Why Male Patients Are Missing from the Fecal Incontinence Conversation

In primary care visits, it’s common to ask older women about urinary incontinence, pelvic health, or changes in bowel function. But what about their male counterparts?

Let’s consider a familiar scenario.

A man in his late sixties comes in for a follow‑up appointment. His blood pressure has stabilized. His diabetes management plan is on track. He even jokes about getting back into golf, as long as the course has “easy bathroom access.”

What he doesn’t say is that he sometimes doesn’t make it in time.

Many men experiencing accidental bowel leakage (ABL) or fecal incontinence (FI) remain invisible in the healthcare conversation. They live with a condition that is stigmatized, misunderstood, and rarely screened for in male populations, despite data showing they are affected almost as often as women.¹

FI affects 7.7% of men and 8.9% of women in the U.S.²

Prevalence is not the clinical gap. Silence is. We cannot treat what we do not ask about.

What the Epidemiology Tells Us

A landmark NHANES population study found that FI affects an estimated 18 million community‑dwelling adults in the U.S.²

And importantly:

Even though rates are similar, men appear in clinics less. Therein lies the problem: men are less likely to ask for help. Delayed care means higher severity when they do finally disclose symptoms.

One study of 764 FI patients found that men delayed seeking care for an average of 37.6 months, compared to 23.7 months in women (p<0.001).¹ By the time they do speak up, FI is more frequently moderate–to–severe in men (71% versus 42%).¹

That silence just magnifies the severity.

Why Male FI Goes Unnoticed

There are several barriers to this issue, rooted in both patient behavior and provider assumptions.

Patient-Driven Barriers:

• Stronger cultural stigma around bowel control and masculinity
• Fear that FI signals aging, frailty, or loss of independence
• Lower routine healthcare utilization than women
• Belief that FI is “not treatable”
• Tendency toward “secret resignation,” coping alone rather than seeking help³
• Less familiarity with FI terminology and treatment options³

In one study, 81% of patients who hadn’t discussed their FI with a provider were unaware that treatments existed.⁷

Provider-Driven Barriers:

• Bias linking bowel leakage primarily to female obstetric injury¹
• Screening questions that focus on urinary incontinence only
• Lack of awareness of male‑specific risk pathways
• Underestimation of how often men experience distress or lifestyle restriction⁵

Result: providers wait for men to bring it up, and men wait for providers to ask.

And 88% of the time, it’s the patient who initiates the conversation.⁷

What Causes FI in Men

While some causes overlap with women, men present with distinct clinical patterns and risks.

Common contributors in male patients include:

• Ano‑rectal or colorectal surgery (e.g., hemorrhoidectomy, fistula repair)¹
• Chronic diarrhea (a leading modifiable cause; present in ~40%-50% of male FI patients)^1,6
• Neurological disorders, including Parkinson’s, stroke, MS, and diabetes with neuropathy
• Chronic constipation and straining
• Pelvic radiation and prostate surgery (including nerve damage)
• Rectal hyposensitivity, often underrecognized⁶
• Comorbidities like irritable bowel syndrome (IBS), diabetes, or mobility limitations⁶

Additionally, medications (like laxatives or metformin), dietary supplements, and certain foods may worsen symptoms, yet these factors are rarely assessed unless the patient volunteers them.⁸

Symptoms That Should Trigger More Questions

The challenge is that bowel leakage in men doesn’t always present in obvious ways. It doesn’t always look like urgency. Clinicians often mistake it for poor hygiene or post-surgical residue. Men may also downplay their symptoms or use indirect language.

Watch for the following:

• “Staining” or passive soiling of underwear
• Skipping outings or avoiding long trips
• Stool leakage during exertion or sneezing
• Skin irritation or rash in the perineal area
• Carrying spare clothes or wipes “just in case”

In one study, 21% of men reported isolated soiling, compared to 5% of women.²

Validated severity tools like the Accidental Bowel Leakage Evaluation (ABLE) or Rapid Assessment Fecal Incontinence Score (RAFIS) scale can help clinicians better quantify symptoms, especially when traditional tools like the Wexner score miss the lifestyle impact.⁸

Why This Matters for Outcomes

FI is not benign. It is a predictor of health decline, not just a quality‑of‑life issue.

Unchecked, it can lead to:^2,5

• Reduced mobility and increased fall risk
• Depression, isolation, and loss of dignity
• Urinary tract infections from intentional dehydration
• Skin breakdown and pressure injuries
• Early nursing home placement

In one Wisconsin study, nursing home FI prevalence approached 50%, making it one of the top contributors to long-term care (LTC) admission.⁶ Families often describe FI as the tipping factor for institutionalization. Addressing it early can help keep patients safely at home longer.

Qualitative studies also show that FI impacts employment, intimacy, body image, and — in women — even their sense of identity as a caregiver or mother.⁸ While less reported in men, similar psychosocial impacts are likely present but unspoken.

