If We Don't Ask, They Won't Tell: Screening for Urinary and Fecal Incontinence by Primary Care Providers

Abstract

Background: More than half of older adults experience urinary (UI) or fecal incontinence (FI), but the majority have never discussed symptoms with health care providers. Little is known about primary care providers’ (PCPs’) screening for UI and FI. Methods: We conducted a cross-sectional electronic survey of PCPs within a Midwest academic institution to ascertain and compare PCPs’ beliefs, attitudes, and behaviors regarding screening and treatment for UI and FI; determine factors associated with screening for FI; and identify potential barriers to and facilitators of FI screening and treatment. Results: Among 154 PCPs, the screening rate for UI (75%) was more than double that for FI (35%;P < .001). PCPs believed that both UI and FI screening were important but felt better informed to treat UI (P < .001). Screening for FI was associated with UI screening (OR, 11.27; 95% CI, 4.9–26.0; P < .001); feeling informed to treat FI (OR, 10.21; 95% CI, 1.2–90.0; P =.01); screening verbally (OR, 3.9; 95% CI, 1.9–8.0; P < .001); perceiving screening as important (OR, 3.7; 95% CI, 1.8–7.4; P < .001); using the term, “accidental bowel leakage” (OR, 2.9; 95% CI, 1.2–6.7; P =.02) or “bowel control issues” (OR, 2.2; 95% CI, 1.1–4.5; P =.03); and being a resident (OR, 0.37; 95% CI, 0.16–0.82; P = .02). PCPs reported high interest in patient and provider educational materials about UI and FI. Conclusions: Most PCPs screen for UI but not FI. High reported interest in educational materials, coupled with high reported rates of perceived importance of screening for UI and FI, suggests that PCPs welcome informative interventions to streamline diagnosis and treatment. (J Am Board Fam Med 2018; 31:774–782.)

Urinary and fecal incontinence are independently associated with falls risk among older women and men with complex needs: A national population study

“…Although difficult to directly compare, due to different age compositions, in a US community‐based study of women (n = 762) and men (n = 778) aged greater than or equal to 50 years, 48.4% of women and 25.6% of men experienced UI, 15.2% of women and 11.1% of men suffered from FI, and 9.4% or women and 5.9% of men experienced both. Notwithstanding, these results further evince that urinary and fecal continence is often concurrent in both women and men aged greater than or equal to 65 years, 27 and would benefit from routine screening within primary health care settings 11 …”

“…This implies that the effect of UI on falls risk is not moderated by FI or vice versa. This gives even greater cause for routine screening of both UI and FI 11 . Notably, the effect sizes and variable definitions were largely different between women and men, which emphasizes the need for more robust sex‐specific evidence 16 .…”

“…Like falls, the pattern of incontinence is age dependent and different between females and males 10 . However, UI is often a neglected problem in older people, 3 and FI often overlooked altogether 9,11 . Yet, both UI and FI can be successfully managed in independent older adults with home‐based integrated geriatric care strategies and aids 11,12 …”

“…10 However, UI is often a neglected problem in older people, 3 and FI often overlooked altogether. 9,11 Yet, both UI and FI can be successfully managed in independent older adults with home-based integrated geriatric care strategies and aids. 11,12 The relationship between UI and falls in older adults has received considerable attention, 10,13,14 although men are commonly underrepresented or ignored in these studies, 14 and many studies suffer from methodological limitations such as incomplete control for confounding.…”

“…9,11 Yet, both UI and FI can be successfully managed in independent older adults with home-based integrated geriatric care strategies and aids. 11,12 The relationship between UI and falls in older adults has received considerable attention, 10,13,14 although men are commonly underrepresented or ignored in these studies, 14 and many studies suffer from methodological limitations such as incomplete control for confounding. [13][14][15] As such, there has been a call for more methodologically robust sex-specific research 16 ; which has garnered at least one response.…”