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Faecal incontinence in older people

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  17 September 2009

Danielle Harari
Danielle Harari*
Affiliation:
Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, Kings College London
*
Address for correspondence: Dr Danielle Harari, Consultant Physician in Elderly Medicine, Department of Ageing and Health, 9th Floor, North Wing, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH. Email: [email protected]
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Summary

Faecal incontinence in older people is a distressing and socially isolating symptom and increases the risk of morbidity, mortality and dependency. Many older individuals with faecal incontinence will not volunteer the problem to their general practitioner or nurse and, regrettably, health care providers do not routinely enquire about the symptom. Even when older people are noted by health care professionals to have faecal incontinence, the condition is often managed passively, especially in the long-term care setting where it is most prevalent. The importance of identifying treatable causes of faecal incontinence in older people, rather than just managing passively, is strongly emphasized in national and international guidance, but audit shows that adherence to such guidance is generally poor. This article describes epidemiology, causes, assessment, diagnosis and treatment of faecal incontinence in older people.

Keywords

Faecal incontinenceconstipationolder people
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 19 , Issue 2 , May 2009 , pp. 87 - 101
Copyright
Copyright © Cambridge University Press 2009

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References

1Nelson, R, Norton, N, Cautley, E, Furner, S. Community-based prevalence of anal incontinence. JAMA 1995; 274: 559–61.CrossRefGoogle ScholarPubMed
2Edwards, NI, Jones, D. The prevalence of faecal incontinence in older people living at home. Age Ageing 2001; 30: 503–7.Google Scholar
3Nakanishi, N, Tatara, K, Shinsho, F, Murakami, S, Takatorige, T, Fukuda, H et al. Mortality in relation to urinary and faecal incontinence in elderly people living at home. Age Ageing 1999; 28: 301–6.CrossRefGoogle ScholarPubMed
4Chassagne, P, Landrin, I, Neveu, C, Czernichow, P, Bouaniche, M, Doucet, J et al. Fecal incontinence in the institutionalized elderly: incidence, risk factors, and prognosis. Am J Med 1999; 106: 185–90.CrossRefGoogle ScholarPubMed
5Finne-Soveri, H, Sorbye, LW, Jonsson, PV, Carpenter, GI, Bernabei, R. Increased work-load associated with faecal incontinence among home care patients in 11 European countries. Eur J Public Health 2008; 18: 323–8.CrossRefGoogle ScholarPubMed
6Landefeld, CS, Bowers, BJ, Feld, AD. National Institutes of Health State-of-the-Science Statement: Prevention of faecal and urinary incontinence in adults. Ann Intern Med 2008; 148: 449–58.CrossRefGoogle ScholarPubMed
7Department of Health. Good practice in continence services. Report No.: PL/CMO/2000/2. London: NHS Executive; 2000.Google Scholar
8Thekkinkattil, DK, Lim, M, Finan, PJ, Sagar, PM, Burke, D. Awareness of investigations and treatment of faecal incontinence among general practitioners: a postal questionnaire survey. Colorectal Dis 2008; 10: 267.CrossRefGoogle ScholarPubMed
9Norton, C, Whitehead, WE, Bliss, DZ, Metsola, P, Tries, J. Conservative and pharmacological management of faecal incontinence in adults. In: Abrams, P, Cardozo, L, Khoury, S, Wein, A (eds), Incontinence. Plymouth, Health Publications; 2005. pp. 1521–63.Google Scholar
10Norton, C, Thomas, L, Hill, J. Management of faecal incontinence in adults: summary of NICE guidance. BMJ 2007; 334: 1370–1.CrossRefGoogle ScholarPubMed
