When families and care teams discuss long-term care placement, the conversation often centers on mobility, cognition, or falls. But bowel control can also play a meaningful role in whether home-based care remains sustainable.

For older adults, fecal incontinence (FI) can increase caregiver strain, complicate hygiene and skin care, affect dignity and social participation, and add to the overall burden of care.1,2 In some cases, it becomes one of the factors that pushes families toward nursing home placement, especially when it coexists with urinary incontinence, impaired mobility, or limited caregiver support.3

For clinicians, this article outlines why earlier identification of accidental bowel leakage matters, what to assess first, and where conservative management may fit before care at home becomes unsustainable.

Why Fecal Incontinence Matters In Care Planning

Fecal incontinence in older adults is often underreported and undertreated. Patients may feel embarrassed, assume it is part of aging, or describe symptoms indirectly. Clinicians may focus on more visible concerns and miss bowel leakage unless they ask directly.1

That matters because bowel leakage influences:

  • Caregiver capacity and burnout
  • Skin integrity and moisture-associated damage
  • Toileting assistance needs
  • Social isolation and quality of life
  • Whether home care remains realistic

In older adults, FI often coexists with urinary incontinence. Together, they further increase care complexity for families and clinicians.4

Related: Why Bowel Control is Often Missed in Primary and Home Health Care

Fecal Incontinence, Caregiver Burden, and LTC Placement

Earlier studies have identified bowel incontinence and caregiver stress as predictors of nursing home placement.2,3 Fecal incontinence may not determine placement alone, but it often acts as an amplifier.

A patient may be medically stable enough to remain at home, but repeated leakage episodes, urgency, skin care needs, laundry burden, and caregiver exhaustion can narrow that window quickly.

For many caregivers, managing FI means repeated clothing and bedding changes, urgent transfers, bathing assistance, and ongoing vigilance around accidents and odor. Research continues to show that toileting assistance and leakage management are substantial sources of caregiver burden.5

When bowel leakage is addressed earlier, clinicians may reduce caregiver burden before care demands intensify. Without intervention, repeated leakage, skin breakdown, and caregiver exhaustion can quickly push families toward considering long-term care placement.

Read More: Helping Loved Ones with Accidental Bowel Leakage (ABL) Stay Home

The Cost of Waiting

Long-term care placement has major financial implications. According to the 2023 Genworth Cost of Care Survey, the national median cost of a semi-private nursing home room is $104,000 annually, while the cost of a private room in a nursing home is $116,800.6

Even modest extensions of successful home-based care may matter to families, health systems, and discharge teams. More importantly, earlier intervention supports outcomes that matter just as much: dignity, confidence, skin protection, caregiver sustainability, and more time at home.

“The clinical question is not just ‘Is this patient incontinent?’ but ‘What can we do now to help them stay home longer?’”

What Earlier Attention Looks Like In Practice

Earlier attention to accidental bowel leakage does not require an elaborate workup. It starts with recognizing that FI is common, meaningful, and often manageable.

1. Screen proactively

Many patients will not volunteer symptoms unless asked. Terms like “accidental bowel leakage” may be more effective than “fecal incontinence” in screening conversations.1

Periodic screening is especially important in older adults with risk factors, including diarrhea, urgency, constipation with overflow, mobility limitations, cognitive impairment, neurologic disease, diabetes, pelvic floor disorders, or concurrent bowel and bladder incontinence.

Helpful screening questions may include:

  • How often are accidents happening?
  • Do episodes occur with urgency, loose stool, or seepage?
  • Is bowel leakage affecting hygiene, caregiving, or the sustainability of home-based care?
  • Has bowel control become harder to manage alongside urinary incontinence or mobility challenges?

Read Next: Starting the Conversation: Helping Patients Open Up About Bowel Leakage

2. Assess for reversible or contributing factors

A practical evaluation may include:

  • Stool consistency and frequency
  • Diarrhea, urgency, or seepage
  • Constipation with overflow
  • Medication effects
  • Dietary triggers
  • Mobility limitations
  • Cognition and ability to toilet independently
  • Perianal skin issues
  • Caregiver capacity

Clinical reviews note that bowel disturbance is often easier to correct and less invasive to treat than sphincter-targeted therapies—making early assessment especially valuable.⁷

3. Reframe the condition

FI should not be presented as inevitable. For many patients, conservative strategies may reduce episodes and improve quality of life.

4. Expand conservative management of fecal incontinence

Options may include bowel habit optimization, fiber or diet modification, medication review, anti-diarrheal therapy, skin care, pelvic floor therapy, and continence products.7

5. Include caregivers in decision-making

The success of home-based care often depends on whether caregivers can realistically manage symptoms over time.

Where Device-Based Options May Fit

Absorbent products can help manage leakage after it occurs, but they do not prevent episodes. For many patients, device-based options may offer another conservative management approach.

