(646) 355-8777

Herman & Wallace Blog

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.

Neutral Language in Patient Care
H&W faculty talks BBGOSO

Upcoming Continuing Education Courses

Pelvic Floor Level 1 - Chicago, IL (Rescheduled)

Apr 3, 2020 - Apr 5, 2020
Location: Cancer Treatment Centers of America - Chicago, IL

Male Pelvic Floor - St. Paul, MN (Rescheduled)

Apr 3, 2020 - Apr 5, 2020
Location: Regions Hospital

Pelvic Floor Level 1 - Boston, MA (Rescheduled)

Apr 3, 2020 - Apr 5, 2020
Location: Marathon Physical Therapy

Chronic Pelvic Pain - Kansas City, MO (Rescheduled)

Apr 3, 2020 - Apr 5, 2020
Location: Saint Luke\'s Health System

Pudendal Neuralgia and Nerve Entrapment - Philadelphia, PA (Rescheduled)

Apr 4, 2020 - Apr 5, 2020
Location: Core 3 Physical Therapy

Pelvic Floor Level 2B - Freehold, NJ (Rescheduled)

Apr 4, 2020 - Apr 6, 2020
Location: CentraState Medical Center

Sexual Interviewing for Pelvic Health Therapists - Seattle, WA (Rescheduled)

Apr 4, 2020 - Apr 5, 2020
Location: Evergreen Hospital Medical Center

Pelvic Floor Level 2A - Grand Rapids, MI (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Mary Free Bed Rehabilitation Hospital

Pelvic Floor Level 1- Kansas City, MO (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Centerpoint Medical Center

Oncology of the Pelvic Floor Level 1 - Grand Junction, CO (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Urological Associates of Western Colorado

Mobilization of Visceral Fascia: The Gastrointestinal System - Arlington, VA (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Virginia Hospital Center

Pelvic Floor Level 2B - East Greenwich, RI (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: New England Institute of Technology

Pilates for the Pelvic Floor - Livingston, NJ (Rescheduled)

Apr 18, 2020 - Apr 19, 2020
Location: Ambulatory Care Center- RWJ Barnabas Health

Genital Lymphedema

Apr 24, 2020

Pelvic Floor Level 1- Canton, OH (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Aultman Hospital

Pelvic Floor Level 1 - Rochester, NY (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Unity Health System

Pediatric Functional Gastrointestinal Disorders - Ann Arbor, MI (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Michigan Medicine

Lumbar Nerve Manual Assessment and Treatment - Madison, WI (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: University of Wisconsin Hospital

Pelvic Floor Level 2A - Winfield, IL (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Northwestern Medicine

Low Pressure Fitness for Pelvic Floor Care - Trenton, NJ (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Robert Wood Johnson Medical Associates

Athletes & Pelvic Rehabilitation - Minneapolis, MN (Rescheduled)

Apr 25, 2020 - Apr 26, 2020
Location: Viverant

Sacral Nerve Manual Assessment and Treatment - Fairlawn, NJ

May 1, 2020 - May 3, 2020
Location: Bella Physical Therapy

Pelvic Floor Level 1 - Fayetteville, AR

May 1, 2020 - May 3, 2020
Location: Washington Regional Medical Center

Pelvic Floor Level 1 - Boise, ID

May 1, 2020 - May 3, 2020
Location: St Luke's Rehab Hospital

Pediatric Incontinence - Duluth, MN

May 1, 2020 - May 3, 2020
Location: Polinsky Medical Rehabilitation Center

Yoga for Pelvic Pain - Online Course

May 2, 2020 - May 3, 2020