11Potter, J, Peel, P, Mian, S, Lowe, D, Irwin, P, Pearson, M et al. National audit of continence care for older people: management of faecal incontinence. Age Ageing 2007; 36: 268–73.CrossRefGoogle Scholar
12Coffey, A, McCarthy, G, McCormack, B, Wright, J, Slater, P. Incontinence: assessment, diagnosis and management in two rehabilitation units for older people. Worldviews Evid Based Nursing 2007; 4: 179–86.Google Scholar
13Pretlove, SJ, Radley, S, Toozs-Hobson, P, Thompson, P, Coomarasamy, A, Khan, KS. Prevalence of anal incontinence according to age and gender: a systematic review and meta-regression analysis. Int Urogynecol J 2006; 17: 407–17.CrossRefGoogle Scholar
14Perry, S, Shaw, C, McGrother, C, Matthews, RJ, Assassa, RP, Dallosso, H et al. Prevalence of faecal incontinence in adults aged 40 years or more living in the community. Gut 2002; 50: 480–4.Google Scholar
15Bharucha, AE, Zinsmeister, AR, Locke, GR, Seide, BM, McKeon, K, Schleck, CD et al. Prevalence and burden of fecal incontinence: a population-based study in women. Gastroenterology 2005; 129: 42–9.CrossRefGoogle ScholarPubMed
16Roberts, RO, Jacobsen, SJ, Reilly, WT, Pemberton, JH, Lieber, MM, Talley, NJ. Prevalence of combined fecal and urinary incontinence: a community-based study. J Am Geriatr Soc 1999; 47: 837–41.CrossRefGoogle ScholarPubMed
17Markland, AD, Goode, PS, Burgio, KL, Redden, DT, Richter, HE, Sawyer, P et al. Correlates of urinary, fecal, and dual incontinence in older African-American and white men and women. J Am Geriatr Soc 2008; 56: 285–90.CrossRefGoogle ScholarPubMed
18Bliss, DZ, Fischer, LR, Savik, K, Avery, M, Mark, P. Severity of fecal incontinence in community-living elderly in a health maintenance organization. Res Nurs Health 2004; 27: 162–73.CrossRefGoogle Scholar
19Melville, JL, Fan, MY, Newton, K, Fenner, D. Fecal incontinence in US women: a population-based study. Am J Obstet Gynecol 2005; 193: 2071–6.Google Scholar
20Schultz, A, Dickey, G, Skoner, M. Self-report of incontinence in acute care. Urologic Nurs 1997; 17: 23–8.Google ScholarPubMed
21Bliss, DZ, Johnson, S, Savik, K, Clabots, CR, Gerding, DN. Fecal incontinence in hospitalized patients who are acutely ill. Nurs Res 2000; 49: 101–8.CrossRefGoogle ScholarPubMed
22Akpan, A, Gosney, MA, Barrett, JA. Factors contributing to fecal incontinence in older people and outcome of routine management in home, hospital and nursing home settings. Clin Interv Aging 2007; 2: 139–45.Google Scholar
23Peet, SM, Castleden, CM, McGrother, CW. Prevalence of urinary and faecal incontinence in hospitals and residential and nursing homes for older people. BMJ 1995; 311: 1063–4.CrossRefGoogle ScholarPubMed
24Brocklehurst, JC, Dickinson, E, Windsor, J. Laxatives and faecal incontinence in long term care. Nurs Stand 1999; 13: 32–6.Google Scholar
25Tobin, GW, Brocklehurst, JC. Faecal incontinence in residential homes for the elderly: prevalence, aetiology and management. Age Ageing 1986; 15: 41–6.Google Scholar
26Prosser, S, Dobbs, F. Case-finding incontinence in the over-75s. Br J Gen Pract 1997; 47: 498–500.Google ScholarPubMed
27Kalantar, JS, Howell, S, Talley, NJ. Prevalence of faecal incontinence and associated risk factors; an underdiagnosed problem in the Australian community? Med J Aust 2002; 176: 54–7.CrossRefGoogle ScholarPubMed
28Stenzelius, K, Westergren, A, Hallberg, IR. Bowel function among people 75+ reporting faecal incontinence in relation to help seeking, dependency and quality of life. J Clin Nurs 2007; 16: 458–68.CrossRefGoogle ScholarPubMed
29Harari, D, Gurwitz, JH, Avorn, J, Choodnovskiy, I, Minaker, KL. Constipation: assessment and management in an institutionalised elderly population. J Am Geriatr Soc 1994; 42: 947–52.CrossRefGoogle Scholar
