Psychological issues surrounding faecal incontinence: experiences of patients and nurses
Continence care breaches social norms about privacy, nakedness and bodily functions. Faecal incontinence (FI) is a condition that is associated with a significant emotional impact, which extends to not only the patient but also the nurse or care worker. Patients can experience feelings of guilt and shame and a sense of ‘incompetence’, which can be connected to childhood experiences. Similarly, nurses and caregivers can encounter feelings of disgust and revulsion, which are often denied, as part of the perceived professional expectation. Nurses can develop self-protective behaviours including emotional detachment and development of a task-orientated approach to physical care. This can, in turn, accentuate the negative feelings experienced by patients with FI. Nurses developing self-awareness through reflection on their own difficult feelings can help to improve communication, which will meet patients' emotional needs and improve the therapeutic relationship. This article aims to encourage nurses and care workers to develop an empathetic understanding of the basic human emotional responses experienced by patients. It also aims to improve nurses' awareness of their own feelings and help them recognise the effect of these emotions on their own behaviours and their patients. Lastly, the importance of providing emotional care to patients with FI is discussed.
Faecal incontinence (FI) is described as the involuntary loss of stool, which can be of either solid or liquid consistency (Menees et al, 2018). The way in which people experience FI varies. For instance, a person might have urge incontinence or the inability to defer defaecation in time to reach the toilet. Conversely, passive soiling can occur, where the person passes stool without being consciously aware of having done so. Faecal leakage can occur as a result of not fully emptying the bowel, that is, where the patient has passed stool, but the rectum has not emptied completely.
There are multiple reasons why a person might develop FI. These can include structural damage to the anal sphincters due to surgical intervention or childbirth. FI that is described as functional is where there is an absence of structural abnormality, but the person experiences incontinence due to problems such as not being able to find a toilet in time or not being able to clean themselves properly following defaecation (Musa et al, 2019). There may be issues with the consistency of the stool or other underlying contributory factors, such as irritable bowel syndrome (IBS), which makes it difficult for the person to defer defaecation.
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