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

* Beuy Joob
* Viroj Wiwanitkit

*Dear Editor*, we read the publication on “*If We Don't Ask, They Won't Tell: Screening for Urinary and Fecal Incontinence by Primary Care Providers*” with a great interest.1 Brown et al.1 found that most practitioners screened for urinary incontinence (UI) but not fecal continence (FI). We would like to share ideas on this issue. As noted by Brown et al., the problems about UI and FI are considered possibly shameful to talk among our patients in our setting in Indochina. The history about urination and defecation is rarely given by the patients unless there is a serious clinical problem. Asking for the UI and FI might get denial response or disguised information. Due to the possible taboo,2–3 it is suggested that the primary care practitioners should specially focus on the possible hidden problems. Special focus might be given to the elderly group whom the problems are common. Establishing trust is needed and it usually takes time to achieve success.4 The primary care nurse might take important role for this activity.4 Using a questionnaire of session interview might be considered, and the additional use of laboratory screening to seek for possible hidden problem in urinary and gastrointestinal tract, regardless of compliant or history of UI and FI, is recommended.

## References

1.  1.Brown HW, Guan W, Schmuhl NB, Smith PD, Whitehead ME, Rogers RG. If we don't ask, they won't tell: screening for urinary and fecal incontinence by primary care providers. J Am Board Fam Med 2018;31:774–82.
    
    [Abstract/FREE Full Text](http://www.jabfm.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NToiamFiZnAiO3M6NToicmVzaWQiO3M6ODoiMzEvNS83NzQiO3M6NDoiYXRvbSI7czoyMjoiL2phYmZwLzMyLzEvMTE5LjIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2.Papenkordt U, Pflege Z. The urinary and fecal incontinence taboo topic: counseled well, secure travel. Pflege 2011;64:329–33.
    
    

3.  3.Pearce L. Time to break the continence taboo. Nurs Stand 2016;30:24–5.
    
    

4.  4.Gray M, Burns SM. Continence management. Crit Care Nurs Clin North Am 1996;8:29–38.
    
    [PubMed](http://www.jabfm.org/lookup/external-ref?access_num=8695032&link_type=MED&atom=%2Fjabfp%2F32%2F1%2F119.2.atom)