Anal inserts are intended to help prevent accidental bowel leakage before it happens. Reviews of conservative treatment options note that mechanical anal inserts may be effective for some patients, though tolerance and patient selection remain important.8

StaySure™ is one such option: a prescription-only silicone anal insert designed to help prevent accidental bowel leakage for up to 24 hours. It is not a cure for underlying conditions, and may not be the right choice for every patient. But within the conservative management spectrum, it may help many patients reduce episodes, lessen hygiene burden, and maintain independence longer.

Appropriate patient selection, shared decision-making, and review of safety information remain essential.

Learn More: A Better Option: Why StaySure™ Fills a Critical Gap in FI Care

Frequently Asked Questions

Is fecal incontinence a risk factor for nursing home placement?

It can be a contributing factor, particularly when it increases caregiver burden or occurs alongside mobility limitations, cognitive impairment, or double incontinence.1,2,3

Should clinicians screen older adults for accidental bowel leakage even if they do not mention it?

Yes. Many older adults do not report symptoms unless asked directly. Periodic screening is recommended, especially in patients with risk factors.1

Can urinary and fecal incontinence occur together?

Yes. Double incontinence may increase caregiving complexity, hygiene burden, and overall care needs.4

What should be assessed before advanced treatment?

Initial assessment should consider stool pattern, diarrhea, constipation with overflow, medications, diet, mobility, cognition, skin concerns, and caregiver capacity.7

Where do device-based options fit in fecal incontinence management?

Device-based options like anal inserts may fit within conservative management for selected patients when the goal is to help prevent leakage and reduce daily burden.8

Can earlier intervention help patients stay at home longer?

It may. Earlier recognition and management may reduce leakage burden, improve caregiver sustainability, and preserve home-based care longer.

The Conversation Starts with the Clinician

Fecal incontinence does not have to become the unspoken tipping point toward long-term care placement.

Earlier identification, practical screening, and expanded conservative management options may help some patients remain at home—with greater dignity, confidence, and support.

Learn How StaySure™ Works

Request Clinical Materials

StaySure™ is a prescription-only medical device designed to help prevent accidental bowel leakage. Talk with your patients about whether it may be appropriate for their care plan.

Disclaimer

StaySure™ is a prescription-only medical device designed to help manage symptoms of accidental bowel leakage. It is not a cure for underlying conditions. Individual results may vary. Consult the Instructions for Use for complete indications, contraindications, and safety information.

References

  1. Whitehead, W. E., Borrud, L., Goode, P. S., Meikle, S., Mueller, E. R., Tuteja, A., Weidner, A., Weinstein, M., & Ye, W. (2009). Fecal Incontinence in US Adults: Epidemiology and Risk Factors. Gastroenterology, 137(2), 512-517.e2. https://doi.org/10.1053/j.gastro.2009.04.054
  2. Bharucha, A. E., Zinsmeister, A. R., Locke, G. R., Seide, B. M., McKeon, K., Schleck, C. D., & Melton, L. J. (2006). Risk Factors for Fecal Incontinence: A Population-based Study in Women. The American Journal of Gastroenterology, 101(6), 1305–1312. https://doi.org/10.1111/j.1572-0241.2006.00553.x
  3. Gorina, Y., Schappert, S., Bercovitz, A., Elgaddal, N., & Kramarow, E. (2014). Prevalence of incontinence among older Americans. Vital & Health Statistics. Series 3, Analytical and Epidemiological Studies, 36, 1–33. https://pubmed.ncbi.nlm.nih.gov/24964267/
  4. Nelson, R., Furner, S., & Jesudason, V. (1998). Fecal incontinence in Wisconsin nursing homes. Diseases of the Colon & Rectum, 41(10), 1226–1229. https://doi.org/10.1007/bf02258218
  5. Dunivan, G. C., Heymen, S., Palsson, O. S., von Korff, M., Turner, M. J., Melville, J. L., & Whitehead, W. E. (2010). Fecal incontinence in primary care: prevalence, diagnosis, and health care utilization. American Journal of Obstetrics and Gynecology, 202(5), 493.e1–493.e6. https://doi.org/10.1016/j.ajog.2010.01.018
  6. Genworth Financial, Inc. (2024, March 12). Genworth Releases Cost of Care Survey Results for 2023: Twenty Years of Tracking Long-Term Care Costs. Genworth Financial, Inc. https://investor.genworth.com/news-events/press-releases/detail/972/genworth-releases-cost-of-care-survey-results-for-2023
  7. Wald, A. (2018). Diagnosis and Management of Fecal Incontinence. Current Gastroenterology Reports, 20(3). https://doi.org/10.1007/s11894-018-0614-0
  8. How, P., Trivedi, P. M., Bearn, P. E., & Thomas, G. P. (2020). Insert devices for faecal incontinence. Techniques in Coloproctology, 25(3), 255–265. https://doi.org/10.1007/s10151-020-02317-3