How Providers Can Improve Detection and Outcomes

Small shifts in language and workflow go a long way.

Normalize and integrate screening

FI is as relevant as fall risk, hydration, or polypharmacy. The key to identifying it in male patients? It’s asking them. But how we ask matters.

If we want real answers, we need to make room for honesty without embarrassment. Here are a few examples of effective, low-stigma screening language.

Add these questions to intake forms or annual visits:

• “Have you had any accidental stool leakage recently, even small amounts?” or “Many men have some loss of bowel control, so have you noticed anything like that?”
• “Any trouble getting to the toilet in time for bowel movements?”
• “Have you noticed any changes in your bowel control?”

Many patients prefer screening via questionnaire, not verbal questioning, especially men.⁷

Don’t wait for ‘severe’

In the CGH study, 56% of non-consulters said they didn’t think their symptoms were serious enough to mention.⁷ But they still experienced quality-of-life disruption and would have welcomed clinician-initiated conversations.

Conduct a focused FI assessment, including:

• Bowel diary and diet/fluid review
• Medication/supplement inventory
• Digital rectal exam — validated as reliable for assessing squeeze and resting tone⁵
• Evaluation of toileting access, mobility, and cognitive factors

Once you've identified contributing factors through assessment, prompt initiation of conservative therapies can often provide meaningful improvement before specialist referral is needed.

Treat sooner, before referring

Not all patients need a specialist first. Over 50% of patients improve with conservative management alone.⁵

The strongest evidence supports:⁵

• Dietary fiber supplementation (Grade A)
• Pelvic floor muscle therapy (Grade B)
• Loperamide or anti-diarrheals (Grade B) — though individual response varies
• Transanal irrigation for persistent symptoms
• Behavioral changes like scheduled toileting

Even simple, early interventions can make a meaningful difference while awaiting specialist care, especially when they’re tailored to the patient’s symptoms and goals.

Where StaySure™ Can Help

Many men hesitate to wear pads or briefs. They worry about discretion, stigma, or loss of autonomy. That’s where StaySure™ offers a different kind of support, one that fits their lifestyle:

StaySure™, a soft silicone rectal insert, is designed to:

• Reduce leakage discreetly
• Maintain continence without external products
• Support independence and daily activity immediately

StaySure™ fits well within first-line conservative options, especially when absorbent garments are not acceptable or effective.

A Call for Inclusive Continence Care

FI does not care about sex. What differs is:

• Who is asked the question
• Who feels safe enough to answer
• Who receives solutions that match their goals

Clinicians can shift the narrative with small, meaningful actions:

• Screen consistently, not selectively
• Validate symptoms, regardless of sex or stigma
• Start with conservative treatment, including newer support tools
• Encourage early disclosure and reduce shame

Fewer men should have to reach a breaking point before getting the care they need. They deserve the same proactive treatment offered to anyone else.

Because bowel health is whole-person health.

It starts with a question. And continues with care and solutions that preserve dignity and independence.

References

1. Muñoz-Yagüe, T., Solís-Muñoz, P., Ciriza de los Ríos, C., Muñoz-Garrido, F., Vara, J., & Solís-Herruzo, J. A. (2014). Fecal incontinence in men: Causes and clinical and manometric features. World Journal of Gastroenterology, 20(24), 7933. https://doi.org/10.3748/wjg.v20.i24.7933
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. Peden-McAlpine, C., Bliss, D., Becker, B., & Sherman, S. (2012). The Experience of Community-Living Men Managing Fecal Incontinence. Rehabilitation Nursing, 37(6), 298–306. https://doi.org/10.1002/rnj.038
4. Mazor, Y., Jones, M., Andrews, A., Kellow, J. E., & Malcolm, A. (2017). Novel insights into fecal incontinence in men. AJP Gastrointestinal and Liver Physiology, 312(1), G46–G51. https://doi.org/10.1152/ajpgi.00362.2016
5. Bliss, D. Z., Mimura, T., Bary Berghmans, Bharucha, A. E., Carrington, E. V., Engberg, S. J., Hunter, K., Santoro, G., Kumaran, T., Sakakibara, R., Emmanuel, A., & Panicker, J. (2024). Clinical assessment, conservative management, specialized diagnostic testing, and quality of life for fecal incontinence: Update on research and practice recommendations. Continence, 9, 101063–101063. https://doi.org/10.1016/j.cont.2023.101063
6. Nelson, R. L. (2004). Epidemiology of fecal incontinence. Gastroenterology, 126, S3–S7. https://doi.org/10.1053/j.gastro.2003.10.010
7. Kunduru, L., Kim, S. M., Heymen, S., & Whitehead, W. E. (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
8. Mundet, L., Ribas, Y., Arco, S., & Clavé, P. (2015). Quality of Life Differences in Female and Male Patients with Fecal Incontinence. Journal of Neurogastroenterology and Motility, 22(1), 94–101. https://doi.org/10.5056/jnm15088