Fecal Incontinence - The Silent Affliction

Gastroenterologists are equipped to assist folks with fecal incontinence (FI) – an awful symptom for reasons that need not be explained.  While many of these individuals experience leakage only occasionally, the fear of an impending episode is ever-present.  They leave home wondering if this will be a day when they will experience a lapse in control.  Many remain at home or curtail social activities because of fear and anxiety.

FI is more common in women and the elderly and is associated with a host of medical conditions.  As expected, it is extremely common in extended care facilities, which can result in actual medical consequences beyond the symptom itself.

So, while the condition is not life-threatening, it is an assault on an individual’s dignity and quality of life.  Importantly, the medical profession has effective weapons available.

But this post is not to discuss the diagnosis and treatment of this condition or any illness.  Indeed, these weekly essays offer medical commentary and do not serve as a 'medical advice'' site.

Here’s the real point of this post.  More often than not, individuals suffering from fecal incontinence do not volunteer this complaint to their doctors, even if their physician is a gastroenterologist.  Most of them cannot overcome the shame and stigma of this symptom.  The closest many of them get is to relate their history of ‘diarrhea’.  The physician needs to ask directly if there has been any leakage or accidents.  At that point, the incontinent patient will usually readily affirm their symptom.   They will be relieved that the ice has been broken and their issue will be addressed.  It is also possible that a patient with FI might deny the symptom even if questioned directly.  I suspect, however, that this is an uncommon occurrence.

Incontinent patients often remain silent.

I have no doubt that many of my patients are suffering from FI silently.  When a 45-year-old sees me for heartburn, I do not inquire about fecal leakage during my routine questioning. Perhaps I should, and this is a professional lapse on my part. There are likely other medical, occupational, or familial issues that physicians do not know or ask about that may have health relevance.  In a perfect world, physicians and caregivers would be omniscient about their patients.  Alas, the world is slightly imperfect.  

Patients may have a variety of troubling issues that they won’t volunteer to health care professionals.  Psychiatric illnesses, alcoholism and addiction, family stress, financial worries, or a lurking fear of malignancy are issues that patients may harbor in silence. If we physicians have established rapport and earned trust, and we ask specific and direct questions, then we may discover what’s really on our patients’ minds.  Isn't this part of our jobs?