Imagine this:

A patient, 72, is recovering at home after a recent hospital stay. Her vitals look good. Medications are reconciled. A nurse checks in weekly, but something’s off. She starts limiting fluids to avoid “accidents,” skips outings with friends, and walks less to stay near the bathroom. Weeks later, she falls and ends up with a fractured hip. A preventable readmission.

No one asked her about bowel control. And she didn’t bring it up.

Fecal incontinence (FI), or accidental bowel leakage (ABL), often exists quietly in the background of clinical conversations. But for patients, these issues are anything but quiet. They erode confidence, limit mobility, and are directly tied to hospital readmissions, increased fall risk, and premature transitions to long-term care, especially when they go unrecognized.1

Providers are trained to lead with empathy and clinical insight. Yet many aren’t routinely screening for bowel leakage. Why is that?

Let’s unpack why this topic remains underreported, why patients hesitate to disclose it, and how we can change the narrative, starting with a more proactive, informed approach across primary and home health care.

The Prevalence Problem Isn’t New, But It’s Still Overlooked

According to data from the CDC’s National Health and Nutrition Examination Survey (NHANES), about 8.3% of adults in the United States experience fecal incontinence at least monthly, a number that increases significantly with age, comorbidities, and mobility issues.2 That’s nearly 1 in 12 adults.

Yet research consistently shows that up to 70% of individuals with FI never discuss it with a healthcare provider.3 Many assume it’s a normal part of aging, are too embarrassed to bring it up, or believe no effective solutions exist.

From a provider’s standpoint, it often falls off the radar unless prompted by a specific complaint. Especially in busy primary care or home health settings, incontinence conversations take a backseat to more urgent issues like medication management, chronic disease monitoring, or post-acute recovery planning.

But by ignoring the quiet presence of FI, we miss a critical opportunity to improve outcomes and quality of life.

When We Don’t Ask, Patients Stay Silent

FI is not only physically uncomfortable but emotionally isolating, too.

In interviews and patient surveys, those living with bowel leakage describe a steady shrinking of their world. They skip community events, avoid travel, and may even resist moving in with family or caregivers because they’re ashamed.

For many, it’s not a matter of choosing not to talk about it, but a learned silence. The stigma around bowel health is powerful. Older adults may feel it’s “undignified” to mention, especially to younger clinicians. Culturally, some patients are conditioned to see FI as taboo or deeply private. Others believe it’s a natural consequence of aging or previous surgeries and therefore unavoidable.

The result: They internalize the burden. And providers may assume all is well unless the patient says otherwise.

Missed FI Can Mean Missed Red Flags

FI often overlaps with other health concerns clinicians do screen for:

  • Falls and fractures, especially during nighttime bathroom trips or urgent attempts to reach a toilet.4
  • Urinary tract infections (UTIs), especially in patients with dual incontinence.5
  • Skin breakdown, moisture‑associated dermatitis, and pressure injuries, especially in immobile or bedbound patients or those with dual incontinence.7
  • Social isolation and depression, as patients may withdraw from normal activities, avoid travel, or stop social engagements.6

Beyond physical and mental health, unaddressed FI erodes dignity, autonomy, and quality of life. In fact, incontinence, particularly dual incontinence, is one of the leading drivers for long-term care (LTC) admission, often cited by families as the “tipping point” for needing help.8,9 For patients who value independence, maintaining bowel continence can be a critical factor in their ability to stay at home.

Dual incontinence affects 2-10% of patients in community-dwelling populations and 23-75% in nursing home residents.5

Why Primary Care and Home Health Play a Key Role

While specialists like gastroenterologists or colorectal surgeons may treat FI, primary care and home health clinicians are uniquely positioned to catch it early.

You see patients longitudinally. You build trust. You notice subtle behavioral changes. And you can intervene before leakage escalates to falls, infection, or institutionalization.

What gets in the way?

  • Lack of time during visits
  • Uncertainty around treatment options
  • Discomfort bringing it up
  • Assumption that someone else will address it

The truth is, FI doesn’t always require referral to a specialist right away. Mild to moderate cases can often be managed conservatively, and, with the right tools, discreetly in the home.

How to Spot Hidden Fecal Incontinence

FI doesn’t always present with frequent accidents. Often, it hides in behavioral and indirect clues:

  • Avoidance of travel, social events, or leaving the house “just in case.”6
  • Sudden reliance on adult incontinence garments or excessive laundry and soiled clothing.
  • Recurrent skin irritation, dermatitis, or unexplained rashes in the perianal area.7,5
  • Reports of urgency, loose stools, diarrhea, or irregular bowel habits (especially in patients with comorbid GI disorders, neurological disease, or medications affecting motility).
  • In home health or caregiving contexts: increased caregiver workload, laundry, odors — patients may feel ashamed to complain.
  • Non‑specific concerns like “falls at night,” unexplained pressure injuries, or repeated UTIs that FI might be contributing to, even if not documented.4,7

Recognizing these red flags requires active listening and a willingness to ask bowel‑health questions directly.

A Shift Toward Proactive Screening and Normalized Language

Here are some simple strategies to make bowel health part of your routine assessments:

Use neutral, straightforward language

Bringing up FI doesn’t have to be awkward. Instead of clinical jargon, try:

  • “Many people over 60 find occasional accidental bowel leakage more common than they expect. Have you noticed leaks or accidents lately?”
  • “Do you ever worry about getting to a bathroom in time when you’re out or at night?”
  • “Some patients find they wear protective garments or change clothes more often. Has that been necessary recently?”

