WEB WOC CONTINENCE CARE TEST WITH VERIFIED ANSWERS
1. encopresis 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
2. sympathetic ner- *involuntary*
vous system role
When the rectum is empty, the SNS inhibits the contrac-
tion of the rectal wall, and contracts the internal anal
sphincter (IAS) to prevent leakage
3. parasympathet- when the rectum is filled post mass transit, it stretches
ic nervous and the PNS sends information to the CNS to coordinate
system role bowel elimination. The rectum then contracts in conjunc-
tion with the ENS and the IAS relaxes. Feces then moves
down the anal canal to the external anal sphincter (EAS)
4. enteric nervous The intrinsic nervous system within the bowel wall. This
system system responds to a variety of stimuli and generates
peristalsis
5. rectoanal in- the involuntary relaxation of the IAS when the rectum is
hibitory reflex stretched that allows feces to move down anal canal
6. sampling reflex 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
7. anal wink 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
, WEB WOC CONTINENCE CARE TEST WITH VERIFIED ANSWERS
8. bulbocaver- in modified lithotomy position, squeeze penis glans to
nosus reflex 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
9. 5 factors that 1: colonic transit, stool volume, and consistency
promote conti- 2: sensory awareness
nence 3: sphincter competence
4: rectal compliance and capacity
5: extrinsic factors
10. secretory diar- The absorptive capacity of the bowel is overwhelmed by
rhea the volume of water and electrolytes that are secreted into
it
11. osmotic (absorp- inadequate or reduced absorption of the bowel
tive) diarrhea
12. functional (motil- Increased motility results in decreased contact time of the
ity) diarrhea stool with the lumen and intestinal mucosa
13. external anal composed of smooth muscle that maintains sphincter
sphincter tone (contraction) and striated muscle that permits volun-
tary control/contractility
14. parasympathet- part of the autonomic nervous system that acts to pro-
ic nervous mote colonic peristalsis and motility activity
system
15. sympathetic ner- part of the autonomic nervous system that acts to reduce
vous system intestinal motility and secretions
16. soluble fiber foods that contain soluble fiber have the ability to absorb
and retain water
*use to help resolve diarrhea
, WEB WOC CONTINENCE CARE TEST WITH VERIFIED ANSWERS
17. insoluble fiber foods that contain insoluble fiber add bulk to the stool and
do not absorb water
*use to help resolve constipation
18. irritable bowel cause is unknown but thought to be multifactorial includ-
syndrome ing: multifactorial: visceral hypersensitivity, enhanced GI
permeability known as "leaky gut", altered composition
of the GI microbiota, low-grade inflammation, altered im-
mune response, autonomic nervous system dysfunction,
altered bile acid metabolism, and psychological distress
19. IBS s/s Abdominal pain, bloating and distention, feelings of in-
complete emptying, changes in stool frequency and con-
sistency, pain relieved by defecation, Abdominal pain as-
sociated with eating and intraluminal stimulation such as
gas, constipation and/or diarrhea
20. obstructed defe- disorders that are characterized by the inability to elimi-
cation syndrome nate normally, even when the stool is an ideal form/con-
sistency. May be the result of muscle/sphincter control
issues or mechanical obstacles
21. pelvic floor *most common cause of obstructed defecation syn-
dyssynergia drome*
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, Diag-
nosed with anorectal manometry
treatment: Pelvic muscle re-education using biofeedback
22. rectocele *type of obstructive defecation syndrome*
herniation/prolapse of the anterior rectal wall into the
1. encopresis 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
2. sympathetic ner- *involuntary*
vous system role
When the rectum is empty, the SNS inhibits the contrac-
tion of the rectal wall, and contracts the internal anal
sphincter (IAS) to prevent leakage
3. parasympathet- when the rectum is filled post mass transit, it stretches
ic nervous and the PNS sends information to the CNS to coordinate
system role bowel elimination. The rectum then contracts in conjunc-
tion with the ENS and the IAS relaxes. Feces then moves
down the anal canal to the external anal sphincter (EAS)
4. enteric nervous The intrinsic nervous system within the bowel wall. This
system system responds to a variety of stimuli and generates
peristalsis
5. rectoanal in- the involuntary relaxation of the IAS when the rectum is
hibitory reflex stretched that allows feces to move down anal canal
6. sampling reflex 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
7. anal wink 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
, WEB WOC CONTINENCE CARE TEST WITH VERIFIED ANSWERS
8. bulbocaver- in modified lithotomy position, squeeze penis glans to
nosus reflex 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
9. 5 factors that 1: colonic transit, stool volume, and consistency
promote conti- 2: sensory awareness
nence 3: sphincter competence
4: rectal compliance and capacity
5: extrinsic factors
10. secretory diar- The absorptive capacity of the bowel is overwhelmed by
rhea the volume of water and electrolytes that are secreted into
it
11. osmotic (absorp- inadequate or reduced absorption of the bowel
tive) diarrhea
12. functional (motil- Increased motility results in decreased contact time of the
ity) diarrhea stool with the lumen and intestinal mucosa
13. external anal composed of smooth muscle that maintains sphincter
sphincter tone (contraction) and striated muscle that permits volun-
tary control/contractility
14. parasympathet- part of the autonomic nervous system that acts to pro-
ic nervous mote colonic peristalsis and motility activity
system
15. sympathetic ner- part of the autonomic nervous system that acts to reduce
vous system intestinal motility and secretions
16. soluble fiber foods that contain soluble fiber have the ability to absorb
and retain water
*use to help resolve diarrhea
, WEB WOC CONTINENCE CARE TEST WITH VERIFIED ANSWERS
17. insoluble fiber foods that contain insoluble fiber add bulk to the stool and
do not absorb water
*use to help resolve constipation
18. irritable bowel cause is unknown but thought to be multifactorial includ-
syndrome ing: multifactorial: visceral hypersensitivity, enhanced GI
permeability known as "leaky gut", altered composition
of the GI microbiota, low-grade inflammation, altered im-
mune response, autonomic nervous system dysfunction,
altered bile acid metabolism, and psychological distress
19. IBS s/s Abdominal pain, bloating and distention, feelings of in-
complete emptying, changes in stool frequency and con-
sistency, pain relieved by defecation, Abdominal pain as-
sociated with eating and intraluminal stimulation such as
gas, constipation and/or diarrhea
20. obstructed defe- disorders that are characterized by the inability to elimi-
cation syndrome nate normally, even when the stool is an ideal form/con-
sistency. May be the result of muscle/sphincter control
issues or mechanical obstacles
21. pelvic floor *most common cause of obstructed defecation syn-
dyssynergia drome*
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, Diag-
nosed with anorectal manometry
treatment: Pelvic muscle re-education using biofeedback
22. rectocele *type of obstructive defecation syndrome*
herniation/prolapse of the anterior rectal wall into the
