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CONDITION/DISORDER SYNONYM

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  • Fecal incontinence (FI)

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ICD-9-CM CODES

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  • 315.4 Coordination disorder (clumsiness, dyspraxia and/or specific motor development disorder)

  • 718.45 Contracture of joint, pelvic region and thigh

  • 719.70 Difficulty in walking

  • 728.2 Muscular wasting and disuse atrophy

  • 728.89 Other disorders of muscle, ligament, and fascia

  • 729.9 Other disorders of soft tissue

  • 780.7 Malaise and fatigue

  • 781.2 Abnormality of gait: Ataxic, paralytic, spastic, staggering

  • 782.3 Edema

  • 786.0 Dyspnea and respiratory abnormalities

  • 786.05 Shortness of breath

  • 787.6 Incontinence of feces

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ICD-10-CM CODE

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  • R15.9 Full incontinence of feces

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PREFERRED PRACTICE PATTERN

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As of July, 2014, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ systems pathology; therefore, the associated or secondary musculoskeletal, cardio­vascular/pulmonary, or potential neuromuscular patterns would be indicated.

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PATIENT PRESENTATION

A 75-year-old male is referred to home health for PT after a 23-hour-observation hospital stay for dehydration and cachexia. He received IV fluids and was discharged home; a friend had brought him to the hospital and took him home. The patient is referred for functional decline and muscle atrophy. His history reveals that over the past 6 months he went out less and less, as he had “occasional accidents” soiling himself and was getting increasingly depressed. He describes little or no appetite, but likes to drink tea. Initial exam reveals limited endurance, fatiguing after 10 minutes of continuous low-level activity, muscle wasting in both of the lower extremities, and difficulty rising from a standard height chair. Throughout the 45 minutes, he is almost continuously expelling gas, and there is a distinct odor of feces.

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FIGURE 31-1

Anal endosonography. A. A woman with normal anal sphincters. B. Anterior defects of the external and internal anal sphincter muscles. EAS, external anal sphincter; IAS, internal anal sphincter. Dashed lines and arrows in B illustrate the ends of the torn EAS. (From Hoffman BL, Schorge J, Schaffer J, Halvorson L, Bradshaw K, Cunningham F. Williams Gynecology. 2nd ed. New York, NY: McGraw-Hill; 2012.)

Graphic Jump Location
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KEY FEATURES

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Description
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  • Loss of bowel control, complete or occasional.

  • There is a broad array of gastrointestinal (GI) disorders that may be encountered, though not managed specifically, by physical therapists.

  • Patients with GI pathology may receive care as a result of secondary problems such as weakness, gait abnormalities, and limited aerobic endurance.

  • Symptoms may be acute, postoperative, chronic, viral, bacterially related, or congenital/hereditary.

  • Complaints often include changes in bowel habits: Constipation, diarrhea, bowel urgency, incontinence, and cramping.

  • Pain is frequently referred to the low back.

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Essentials of Diagnosis
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  • Must be made by a physician and confirmed by medical diagnostic testing

  • Complaints of

    • Abdominal pain: Constant or intermittent

    • Abdominal tenderness

    • Nausea

    • Vomiting

    • Diarrhea or ...

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