30Rodriguez, NA, Sackley, CM, Badger, FJ. Exploring the facets of continence care: a continence survey of care homes for older people in Birmingham. J Clin Nurs 2007; 16: 954–62.CrossRefGoogle Scholar
31McHugh, S, Diamant, NE. Effect of age, gender and parity on anal canal pressures. Digest Dis Sci 1987; 32: 726–36.CrossRefGoogle ScholarPubMed
32Matheson, DM, Keighley, MRB. Manometric evaluation of rectal prolapse and faecal incontinence. Gut 1981; 22: 126–9.Google Scholar
33Loening-Baucke, V, Anuras, S. Effects of age and sex on anorectal manometry. Am J Gastroenterol 1985; 80: 50–3.Google ScholarPubMed
34Ryhammer, AM, Laurberg, S, Bek, KM. Age and anorectal sensibility in normal women. Scand J Gastroenterol 1997; 32: 278–84.CrossRefGoogle ScholarPubMed
35Loening-Baucke, V, Anuras, S. Sigmoidal and rectal motility in healthy elderly. J Am Geriatr Soc 1984; 32: 887–91.Google Scholar
36Vaccaro, CA, Cheong, DM, Wexner, SD, Nogueras, JJ, Salanga, VD, Hanson, MR, Phillips, RC. Pudendal neuropathy in evacuatory disorders. Dis Colon Rectum 1995; 38: 166–71.CrossRefGoogle ScholarPubMed
37Wang, JY, Patterson, TR, Hart, SL, Varma, KG. Fecal incontinence: Does age matter? Characteristics of older vs. younger women presenting for treatment of fecal incontinence. Dis Colon Rectum 2008; 51: 426–31.CrossRefGoogle ScholarPubMed
38Read, NW, Abouzekry, L, Read, M, Howell, P, Ottewell, D, Donnelly, TC. Anorectal function in elderly patients with faecal impaction. Gastroenterol 1985; 89: 959–66.Google Scholar
39Kinnunen, O. Study of constipation in a geriatric hospital, day hospital, old people's home and at home. Aging 1991; 3: 161–70.Google Scholar
40Monane, M, Avorn, J, Beers, MH, Everitt, DE. Anticholinergic drug use and bowel function in nursing home patients. Arch Intern Med 1993; 153: 633–8.Google Scholar
41Phillips, C, Polakoff, D, Maue, SK, Mauch, R. Assessment of constipation management in long-term care patients. J Am Med Dir Assoc 2001; 2: 149–54.CrossRefGoogle ScholarPubMed
42Robson, KM, Kiely, DK, Lembo, T. Development of constipation in nursing home residents. Dis Colon Rectum 2000; 43: 940–3.CrossRefGoogle ScholarPubMed
43Stewart, RB, Moore, MT, Stat, M, Marks, RG, Hale, WE. Correlates of constipation in an ambulatory elderly population. Am J Gastroenterol 1992; 87: 859–64.Google Scholar
44Whitehead, WE, Drinkwater, D, Cheskin, LJ, Heller, BR, Schuster, MM. Constipation in the elderly living at home. J Am Geriatr Soc 1989; 37: 423–9.CrossRefGoogle ScholarPubMed
45Harari, D, Gurwitz, JH, Avorn, J, Choodnovskiy, I, Minaker, KL. Correlates of regular laxative use by frail elderly persons. Am J Med 1995; 99: 513–8.Google Scholar
46Brock, C, Curry, H, Hanna, C, Knipfer, M, Taylor, L. Adverse effects of iron supplementation: A comparative trial of a wax-matrix iron preparation and conventional ferrous sulfate tablets. Clin Ther 1985; 7: 568–73.Google Scholar
47Traube, M, McCallum, RW, Members of American College of Gastroenterolgy's Committee on FDA Related Matters. Calcium-channel blockers and the gastrointestinal tract. Am J Gastroenterol 1984; 79: 892–6.Google Scholar
48Talley, NJ, Fleming, KC, Evans, JM. Constipation in an elderly community: A study of prevalence and potential risk factors. Am J Gastroenterol 1996; 91: 19–25.Google Scholar
49Jones, RH, Tait, CL. Gastrointestinal side-effects of NSAIDs in the community. Br J Clin Pract 1995; 49: 67–70.Google Scholar
50Donald, IP, Smith, RG, Cruikshank, JG, Elton, RA, Stoddart, ME. A study of constipation in the elderly living at home. Gerontology 1985; 31: 112–8.CrossRefGoogle ScholarPubMed
51Edwards, LL, Quigley, EM, Pfeiffer, RF. Gastrointestinal dysfunction in Parkinson's disease: frequency and pathophysiology. Neurology 1992; 42: 726–32.Google Scholar
