Skin Integrity, Bowel and Bladder Care

The combination of weakened perineal muscles, urinary tract as well as other infections, and interruptions in peristalsis (whether neurogenic or medication induced) all contribute to a common problem among ventilator-dependent individuals—stool and urine incontinence—with its attending consequence of skin breakdown. Reduced ambulation, the inability to transfer to a toilet for evacuation, and general cognitive impairment often impair resolution of these issues. The resulting low self-esteem becomes a further barrier. 

Defecation starts with stimulation of the sensory nerve fibers of the rectum, leading to an involuntary spinal reflex that causes contraction of the rectum and the opening of the internal and external sphincters. The voluntary, somatic system completes the evacuation, after which the brain sends signals to the external sphincter to close and inhibit further elimination. Any damage to the CNS, such as a cerebrovascular accident, brain tumor, multiple sclerosis, or motor neuron diseases, can impair the bowel s volrmtary and involuntary responses. These CNS changes may result in inaccurate, involrmtaiy responses of the bowel, such as flaccidity of the rectum, expulsion of contents, or sphincter and rectal hyperactivity (3). 

After this period, the program can be modified every other day. If the patient does not have a bowel movement, then it may be necessary to change the routine every third day or three times a week. A spontaneous bowel movement that occurs close to the rectal stimulant is a sign that the reflex response and muscle control are improving. In this situation, the rectal medication should be held to see if the patient would continue to have spontaneous 

Topical preparations for the skin and rectal tissue can decrease hemorrhoids, ulcerations, fissures, and dermatitis, thus preventing secondary incontinence. In time, if the patient becomes more mobile and can tolerate being up, then the program should be conducted using a commode, a toilet, or a combination of both. 

Loose bowels may need to be collected in a fecal incontinence pouch, which can be challenging to keep on the patient. Rectal tube products that divert into a drainage bag are often needed for a week to give the skin the ability to heal. The rectal tube can be irrigated every two to four hours to prevent debris from clogging it, and to provide a stimulant to empty the sigmoid and rectum. This process is important because when the tube is removed, the bowel has received a daily program and responds to the rectal medication in the same 

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