Added: Arnetta Wilford - Date: 02.01.2022 09:19 - Views: 35259 - Clicks: 8341
Julia Herbert discusses how anal plugs can be used to improve the quality of life for people with faecal incontinence. Abstract Herbert, J. Nursing Times; 13, 66— Living with anal incontinence can have a ificant impact on the lives of sufferers and their families.
A female patient in her 50s shared her experiences of having faecal incontinence as a result of a obstetric injury sustained at the delivery of her first son 24 years ago. I knew that as soon as we had eaten and the dancing started that I would be expected to get up and dance with the best man. I spent the whole day pretending to limp with my leg bandaged to fake the injury. Imagine inventing stories to avoid social situations because of a fear of losing control of bowel function.
This is a regular occurrence for many people who experience anal incontinence. Sometimes patients do not actually have regular episodes of incontinence but the fear of incontinence without warning can have a serious impact on their quality of life. They describe difficulty coping in the workplace and having to leave work because of their bowel using butt plugs others describe difficulties with personal relationships. However, this definition does not take into the more common, yet no less embarrassing symptom of incontinence of flatus or gas wind.
This meta-analysis of 29 prevalence studies concluded that prevalence rates for anal incontinence were 0. There are numerous causes of anal incontinence and each case should be thoroughly assessed by a healthcare professional Box 1.
Women following childbirth especially following third-degree and fourth-degree obstetric injury. Following a detailed assessment it may be appropriate to offer conservative therapy, medications or surgical interventions. These are outlined in Box 2. Unfortunately for some patients, none of the options listed in Box 2 are suitable, or the patient may choose not to follow these options.
Other patients may need assistance in managing their incontinence while undergoing treatment for their continence problem. In these cases, the use of an anal plug device may be beneficial to some patients. The device is available in two sizes, small and large prescription codes The choice of size is mostly down to individual experience and it is usual to recommend that patients try the smaller plug first, progressing to the larger if leakage still occurs.
The anal plug is made of porous, slightly absorbent foam which is able to let air pass through it. It is packaged in a dissolvable film which dissolves on contact using butt plugs the body fluids in the rectum to release a mushroom-shaped plug. The plug in its unexpanded form looks like a suppository. This is inserted into the anal canal using a lubricant to ease insertion. It is important that the patient understands the anatomy of the anal canal and lower rectum, so that they know the correct position for the plug.
Once inserted, the plug should sit at the upper end of the anal canal. It is essential that it is inserted completely through the length of the anal canal as it is extremely uncomfortable if the plug expands in the lower end of the canal. Because of the materials used in the plug, it is not flushable.
Norton and Kamm carried out a trial with this product, comparing the two sizes, and found there was a high failure rate with both. Fourteen out of 20 patients were unable using butt plugs tolerate either size. In our specialist bowel dysfunction clinic, we were experiencing similar problems. We therefore decided to try a different approach when patients first try the product.
Our standard practice was to give patients a sample box of plugs containing three of each size and send them home to try them. We found that patients did not use the plugs. When this occurred, we were not sure if it was because of intolerance of the product, misplacement in the anal canal or anxiety about using the plug.
Patients are invited to attend clinic for a short minute appointment approximately one hour before their actual appointment. One of the specialist clinicians inserts the plug device and the patient is able to go and have a drink and walk around the health centre, testing the plug with the knowledge that it has been correctly inserted. We tell the patients that using a plug for the first time is like getting used to wearing contact lenses, as the tissues around the anus are sensitive to the foreign object.
Patients have using butt plugs reassured by this approach as they know that a specialist is available if there are any difficulties As a result there have been increased uptake by patients and success with using the plug Boxes 3 and 4. Mr Green is aged 48 and has a five-year history of undiagnosed rectal mucosal prolapse. His GP did not examine him but treated him for haemorrhoids. He was examined by his GP and had a surgical repair of the prolapse but was immediately unable to control faeces and experienced faecal incontinence of soft, formed stool 2—3 times per day.
He attended the specialist bowel dysfunction clinic where he was taught external anal sphincter exercises, given dietary advice and prescribed a combination of bulking agent and titratable doses of liquid loperamide. He continued to experience episodes of incontinence, although fewer than when he was first referred to the clinic. His main issue was a fear of returning to work. He tried anal plugs and decided that using these would give him enough confidence to return to work. Mrs Ackers is aged 42 and has a history of faecal urgency and faecal incontinence for six years.
Her BMI is greater than 35 and she has had multiple operations for anal abscesses. She tried anal sphincter exercises, dietary modification and medications but there was no improvement. A trial of a plug was offered to Mrs Ackers but she initially declined this due to embarrassment. She then took a sample pack home with her but reported extreme discomfort with using the plug and did not feel it was suitable for her.
On further questioning, the patient reported that due to her size she had had some difficulty inserting the plug.
She had been told by a consultant that she had a long anal canal and she did not feel that she would be able to insert plugs herself. After some discussion she was persuaded to have a trial of the device in the clinic. Her anal canal was actually of average length 3cm and the device was using butt plugs easily. She was very aware of the device but did not experience extreme discomfort and was prepared to try it again at home. With a better understanding of her anatomy and the reassurance that the device was correctly inserted, she is now using the plugs regularly and reports a ificant improvement in her quality of life.
Although anal plug devices are not using butt plugs for all patients with anal incontinence, they can make a ificant difference to their quality of life. In some European countries, a wider variety of anal plug devices is available. There is a possibility that, with further research and development, this device could be suitable for more people. London: NICE. Norton, C. Colorectal Disease ; 3: 5, — Pretlove, S. International Urogynaecology Journal ; 4, — in or Register a new to the discussion.
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