Case study: Jim who has faecal incontinence

Jim is in a intermediate care unit. He had a stroke several years ago. He has a pacemaker in. He has cellulitis on his legs and a lot of health problems as a result of his stroke. He has dysphasia, so he can’t communicate properly. He is confined to a wheelchair and had been managing his urinary continence himself by using a urine bottle until he became so frail and weak that he wasn’t able to do so.

Jim’s presenting symptoms at the time of his continence assessment:

• His main urinary problem was a bit of urgency

• History of constipation

• The unit were asked to keep 24 hours worth of pads to look at and they had various amounts of urine in them but almost every single one had some faecal smearing on it

• Fluid intake and output charts and unfortunately even the ones from hospital and the ones from intermediate care, all had gaps in them

• Medication charts – prescribed laxatives but wasn’t always getting them

• In a face-to-face meeting with care home staff, his family and social workers, although he was not really able to make a lot of sense because of his dysphasia, his daughter was able to translate for him and it was discovered that he hadn’t actually sat on the toilet for three years

Your task

Based on the information above, what would your first priority be in considering how to promote recovery of Jim’s bowel function? And why would this be? Do you think it is likely that Jim will recover his bowel function?

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