Identifying the prevalence and associated factors of fecal incontinence in the acute care setting

Fecal incontinence defined as the involuntary loss of gas or stool, is associated with skin breakdown, patient embarrassment and increased health care costs. The prevalence of this silent epidemic is unknown. The aim of this study was to determine the prevalence and associated factors of fecal incontinence in acutely ill adult hospitalized patients. Two cross sectional point- prevalence studies were conducted across seven hospitals in a Midwestern metropolitan area. A data collection tool was developed and used by trained data collectors to obtain demographic information, the presence of fecal incontinence, and associated factors. Demographic data included gender, age and unit type. Data gathered in relation to associated factors included medication, neurological disease, gut motility, diet, clostridium difficile infection and anal dysfunction. Twenty percent (221) of the 1083 patients were affected by fecal incontinence. Nearly half (49.3%) of the fecal incontinence was medication related, with 40.3% disease related. Additional associated factors included gut motility (30.3%), diet (18.1%), clostridium difficile infection (11.3%) and anal dysfunction (5.9%). Using logistic regression analysis, significant predictors for fecal incontinence were unit type and age. Gender differences were not noted. In addition to adding to the knowledge base regarding fecal incontinence in the acute care setting, this study provided a framework for collaborative research efforts between many members of a local Wound, Ostomy & Continence Nurses Society Affiliate across several hospital systems. The results demonstrate that fecal incontinence is a significant problem for hospitalized adult patients. An improved awareness of the prevalence and predominant factors associated with fecal incontinence can guide hospitals in developing programs to identify and manage these patients. Efforts to improve continence should be explored, in order to maintain the patient’s skin integrity and dignity.