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Nurse Practitioner:
doi: 10.1097/01.NPR.0000366129.91105.ca
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Acquired fecal incontinence in community-dwelling adults

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INSTRUCTIONS Acquired fecal incontinence in community-dwelling adults

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Acquired fecal incontinence in community-dwelling adults

General Purpose: To provide the NP with information needed to assess and treat adults with FI. Learning Objectives: After reading the preceding article and taking the following test, you will be able to: 1. Identify the anatomy and physiology involved in FI. 2. Describe how to assess for FI. 3. Discuss strategies to manage FI.

1. Which is responsible for anal tone?

a. anorectal junction

b. colorectal motility

c. pudendal nerves

d. internal and external anal sphincters

2. The anal sampling reflex begins when rectal filling causes

a. the IAS to open.

b. the EAS to open.

c. pressure on the PBR muscle.

d. pressure on the EAS.

3. Forceps deliveries or mediolateral episiotomies place women at risk for FI secondary to

a. nerve damage.

b. EAS tears.

c. PBR muscle damage.

d. damage to the anorectal junction.

4. Anorectal surgery may exacerbate FI because of

a. fistula formation.

b. PBR muscle injury.

c. injury to the pudendal nerve.

d. stretch injury from the anal retractor.

5. Why are MS patients at risk for FI?

a. They have a high incidence of intestinal enteropathy.

b. Fibrosis of connective tissue decreases colorectal capacity.

c. Antibodies attack the myelin sheath of motor and sensory nerves.

d. Autonomic nervous system pathways signaling rectal distension are damaged.

6. Patients with chronic diarrhea are at risk for FI because

a. diarrhea stool overflows the anorectal unit.

b. chronic overuse weakens the EAS.

c. they develop increased rectal capacity, which damages the pudendal nerve.

d. they develop increased rectal capacity, which stretches the PBR muscle.

7. Which 50-year-old patient is most likely to suffer from FI?

a. male with a low body mass index (BMI).

b. female with a low BMI.

c. male with a high BMI.

d. female with a high BMI.

8. The authors recommend initiating a conversation about possible FI by asking

a. Do you have problems with FI?

b. Do you have any problems with your bowels or elimination?

c. How often do you have bowel movements? What is their consistency?

d. Do you have problems with leaking stool or soiling underwear/sheets?

9. If the patient has both urinary incontinence and FI, the NP should suspect

a. S2–S4 nerve disruption.

b. pudendal nerve damage.

c. pelvic floor muscle weakness.

d. autonomic nervous system dysfunction.

10. Stress FI is defined as

a. FI caused by pelvic sensory dysfunction.

b. FI stimulated by cough or physical strain.

c. FI occurring without warning, usually at night.

d. the inability to delay defecation by 60 seconds or more.

11. What position is recommended for the perineal and anorectal exams?

a. knee-chest

b. dorsal recumbent

c. left lateral or prone

d. lithotomy or prone

12. To illicit the anocutaneous reflex,

a. stroke the perianal skin.

b. use a cotton wisp to lightly stimulate the anus.

c. perform a DRE of the resting anus.

d. perform a DRE hooking the finger over the PBR sling.

13. The preferred medication for chronic diarrhea is

a. loperamide.

b. fiber.

c. difenoxin with atropine.

d. diphenoxylate with atropine.

14. Which statement is true?

a. Manometry uses perianal electrodes.

b. Biofeedback with manometry allows the patient to visualize sphincter contraction.

c. The efficacy of biofeedback is well validated by research.

d. Effective pelvic muscle exercises involve assistance from abdominal muscles.

15. Studies indicate that electrical stimulation

a. significantly improves the function of the IAS.

b. significantly improves the function of the EAS.

c. lacks strong evidence of improving sphincter function.

d. lacks strong evidence of improving PBR muscle function.

16. Which statement about urge resistance education is not accurate?

a. It is easily taught by a primary care provider.

b. It requires significant patient motivation.

c. It compensates for a nonintact EAS.

d. It teaches the patient to gradually hold stool longer.

17. Which statement about leakage control in community-dwelling FI patients is accurate?

a. One of the best options is a small anorectal dressing.

b. Absorbent pads help protect the fragile skin of elderly patients.

c. Oral deodorants, such as bismuth subgallate, are not effective.

d. Anal plugs and bags are good options for most patients.

18. Which diagnostic test is used to assess structural integrity of sphincter tears?

a. endoanal manometry

b. endoanal ultrasonography

c. sacral nerve stimulation

d. anorectal EMG

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