52Ron, Y, Leibovitz, A, Monastirski, N, Habot, B, Segal, R. Colonic transit time in diabetic and nondiabetic long-term care patients. Gerontology 2002; 48: 250–3.CrossRefGoogle ScholarPubMed
53Camilleri, M. Gastrointestinal problems in diabetes. Endocrinol Metab Clin North Am 1996; 25: 361–78.Google Scholar
54Towers, AL, Burgio, KL, Locher, JL. Constipation in the elderly: influence of dietary, psychological and physiological factors. J Am Geriatr Soc 1994; 42: 701–6.Google Scholar
55Muller-Lissner, SA. Effects of wheat bran on weight of stool and gastrointestinal transit time: a meta analysis. BMJ 1988; 296: 615–7.Google Scholar
56Barrett, JA, Brocklehurst, JC, Kiff, ES, Ferguson, G, Faragher, EB. Anal function in geriatric patients with faecal incontinence. Gut 1989; 30: 1244–51.CrossRefGoogle ScholarPubMed
57Garvey, M, Noyes, RJ, Yates, W. Frequency of constipation in major depression; Relationship to other clinical variables. Psychosomatics 1990; 31: 204–6.Google Scholar
58Nakanishi, N, Tatara, K, Naramura, H, Fujiwara, H, Takashima, Y, Fukunda, H. Urinary and faecal incontinence in a community-residing older population in Japan. J Am Geriatr Soc 1997; 45: 215–9.Google Scholar
59Johanson, JF, Irizarry, F, Doughty, A. Risk factors for fecal incontinence in a nursing home population. J Clin Gastroenterol 1997; 24: 156–60.Google Scholar
60Chassagne, P, Landrin, I, Neveu, C, Czernichow, P, Bouaniche, M, Doucet, J et al. Fecal incontinence in the institutionalized elderly: incidence, risk factors, and prognosis. Am J Med 1999; 106: 185–90.CrossRefGoogle ScholarPubMed
61Harari, D, Coshall, C, Rudd, AG, Wolfe, CD. New-onset fecal incontinence after stroke: prevalence, natural history, risk factors, and impact. Stroke 2003; 34: 144–50.CrossRefGoogle Scholar
62Nakayama, H, Jorgensen, HS, Pedersen, PM, Raaschou, HO, Olsen, TS. Prevalence and risk factors of incontinence after stroke: The Copenhagen Stroke Study. Stroke 1997; 28: 58–62.Google Scholar
63Brittain, KR, Perry, S, Shaw, C, Matthews, R, Jagger, C, Potter, J. Isolated urinary, fecal and double incontinence: Prevalence and degree of soiling in stroke survivors. J Am Geriatr Soc 2006; 54: 1915–9.CrossRefGoogle ScholarPubMed
64Brocklehurst, JC, Andrews, K, Richards, B, Laycock, PJ. Incidence and correlates of incontinence in stroke patients. J Am Geriatr Soc 1985; 33: 540–2.Google Scholar
65Baztan, JJ, Domenech, JR, Gonzalez, M. New-onset fecal incontinence after stroke: risk factor or consequence of poor outcomes after rehabilitation? Stroke 2003; 34: 101–2.CrossRefGoogle ScholarPubMed
66Ostbye, T, Seim, A, Krause, KM, Feightner, J, Hachinski, V, Sykes, E et al. A 10-year follow-up of urinary and fecal incontinence among the oldest old in the community: the Canadian Study of Health and Aging. Can J Aging 2004; 23: 319–31.Google Scholar
67Sun, W, Katsinelos, P, Horowitz, M, Read, NW. Disturbances in anorectal function in patients with diabetes mellitus and faecal incontinence. Eur J Gastroenterol Hepatol 1996; 8: 1007–12.CrossRefGoogle ScholarPubMed
68Russo, A, Botten, R, Kong, MF. Effects of acute hyperglycaemia on anorectal motor and sensory function in diabetes mellitus. Diabet Med 2004; 21: 176–82.CrossRefGoogle ScholarPubMed
69Rasmussen, OO, Christiansen, J, Tetzschner, T, Sorensen, M. Pudendal nerve function in idiopathic fecal incontinence. Dis Colon Rectum 2000; 43: 633–6.CrossRefGoogle ScholarPubMed
70Barrett, JA, Brocklehurst, JC, Kiff, ES, Ferguson, G, Faragher, EB. Rectal motility studies in geriatric patients with faecal incontinence. Age Ageing 1990; 19: 311–7.Google Scholar
