When people who have been ambulatory in everyday life and are suddenly are confronted with a stroke, accident injury or other experience find themselves bedridden on their back it causes a reality shock to them. The management of urine and bowel function creates an emotional and physical challenge that quickly impacts their mental state.
The issues of embarrassment, odor containment, morale, withdrawal, and avoidance of visitors begins the process of depression. Depression is treatable with medicines however; complications of constipation and further physical changes in bowel function create more social issues to be managed. Anticholonergic medications to treat depression induce constipation that then requires stool softeners be prescribed to create bowel movements. These same medications alter other body functions by causing pupil dilation of the eyes and blurred vision as a result of paralysis of ocular accommodation. The inability to read clearly is another new functional change new to the person who has become bedfast and depresses. Diarrhea is a frequent concomitant of this combination of methods to deal with the function of the bowel. The desired balance of bowel function that is normal in healthy individuals is now in a state of induced unpredictable imbalance..
The person has now reached the first stage of concern for continence and or incontinence care.