Men and women experience different barriers to care seeking for fecal incontinence

Abstract

Background: Despite effective treatments for fecal incontinence (FI), FI remains underdiagnosed and undertreated. This study sought to characterize and compare rates of, delays in, experiences with, and barriers to care seeking for FI among men and women.

Methods: This study was a secondary analysis of electronic survey data collected from adults with FI. The survey included the use of a validated instrument to assess FI severity and questions that now comprise a validated instrument for assessing barriers to care seeking for FI in women. Descriptive analyses characterized differences between men and women. χ² testing for categorical variables and t-testing for normally distributed continuous variables compared statistical differences.

Results: The sample (N = 548) was predominately female (84%), non-Hispanic White (90%), and insured (96%), with a mean Vaizey score (13.4 ± 5.3) consistent with moderate or severe FI. Care seeking rates (p = 0.81) and symptom duration before care seeking (p = 0.23) did not differ between women and men, but women were more likely than men to be told that effective treatments exist; most male and female respondents who sought care were offered treatment. Very few respondents had been asked about FI by a healthcare provider. Whereas normative thinking, limited life impact, and believing that a healthcare provider could not help were more common barriers to care seeking among men, avoidance, fear, and discouragement were more common in women.

Conclusions: Men and women with FI seek care at similar rates and after experiencing symptoms for a similar duration of time. Very few patients with FI have been screened for it by a healthcare provider. Barriers to FI care seeking are different for women and men, and men are less likely than women to be informed about effective treatments by a healthcare provider.

Keywords: accidental bowel leakage; barriers to care; fecal incontinence; female; male; quality of life.

Figure 1.. CONSORT Diagram FI, fecal incontinence

The CONSORT diagram depicts the recruitment and enrollment of respondents in this study. Among 58,579 emails sent, 548 respondents (458 women, 90 men) were eligible for inclusion in this analysis.

Figure 2.. Commonly endorsed barriers to care seeking for fecal incontinence (FI), stratified by gender

Figure 2 displays rates of reported barriers to care seeking for fecal incontinence (FI) faced by respondents, stratified by sex. Fear of or lack of knowledge about treatment for FI were the most commonly cited barriers by both men and women.