WEB WOC Continence Care Exam
Questions And Answers (Guaranteed A+)
Encopresis - answer✔a disorder characterized by repeated stool evacuation in inappropriate
places in children over the age of four
primary: children who never reached continence
secondary: children who reached continence for at least a year and are now relapsed
sympathetic nervous system role - answer✔*involuntary*
When the rectum is empty, the SNS inhibits the contraction of the rectal wall, and contracts the
internal anal sphincter (IAS) to prevent leakage
parasympathetic nervous system role - answer✔when the rectum is filled post mass transit, it
stretches and the PNS sends information to the CNS to coordinate bowel elimination. The
rectum then contracts in conjunction with the ENS and the IAS relaxes. Feces then moves down
the anal canal to the external anal sphincter (EAS)
enteric nervous system - answer✔The intrinsic nervous system within the bowel wall. This
system responds to a variety of stimuli and generates peristalsis
rectoanal inhibitory reflex - answer✔the involuntary relaxation of the IAS when the rectum is
stretched that allows feces to move down anal canal
sampling reflex - answer✔when rectal contents contact Anoderm (receptors at distal anal
canal) for differentiation
allows squamous epithelium below the Denate Line with sensory receptors that differentiate
between solid, liquid, gaseous rectal contents
anal wink - answer✔with cotton swab, swipe at 5 and 7 o'clock on the buttocks with the patient
in the modified lithotomy position
a focused physical exam that assesses prostate and pelvic muscle control and verifies function
of pudendal nerve
bulbocavernosus reflex - answer✔in modified lithotomy position, squeeze penis glans to verify
external anal sphincter wink or flick the clitoris in females
a focused physical exam that assesses prostate and pelvic muscle control and verifies function
of pudendal nerve
5 factors that promote continence - answer✔1: colonic transit, stool volume, and consistency
2: sensory awareness
3: sphincter competence
4: rectal compliance and capacity
5: extrinsic factors
secretory diarrhea - answer✔The absorptive capacity of the bowel is overwhelmed by the
volume of water and electrolytes that are secreted into it
osmotic (absorptive) diarrhea - answer✔inadequate or reduced absorption of the bowel
functional (motility) diarrhea - answer✔Increased motility results in decreased contact time of
the stool with the lumen and intestinal mucosa
external anal sphincter - answer✔composed of smooth muscle that maintains sphincter tone
(contraction) and striated muscle that permits voluntary control/contractility
parasympathetic nervous system - answer✔part of the autonomic nervous system that acts to
promote colonic peristalsis and motility activity
sympathetic nervous system - answer✔part of the autonomic nervous system that acts to
reduce intestinal motility and secretions
soluble fiber - answer✔foods that contain soluble fiber have the ability to absorb and retain
water
*use to help resolve diarrhea
insoluble fiber - answer✔foods that contain insoluble fiber add bulk to the stool and do not
absorb water
ALL RIGHTS RESERVED.
*use to help resolve constipation
irritable bowel syndrome - answer✔cause is unknown but thought to be multifactorial
including: multifactorial: visceral hypersensitivity, enhanced GI permeability known as "leaky
gut", altered composition of the GI microbiota, low-grade inflammation, altered immune
response, autonomic nervous system dysfunction, altered bile acid metabolism, and
psychological distress
IBS s/s - answer✔Abdominal pain, bloating and distention, feelings of incomplete emptying,
changes in stool frequency and consistency, pain relieved by defecation, Abdominal pain
associated with eating and intraluminal stimulation such as gas, constipation and/or diarrhea
obstructed defecation syndrome - answer✔disorders that are characterized by the inability to
eliminate normally, even when the stool is an ideal form/consistency. May be the result of
muscle/sphincter control issues or mechanical obstacles
pelvic floor dyssynergia - answer✔*most common cause of obstructed defecation syndrome*
results from the inability to coordinate pelvic floor and sphincter relaxation and abdominal
muscle contraction. Person inadvertently contracts sphincter when trying to relax it
diagnosis: sphincter remains contracted when person is instructed to bear down, Impaired
rectal sensation, Diagnosed with anorectal manometry
treatment: Pelvic muscle re-education using biofeedback
rectocele - answer✔*type of obstructive defecation syndrome*
herniation/prolapse of the anterior rectal wall into the posterior vagina
diagnosis: may coexist with rectal bleeding and urinary incontinence, Patient may admit
supporting perineum through vagina (splinting) to facilitate defecation, May be identified pelvic
exam and defecography - radiographic visualization of rectoanal function, When visible, intact
bowel is visualized - looking at the outside wall of the bowel with stool contained inside
treatment: conservative treatment (pelvic floor exercises, diet/stool management), Pessary,
Surgery to repair
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