71Nygaard, IE, Rao, SS, Dawson, JD. Anal incontinence after anal sphincter disruption: a 30-year retrospective cohort study. Obstet Gynecol 1997; 89: 896–901.CrossRefGoogle ScholarPubMed
72Ng, SC, Chen, YC, Lon, LY, Chen, GD. Anorectal dysfunction in women with urinary incontinence or lower urinary tract symptoms. Int J Gynaecol Obstet 2002; 77: 139–45.Google Scholar
73Meschia, A, Buonaguidi, A, Pifarotti, P, Somigliana, E, Amicarelli, F. Prevalence of anal incontinence in women with symptoms of urinary incontinence and genital prolapse. Obstet Gynecol 2002; 100: 719–23.Google Scholar
74Goulding, A, Taylor, RW, Keil, D, Gold, E, Lewis-Barned, NJ, Williams, SJ. Lactose malabsorption and rate of bone loss in older women. Age Ageing 1999; 28: 175–80.CrossRefGoogle ScholarPubMed
75Al-Eidan, FA, McElnay, JC, Scott, MG, Kearney, MP. Clostridium difficile-associated diarrhoea in hospitalised patients. J Clin Pharm Ther 2000; 25: 101–9.Google Scholar
76Tal, S, Guverich, A, Guller, V. Risk factors for recurrence of Clostridium difficile-associated diarrhea in the elderly. Scand J Infect Dis 2002; 34: 594–7.CrossRefGoogle ScholarPubMed
77Sonnenberg, A, Muller, AD. Constipation and cathartics as risk factors of colorectal cancer: A meta-analysis. Pharmacology 1993; 47 (suppl 1): 224–33.Google Scholar
78Kim, T, Chae, G, Chung, SS, Sands, DR, Speranza, JR, Weiss, EG et al. Fecal incontinence in male patients. Colorect Dis 2008; 10: 124–30.CrossRefGoogle ScholarPubMed
79Morgan, R, Spencer, B, King, D. Rectal examinations in elderly subjects: attitudes of patinets and doctors. Age Ageing 1998; 27: 353–6.CrossRefGoogle Scholar
80Osterberg, A, Graf, W, Karlbom, U, Pahlman, L. Evaluation of a questionnaire in the assessment of patients with faecal incontinence and constipation. Scand J Gastroenterol 1996; 31: 575–80.CrossRefGoogle ScholarPubMed
81O'Keefe, EA, Talley, NJ, Tangalos, EG, Zinsmeister, AR. A bowel symptom questionnaire for the elderly. J Gerontol 1992; 47: M116–121.Google Scholar
82Frank, L, Flynn, J, Rothman, M. Use of a self-report constipation questionnaire with older adults in long-term care. Gerontologist 2001; 41: 778–86.Google Scholar
83Engel, AF, Kamm, MA, Bartram, CI, Nicholls, RJ. Relationship of symptoms in faecal incontinence to specific sphincter abnormalities. Int J Colorect Dis 1995; 10: 152–5.CrossRefGoogle ScholarPubMed
84Longstreth, GF, Thompson, WG, Chey, WD, Houghton, LA, Mearin, F, Spiller, R. Functional bowel disorders. Gastroenterology 2006; 130: 1480–91.CrossRefGoogle ScholarPubMed
85Harari, D, Gurwitz, JH, Avorn, J, Bohn, R, Minaker, KL. How do older persons define constipation? Implications for therapeutic management. J Gen Int Med 1997; 12: 63–6.CrossRefGoogle ScholarPubMed
86Hallan, RI, Marzouk, DE, Waldron, DJ, Womack, NR, Williams, NS. Comparison of digital and manometric assessment of anal sphincter function. Br J Surg 1989; 76: 973–5.Google Scholar
87McKay, LF, Smith, RG, Eastwood, MA. An investigation of colonic function in the elderly. Age Ageing 1983; 12: 105–10.CrossRefGoogle ScholarPubMed
88Starrveld, JS, Pols, JS, Van Wijk, MA. The plain abdominal radiograph the assessment of constipation. Gastroenterol 1990; 28: 335–8.Google Scholar
89Majumdar, SR, Fletcher, RH, Evans, AT. How does colorectal cancer present? Symptoms, duration, and clues to location. Am J Gastroenterol 1999; 94: 3039–45.Google Scholar
90Pepin, C, Ladabaum, U. The yield of lower endoscopy in patients with constipation: survey of a university hospital, a public county hospital, and a Veterans Administration medical center. Gastrointest Endosc 2002; 56: 325–32.Google Scholar
91US Preventive Services Task Force. Agency for Healthcare Research and Quality. Screening for Colorectal Cancer. Rockville, MD: http://www.ahrq.gov/clinic/uspstf/uspscolo.htm; 2002.Google Scholar