It’s also important to keep in mind that patients prefer the term “accidental bowel leakage,” and this is supported by the National Institutes of Health (NIH) as stigma-reducing language.10

Normalize it across ages and conditions

Patients of all ages can experience FI, from new moms with pelvic floor trauma to adults with IBS to seniors with reduced sensation. Avoid assuming it’s “just part of aging” or “only happens in certain populations.”

Make it part of your intake or annual wellness visits

Just as we routinely ask about depression, sleep, or fall history, we can ask about bowel control. Consider using checkboxes or quick screener tools as part of intake paperwork:

  • Add one or two FI questions to annual wellness, fall‑risk, or chronic‑care checklists.
  • When documenting falls, skin breakdown, UTIs, or mobility issues, include bowel control in the review of systems.

Creating a safe, judgment-free environment helps patients feel more comfortable sharing their symptoms. It may be helpful to offer privacy and allow for written or self-reported responses if patients are uncomfortable speaking aloud.

Document, then act, even if the solution is small

Simple changes can yield some powerful results, ranging from diet or fiber support to pelvic floor referrals to introducing new product options that offer confidence without bulk.

Light-Touch Solutions That Patients Can Actually Use

Many patients live with leakage for years because the options presented are bulky, outdated, or impractical. Absorbent products may not offer full protection. Surgical interventions may feel too extreme. And if patients live alone or work full time, complex routines or device-based interventions might not be realistic.

That’s where simple, discreet tools like StaySure™ can fit in, offering reliable bowel support that doesn’t require a complicated regimen. It’s not a cure, but rather a bridge back to normal life. A way to participate in community again, maintain independence, and avoid unwanted transitions.

Clinicians play a critical role in introducing the full spectrum of options, and to treat bowel health with the same clinical attention given to other vital signs.

Frequently Asked Questions

How do I know if a patient has ABL if they won’t tell me?

Watch for clues: reduced social activity, unexplained skin issues, hesitancy around hydration or mobility. Proactive screening questions are key.

What can I recommend for patients who don’t want to wear pads or briefs?

There are discreet options like silicone rectal inserts (e.g., StaySure™), which are comfortable, easy to use, and help many patients resume daily activities with confidence.

What if the patient is too embarrassed to discuss it?

Create a safe, shame-free environment. Normalize it as a health issue. Let them know you’ve seen it before and there are ways to help.

Reclaiming a Missing Piece of Patient Care

When we don’t ask, patients stay silent.

When we do ask, gently, consistently, and without judgment, we uncover one of the most impactful care gaps affecting our aging and medically complex populations.

Fecal incontinence is more than an inconvenience. It’s a marker for broader risk. And it’s a quality-of-life issue we can do something about.

Let’s start by asking the question.

References

  1. Kayser, S. A., Koloms, K., Murray, A., Khawar, W., & Gray, M. (2021). Incontinence and Incontinence-Associated Dermatitis in Acute Care. Journal of Wound, Ostomy & Continence Nursing, 48(6), 545–552. https://doi.org/10.1097/won.0000000000000818
  2. 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
  3. Lalitha Kunduru, Heymen, S., Whitehead, W. E., & Kim, S. M. (2015). Factors That Affect Consultation and Screening for Fecal Incontinence. Clinical Gastroenterology and Hepatology, 13(4), 709–716. https://doi.org/10.1016/j.cgh.2014.08.015
  4. Schluter, P. J., Askew, D. A., Jamieson, H. A., & Arnold, E. P. (2020). Urinary and fecal incontinence are independently associated with falls risk among older women and men with complex needs: A national population study. Neurourology and Urodynamics, 39(3), 945–953. https://doi.org/10.1002/nau.24266
  5. Abe, T., Matsumoto, S., Kunimoto, M., Yoshikazu Hachiro, Ota, S., Ohara, K., Inagaki, M., Yusuke Saitoh, & Murakami, M. (2024). Prevalence of Double Incontinence and Lower Urinary Tract Symptoms in Patients with Fecal Incontinence: A Single-center Observational Study. Journal of the Anus Rectum and Colon, 8(1), 30–38. https://doi.org/10.23922/jarc.2023-040
  6. Wang, Y., Li, N., Zhou, Q., & Wang, P. (2023). Fecal incontinence was associated with depression of any severity: insights from a large cross-sectional study. International Journal of Colorectal Disease, 38(1). https://doi.org/10.1007/s00384-023-04563-x
  7. Park, K. H., & Choi, H. (2016). Prospective study on Incontinence-Associated Dermatitis and its Severity instrument for verifying its ability to predict the development of pressure ulcers in patients with fecal incontinence. International Wound Journal, 13(1), 20–25. https://doi.org/10.1111/iwj.12549
  8. Leung, F. W., & Schnelle, J. F. (2008). Urinary and Fecal Incontinence in Nursing Home Residents. Gastroenterology Clinics of North America, 37(3), 697–707. https://doi.org/10.1016/j.gtc.2008.06.005
  9. Bliss, D. Z., Gurvich, O. V., Eberly, L. E., & Harms, S. (2017). Time to and predictors of dual incontinence in older nursing home admissions. Neurourology and Urodynamics, 37(1), 229–236. https://doi.org/10.1002/nau.23279
  10. Hassani, D., Arya, L., & Andy, U. (2020). Continence: Bowel and Bladder and Physical Function Decline in Women. Current Geriatrics Reports, 9(2), 64–71. https://doi.org/10.1007/s13670-020-00313-x