checks from research staff. Anorectal assessments were completed on a subset of 29 residents.
RESULTS
The intervention significantly increased physical activity, frequency of toileting, and food and fluid intake. UI improved (P=.049), as did frequency of bowel movements (P <.001) and percentage of bowel movements (P <.001) in the toilet. The frequency of FI did not change. Eighty-nine percent of subjects who underwent anorectal testing showed a dyssynergic voiding pattern, which could explain the lack of efficacy of this intervention program alone on FI.
CONCLUSION
This multicomponent intervention significantly changed multiple risk factors associated with FI and increased bowel movements without decreasing FI. The dyssynergic voiding pattern and rectal hyposensitivity suggest that future interventions may have to be supplemented with bulking agents (fiber), biofeedback therapy, or both to improve bowel function.

• 出版日期2010-8