Bowel incontinence

• Fecal incontinence (FI)
• Faecal incontinence

• 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
• 782.3 Edema
• 786.0 Dyspnea and respiratory abnormalities
• 786.05 Shortness of breath
• 787.6 Incontinence of feces

• R15.9 Full incontinence of feces

• As of February 2013, 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

Description

• Loss of bowel control, complete or occasional
• There is a broad array of 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, post-operative, 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

Essentials of Diagnosis

• 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 constipation; changes in bowel habits
  • Bloating
  • Possible rectal bleeding
  • Rectal/anal irritation
  • Acute drops in blood pressure which may result in decreased blood flow to intestines
  • Inability to swallow
  • Lack of appetite
  • Unexplained weight loss
  • Abdominal pain upon ingesting food
  • Possible joint pains
  • Dark stool or bright red blood in stool
  • Malaise/fatigue
• Description by individual
  • Recent illness (bacterial, viral)
  • Ingestion of spoiled food

General Considerations

• PTs should recognize the possibility of GI pathology in differential diagnosis, especially when findings are not consistent with conditions commonly treated: musculoskeletal, neuromuscular, integumentary, cardiopulmonary, functional and mobility dysfunction secondary to medical pathology
• As GI symptoms are frequently referred to the back and shoulders, patients may be inappropriately referred to PT
• Diagnosis for more occult problems may take time and require intensive medical diagnostic testing
• GI disorders occur throughout the lifespan (birth through geriatric)
• May result in secondary problems indicating the need for physical therapy intervention: impairment of aerobic capacity and muscle endurance, sarcopenia, weakness, impaired muscle performance, musculoskeletal problems, neuromuscular problems, weight loss or weight gain
• Symptoms may include chronic diarrhea, episodic diarrhea, loss of bowel control (incontinence or urgency), blood in stool
• Because GI disorders frequently refer pain to other body areas, individuals may be referred to PT inappropriately
• GI problems may be commonly related to stress, constipation, more serious problems such as autoimmune conditions (Crohn’s disease), or acute pain from appendicitis
• In adults females, GI complaints may be indicative of cancer or tumors in the reproductive organs, or ...