Certified Rehabilitation Registered Nurse (CRRN) Practice Exam

A patient with an autonomous neurogenic bowel may experience incontinence during transfers because:

1. Anal sphincters are flaccid and do not retain stool under abdominal pressures

2. The rectum will reflexively empty when stool enters it

3. This problem is associated with stress incontinence

4. Sensation is impaired which limits reflex contraction of the external sphincter

The correct answer is: Anal sphincters are flaccid and do not retain stool under abdominal pressures

The correct answer highlights that in patients with an autonomous neurogenic bowel, the anal sphincters are flaccid, meaning they lack the necessary tone to retain stool in the rectum, especially when abdominal pressure increases during transfers. This condition often arises due to nerve damage or dysfunction that affects the control of bowel movements, leading to difficulties in retaining stool. In terms of the clinical implications, when abdominal pressure increases during movements such as transfers, the inability of the anal sphincters to maintain closure allows for the involuntary release of stool, resulting in incontinence. Therefore, the flaccidity of the anal sphincters directly contributes to the patient's experience of incontinence under these circumstances. The other choices relate to different aspects of bowel and bladder function, but do not address the specific mechanism of incontinence in the context of an autonomous neurogenic bowel as accurately as the correct answer does. For instance, while reflexive emptying of the rectum may occur, it is not the direct mechanism responsible for incontinence during transfers. Sensation impairment can affect the individual's ability to recognize the need to defecate, but that does not inherently cause incontinence during physical movements. Such nuances underscore the importance of understanding the physiological basis of autonomic