EFFECTS OF PROMPTED VOIDING ON FECAL CONTINENCE AMONG NURSING-HOME RESIDENTS

OBJECTIVE: To determine the effects of prompted voiding on fecal conti nence in nursing home residents. DESIGN: Prospective, uncontrolled tri al of prompted voiding for urinary incontinence. PARTICIPANTS: One hun dred sixty-five nursing home residents who completed a 9 to 10-week tr ial. MEASUREMENTS: Trained research aides performed physical checks fo r urinary and fecal incontinence hourly from 8 AM to 6 PM for 3 days ( total of 33 checks) at baseline, for the last 3 days of a 1-week trial of prompted voiding, and after 9 to 10 weeks of prompted voiding. RES ULTS: After 9 to 10 weeks of prompted voiding, there was no significan t-change in the frequency of incontinent bowel movements per resident (1.1 [95% CI .83, 1.4] to .87 [95% CI .67, 1.1]; P = 0.140). There was a significant increase in the number of continent bowel movements per resident (.17 [95% CI .10, .24] to .62 [95% CI .45, .80]; P = .000). This increase occurred in residents whose urinary incontinence respond ed well to prompted voiding as well as those whose urinary incontinenc e did not respond. The percentage of bowel movements that were contine nt also increased significantly from 18% (95% CI 8,29) at baseline to 45% (95% CI 32,57) after 9 to 10 weeks of intervention (P = .000). In addition to these findings, we noted a marked increase in the total fr equency of bowel movements after the first week of prompted voiding. T his may have resulted from the relief of fecal impactions caused by th e increased toileting, mobility, and fluid intake that occurred with p rompted voiding. CONCLUSION: Prompted voiding did not change the frequ ency of incontinent bowel movements significantly in this sample of nu rsing home residents. However, the number of continent bowel movements and the percentage of bowel movements that were continent did increas e. Our data must be interpreted cautiously because our study was desig ned primarily as an intervention for urinary, not fecal, incontinence and the design was neither blinded nor controlled. Trials of systemati c toileting schedules specifically directed at fecal incontinence, wit h attention to fecal impaction, diet, fluid intake and laxative use, s hould be conducted.