Fecal incontinence: Skin protection

According to a research review by senior staff nurse Julie Patrick-Heselton, fecal incontinence in critical illness “…is distressing, unpleasant and frequently socially disruptive to patients.” Because patients who require intensive care often have diarrhea, skin care and avoidance of infection are important for patient health. If bowel care is not made a priority, patients can additionally suffer from abdominal bloating, vomiting, dehydration, urinary issues, and bowel obstruction and perforation according to the article. Skin that is exposed to excess moisture from urine or stool becomes more fragile and at risk for breakdown. If a pressure ulcer occurs due to skin breakdown, infection becomes a major health risk.

If you are working with patients who are at risk for skin breakdown due to urinary or fecal incontinence, it is important to provide education about skin protection including barrier creams. These topics are discussed in the Herman & Wallace course series, and handouts are available in the Urinary Incontinence and the Prolapse and Colorectal Care Manuals. This study refers to Cavilon Durable Barrier Cream, and describes its use with incontinence pads for maximizing protection. For most patients, anything that contains zinc oxide or other water-repelling substance can assist in keeping the skin less moist and therefore less susceptible to breakdown.

Another resource described in this article is the Flexi-Seal FMS (Fecal Management System). It is a device that uses a tube to divert loose or liquid stool into a bag so that skin is protected. Although this is not something that most patients in outpatient rehab would utilize, I can think of a few patients who may have been able to use such a device during periods of diarrhea and skin irritation. (One patient I recall had to periodically go through a medical procedure and take antibiotics, which always increased her fecal incontinence for several weeks. One strategy we also implemented was having her talk to a pharmacist about changing the form of antibiotic that she used from a broad spectrum to a narrow spectrum antibiotic, which was very helpful.)

While fecal incontinence may resolve in patients following a bout of critical care at hospital, I have worked with several patients who suffer from long-term diarrhea or from chronic infection of C. difficile. Diarrhea is not normal, and patients must be sure to be evaluated medically to reveal the cause of the issue. Many patients we meet in the clinic have been suffering from bowel issues for years, some for decades. Patients can routinely be screened by all providers (pelvic rehab providers or not) for bowel and bladder issues so that appropriate referral can be provided. Protecting perianal skin as well as reducing the psychosocial impact of fecal leakage is a goal that we can all work towards for the sake of our patients.