How should urinary and fecal incontinence be managed in patients with pressure injuries (pressure ulcers)?

Updated: Mar 26, 2020
  • Author: Christian N Kirman, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

The wound and surrounding intact skin must be kept clean and free of urine and feces through frequent inspection and cleansing. Appropriate evaluation of urinary or fecal incontinence is complex but must be performed thoroughly. Potentially reversible causes should be identified and treated. Urinary incontinence secondary to urinary tract infection (UTI) should be treated with antibiotics. Fecal incontinence secondary to diarrhea may be related to an infectious cause (eg Clostridium difficilepseudomembranous colitis) that resolves with appropriate antibiotics.

Manual disimpaction and the addition of stool bulking agents to the diet may relieve overflow fecal incontinence. Urinary or fecal incontinence with no treatable cause may be minimized by establishing a bowel and bladder regimen. Constipating agents and a low residue diet also may be helpful.

Diapers and incontinence pads may be useful absorbing moisture away from the surface of the skin, provided that they are checked regularly and changed when soiled. If used inappropriately, these products may actually aggravate maceration and result in dermatitis. A bladder catheter or (in males) a condom catheter may be used to control urinary incontinence. In very severe cases involving chronic stool contamination, surgical diversion should be considered.


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