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.

So, while the condition is not life threatening, it is an assault on an individual’s quality of life.

It’s more common in women and the elderly and is associated with a host of medical conditions.  Fecal incontinence is extremely common in extended care facilities which can result in medical consequences.

This post is not to discuss the diagnosis and treatment of this condition.  Indeed, this blog is a medical commentary site, not an ‘ask a doctor’ site.

Here’s the 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 readily affirm their symptom and are often relieved that the ice has been broken and their issue will be addressed. 

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, inquiring about fecal leakage is not included in my routine questioning.  Unless these patients indicate the presence of this symptom during an interview with my staff preceding the visit, then I will not be aware of the issue.  It’s also possible that a patient with FI would deny the symptom if questioned directly.

The larger point is that patients may have a variety of important issues that they won’t volunteer to health care professionals.  Psychiatric illnesses, alcoholism and addiction, family stress, financial distress or a lurking fear that a malignancy may be present are among issues that patients may not actively share. 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.