92Ness, RM, Manam, R, Hoen, H, Chalasani, N. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol 2001; 96: 1797–802.CrossRefGoogle ScholarPubMed
93Nazarko, L. Commode design for frail and disabled people. Prof Nurs 1995; 11: 95–7.Google Scholar
94Baumgarten, M, Margolis, D, Gruber-Baldini, AL. Pressure ulcers and the transition to long-term care. Adv Skin Wound Care 2003; 16: 299–304.Google Scholar
95Jackson, SL, Weber, AM, Hull, TL, Mitchinson, AR, Walters, MD. Fecal incontinence in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol 1997; 89: 427.Google Scholar
96Byrne, CM, Pager, CK, Rex, J, Roberts, R, Solomon, MJ. Assessment of quality of life in the treatment of patients with neuropathic fecal incontinence. Dis Colon Rectum 2002; 45: 1431–6.CrossRefGoogle ScholarPubMed
97Harari, D, Norton, C, Lockwood, L, Swift, C. Treatment of constipation and faecal incontinence in stroke patients: randomised controlled trial. Stroke 2004; 35: 2549–55.Google Scholar
98Chassagne, P, Jego, A, Gloc, P, Capet, C, Trivalle, C, Doucet, J et al. Does treatment of constipation improve faecal incontinence in institutionalized elderly patients? Age Ageing 2000; 29: 159–64.Google Scholar
99Petticrew, M, Watt, I, Sheldon, T. Systematic review of the effectiveness of laxatives in the elderly. Health Technology Assessment 1997; 1 (13).Google Scholar
100Ramkumar, D, Rao, SS. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterol 2005; 100: 936–71.CrossRefGoogle ScholarPubMed
101Gallagher, PF, O'Mahoney, D, Quigley, EM. Management of chronic constipation in the elderly. Drugs Ageing 2008; 25: 807–21.CrossRefGoogle ScholarPubMed
102Puxty, JA, Fox, RA. Golytely: a new approach to faecal impaction in old age. Age Ageing 1986; 15: 182–4.Google Scholar
103Chen, CC, Su, MY, Tung, SY, Chang, FY, Wong, JM, Geraint, M. Evaluation of polyethylene glycol plus electrolytes in the treatment of severe constipation and faecal impaction in adults. Curr Med Res Opin 2005; 21: 1595–602.CrossRefGoogle ScholarPubMed
104Korzets, A, Dicker, D, Chaimoff, C, Zevin, D. Life-threatening hyperphosphatemia and hypocalcemic tetany following the use of Fleet enemas. J Am Geriatr Soc 1992; 40: 620–1107.Google Scholar
105Norton, C, Chelvanayagam, S, Wilson-Barnett, J, Redfern, S, Kamm, MA. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterol 2003; 125: 1320–9.Google Scholar
106Burgio, KL, Locher, JL, Goode, PS. Behavioural vs drug therapy for urinary urge incontinence in older women: a randomized controlled trial. J Am Geriatr Soc 2000; 48: 370–4.CrossRefGoogle Scholar
107Harari, D, Igbedioh, C. Restoring continence in frail older people living in the community: What factors influence successful treatment outcomes? Age Ageing 2009; 38: 228–33.Google Scholar
108Bates-Jensen, BM, Alessi, C, Al-Samarrai, NR, Schnelle, JF. The effects of an exercise and incontinence intervention on skin health outcomes in nursing home residents. J Am Geriatr Soc 2003; 51: 348–55.CrossRefGoogle ScholarPubMed
109Ouslander, JG, Simmons, S, Schnelle, J, Uman, G, Fingold, S. Effects of prompted voiding on fecal continence among nursing home residents. J Am Geriatr Soc 1996; 44: 424–8.Google Scholar
110Stokes, G. Psychological approaches to bowel care in older people with dementia. In: Potter, J, Norton, C, Cottenden, A (eds), Bowel Care in Older People. London: Royal College of Physicians; 2002. pp. 97–109.Google Scholar
111Bliss, DZ, Fischer, LR, Savik, K. Self-care practices of the elderly to manage fecal incontinence. J Gerontol Nurs 2005; 31: 35–44.Google Scholar
112Akpan, A, Gosney, MA, Barrett, JA. Privacy for defecation and fecal incontinence in older adults. J Wound Ostomy Continence Nurs 2006; 33: 536–40.CrossRefGoogle ScholarPubMed