Schnelle and colleagues conducted a randomized, controlled trial of interventions to improve urinary and fecal incontinence and constipation in 125 residents at six nursing homes. Sixty-five participants were randomized to the intervention group and 60 to the control group. Interventions, which were provided every two hours on weekdays between 7 AM and 3:30 PM for 12 consecutive weeks, included trained research staff prompting residents to use the toilet, caring for participants after episodes of incontinence, increasing residents' physical activity, and increasing their daily food and fluid intake. Typical care was given to the control group by nursing home staff. All 125 residents were checked for evidence of incontinence every two hours from 7 AM to 3:30 PM for 10 consecutive weekdays at baseline and again on each day of the intervention for the intervention subjects and for 10 days afterward for the control subjects.

Participants in the intervention group significantly increased their physical activity, toileting frequency, and food and fluid intake compared with participants in the control group. The intervention also resulted in improved urinary incontinence, bowel movement frequency, and percentage of appropriate toileting episodes. However, no significant differences were seen between groups in the frequency of fecal incontinence.

Of the total participants, 29 underwent anorectal testing; 25 of these had a dyssynergic defecation pattern while straining, resulting in incomplete expulsion of fecal matter. This subset also showed low squeeze pressure and impairment in both resting basal pressure and rectal sensation thresholds, which could explain the episodes of fecal incontinence between periods of appropriate toileting.

The authors suggest that an interventional program including fiber to increase stool volume and firmness, prompting, and reminders not to strain during defecation might be helpful in reducing episodes of fecal incontinence.