For many patients, fecal incontinence (FI), or accidental bowel leakage (ABL), is a quiet burden. It’s not just a matter of discomfort or embarrassment. It’s a barrier to daily life, emotional well-being, and independence.

And yet, most patients won’t bring it up on their own.

In fact, research shows fewer than 30% of people living with FI report their symptoms to a healthcare provider.1 For many, it’s not that they don’t want help; it’s that they don’t know how to ask. As providers, we have the opportunity to change that dynamic by making the first move.

Why Patients Don’t Speak Up

To create a space where patients feel safe opening up, we need to understand the roadblocks that keep them silent. Common emotional and psychological barriers include:2

  • Shame or stigma: Many believe they’re the only ones experiencing bowel leakage, which makes them feel isolated or “abnormal.”
  • Fear of diagnosis or invasive treatment: Patients may fear a serious underlying condition or assume surgery is the only option.
  • Minimization or resignation: Especially in older adults, FI is often dismissed as a natural part of aging, or simply something to endure.
  • Negative past experiences: Some may have previously felt dismissed when raising sensitive issues.

These barriers are powerful. That’s why the provider’s role is not just to diagnose and treat, but to invite the conversation.

The Importance of Opening the Door

Asking directly about bowel symptoms can feel awkward, even for experienced providers. But patients take their cue from you. When you ask with compassion and neutrality, it helps normalize the topic. It sends the message:

“This is a medical issue, not a personal failing. You deserve support.”

Proactive screening also improves outcomes. FI is highly underdiagnosed, especially in men, and is associated with depression, social withdrawal, and increased risk of long-term care placement.3 A few simple questions could help someone stay in their home, reconnect with daily life, and regain their confidence.

How to Ask About FI with Empathy

Here are strategies providers can use to make these conversations easier for you and your patients.

1. Normalize It Early

Introduce bowel health as a routine part of wellness checks or GI symptom reviews, just like you would ask about sleep or diet. For example:

  • “I always ask my patients about bladder and bowel control, since changes are more common with age or certain health conditions. Have you noticed any leakage or urgency that’s hard to manage?”

This reinforces that FI isn’t taboo, but just another part of health.

2. Use Plain, Clear Language

Medical terms like “fecal incontinence” may not resonate with patients. Try:

  • “Have you ever had accidents or unexpected leakage of stool or gas?”
  • “Are you having trouble making it to the bathroom in time?”
  • “Do you ever soil your underwear without realizing it?”

Avoid euphemisms or vague phrasing. Clear language reduces confusion and helps patients feel seen.

3. Watch for Indirect Cues

Patients may not disclose FI directly, but they might hint at it in other ways, such as:

  • Avoiding social situations
  • Describing hygiene difficulties or rashes
  • Reporting sudden lifestyle changes (e.g., avoiding exercise, travel, or intimacy)
  • Expressing embarrassment, sadness, or anxiety without clear cause

When you notice these patterns, a gentle follow-up like “Can I ask—have you noticed any issues with bowel control or leakage?” can bridge the gap.

4. Offer Permission to Be Honest

Sometimes all patients need is to hear that it’s okay to talk about it.

You can say:

  • “This is something I hear more often than you might think.”
  • “It’s not uncommon, and there are things we can try that don’t involve surgery.”
  • “If this ever becomes a concern for you, know that we can work on it together.”

By opening the door now, even if they’re not ready to walk through it, you’ve made future disclosure easier.

Who to Ask: High-Risk Populations

While FI can affect anyone, some groups may benefit from routine screening. Consider asking about bowel leakage in patients who are:4

  • Age 65 or older
  • Managing urinary incontinence or declining mobility
  • Living with chronic diarrhea or loose stools
  • Recovering from anorectal or colorectal procedures
  • Reporting unexplained weight loss, hygiene issues, or social withdrawal

These signs are often overlooked, but catching them early can lead to more conservative, successful interventions.

What to Say Next When a Patient Says Yes

Once a patient opens up, affirm their experience:

  • “Thank you for telling me. I know this isn’t easy to talk about.”
  • “This is more common than you might think, and you’re not alone.”
  • “There are options we can explore that help many people manage this.”

From there, assess symptom severity, potential causes (e.g., diarrhea, nerve damage, prior surgeries), and quality of life impacts. Then explain that treatment can range from conservative options like diet changes and pelvic floor training to medical devices like discreet rectal inserts or pads.

How StaySure™ Helps Support These Conversations

For patients who may feel especially overwhelmed or resistant to bulky products, StaySure™ offers a discreet, clinically thoughtful option.

StaySure™ is a soft, comfortable rectal insert made from 100% silicone. It’s designed to seal the anorectal junction to help prevent leakage, without the bulk, visibility, or frequent changes associated with pads.

Because it’s simple, comfortable, and easy to use, it can be a bridge for patients who are not yet ready for more complex interventions but need a solution now.

How It Works Download StaySure™ Clinician Brochure

Creating a More Inclusive, Compassionate Standard of Care

Talking about bowel leakage shouldn’t be the hardest part of your appointment. When we lead with empathy, clarity, and options, we help patients move past shame and toward meaningful care.

Fecal incontinence is not rare. It is not untreatable. And it does not have to go unspoken.

Let’s make the conversation a little easier, for everyone.

References

  1. 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
  2. Brown, H. W., Guan, W., Schmuhl, N. B., Smith, P. D., Whitehead, W. E., & Rogers, R. G. (2018). If We Don’t Ask, They Won’t Tell: Screening for Urinary and Fecal Incontinence by Primary Care Providers. The Journal of the American Board of Family Medicine, 31(5), 774–782. https://doi.org/10.3122/jabfm.2018.05.180045
  3. Rebullar, K., Orcutt, D. J., Kaufman, M. R., Dmochowski, R. R., & Sebesta, E. M. (2025). Fecal Incontinence Drives the Psychosocial Burden in Patients with Dual Incontinence. International Urogynecology Journal, 36(11). https://doi.org/10.1007/s00192-025-06192-0
  4. Pasricha, T., & Staller, K. (2021). Fecal Incontinence in the Elderly. Clinics in Geriatric Medicine, 37(1), 71–83. https://doi.org/10.1016/j.cger.2020.08.006