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

To the Authors: We are thrilled that you took the time to read and comment on our article. Thank you for offering a cultural perspective on the stigma surrounding urinary and fecal incontinence. Importantly, you note that patients may deny that they suffer from these conditions, even when physicians ask about them, and that building trust with patients will facilitate more honest and open discussions about urination and defecation, which are taboo topics for many people.

In a previous qualitative study, we learned that patients find it difficult to initiate discussions about incontinence with medical providers because of the associated shame and embarrassment.¹ These patients prefer that their providers ask openly about possible urinary or fecal incontinence. Providers, on the other hand, say they prefer that patients volunteer this information. This predicament makes fecal incontinence a “hidden problem” in itself.

Your suggestion of initiating the discussion with less taboo topics such as diarrhea or constipation may be a successful approach that preserves patient comfort. Initiating discussion in a patient-centered manner, possibly with assistance of questionnaires or universal screening by allied health professionals, is crucial to bringing the problem of fecal incontinence out of hiding. Thankfully, a broad range of effective treatments is available to patients.

Thank you again for your input on this important topic.