Person - Prostate Predicaments Part 2:  Managing Bowel Issues

Prostate Predicaments Part 2:  Managing Bowel Issues

Prostate Predicaments Part 2:  Managing Bowel Issues

By Corey Heerschap, RN, NSWOC, WOCC(c), MScCH

In Part 1 of the series “Prostate Predicaments” for prostate cancer awareness month we discussed the complication of urinary incontinence after prostate surgery. In this article we will discuss the issues surrounding fecal incontinence post prostate cancer treatment.

Why Fecal Incontinence Occurs

Bowel incontinence occurs when you leak a small amount of stool or when you have total loss of bowel control.1 Unlike urinary incontinence, bowel or fecal incontinence is not expected after prostate surgery.1 Other treatments for prostate cancer, however, such as radiation, have a higher chance of leading to fecal incontinence.1 One in five men have their quality of life affected by this complication.1

Both forms of radiation, external and internal (Brachytherapy), can cause bowel incontinence. 2, 3 Although the exact reason this happens is unknown, it is thought to be due to nerve damage that control the muscles that let you manage when you are going to have a bowel movement.4 Early on during radiation treatment the inside of the bowel may become inflamed which may also lead to bowel incontinence.4

Treatment Options

No matter the treatment option chosen for management of prostate cancer you should inform your healthcare team, such as your surgeon or doctor, if you are having any issues with your bowels after treatment. Many men may find it stressful to talk to their doctor about fecal incontinence, however it is vitally important to let them know since this can become a serious issue. The good news is there are  many options to address this problem.1 Speaking to a continence specialist can assist in choosing the right form of management for you.

Protecting your skin

When stool meets the skin it can become painful and may lead to a wound which can then become an infection if not prevented.5 Skin should be cleansed of stool as soon as possible after any incontinence episode. Cleansing, moisturizing and protecting the skin are the three key steps to prevent skin complications.5 Standard soaps can be hard on the skin and “no rinse” skin cleansers are suggested for better protection.5 Moisturizers and moisture barriers can then be applied after the skin has been dried to protect the skin.5

Managing Leaks

Discuss with your doctor or continence specialist about possible medications and diet changes that may help with your incontinence.5 There are several ways to contain the stool.  External fecal pouches can be connected to a collection device and keep stool away from the skin when there are large amounts of liquid stool.5 Another device that may be discussed with your healthcare provider is an anal plug. This is a device that sits inside the anal canal and absorbs liquid to prevent leakage.5 Incontinence products such as reusable and disposable briefs, under-pads and/or disposable liners can be used to catch stool. It is important to use these products in combination with good skin care and to change them as soon as possible after an episode of incontinence.5 

When deciding which fecal continence management product and treatment is right for you, it is important to make sure you understand how the products work, how to store them and how to throw them away.5 Your doctor or continence specialist can assist with educating you about these topics. These specialists may also discuss biofeedback with you: techniques to improve muscle tone and assist in controlling your continence.5 If these options have been ineffective for you, ask your doctor about seeing a neurological or surgical specialist.5

Key Take Away

The key take-away: there are many options available to manage fecal incontinence—speak to your healthcare professional regarding the best options that will enable you to live your life to the fullest.

References

1Prostate Cancer Foundation of Australia. (2014). Understanding bowel disturbances following prostate cancer treatment. Retrieved from: https://www.prostate.org.au/media/468686/understanding-bowel-disturbance.pdf

2Loganathan, A., Schloithe, A.C., Hutton, J., Yeoh, E.K., Fraser, R., Dinning, P.G., & Wattchow, D. (2015) Pudendal nerve injury in men with fecal incontinence after radiotherapy for prostate cancer. Acta Oncologica, 54(6), 882-888, DOI: 10.3109/0284186X.2015.1010693

3Lamb, N., Trabinino, L., & Hackford, A. (2011). Patients’ perspectives on fecal incontinence after brachytherapy for localized prostate cancer. Diseases of the Colon & Rectum, 54(5), 615-621.

4Maeda, Y., Hoyer, M., Lundby, L., & Norton, C. (2011). Faecal incontinence following radiotherapy for prostate cancer: A systematic review. Radiotherapy & Oncology, 98(2), 145-153.

5Willson, M.M., Angyus, M., Beals, D., Callan, L., Francis, K., Kingan, M.J., & Kathleen Poras, O. (2014). Executive summary: A quick reference guide for managing fecal incontinence (FI). J Wound Ostomy Continence Nurs, 41(1), 61-69.

Corey Heerschap

Corey Heerschap

Corey is a certified nurse specialized in wound, ostomy and continence. He is a researcher, educator, and advocate for excellence in wound, ostomy and continence care.
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