COM Outlook Spring 2019

38 | DR. KIRAN C. PATEL COLLEGE OF OSTEOPATHIC MEDICINE FACULTY PERSPECTIVE FACULTY Perspective Bowel incontinence (BI), also called fecal inconti- nence and accidental bowel leakage, is a devastating illness. BI is defined as the accidental passing of solid or liquid stools from the anus. It is generally caused by degeneration, irritation, and weakness of the anal sphincter and pelvic floor muscles, which can result in occasional loss of bowel control. Some feel an urgent need, while others have no sensation at all and total loss of bowel control. BI is more common than most people think. Among noninstitutionalized people living in the community, between 7 to 15 percent have had BI in the past year. Risk factors are numerous and in- clude certain medica- tions (e.g., metformin), obesity, trauma during childbirth, digestive tract disorders, constipa- tion, smoking, chronic disease, spinal cord injury, stroke, and other known and unknown causes. BI is more common among women and more common as people age. People with BI often suffer emotionally, physically, and socially. In addition to physical discomfort due to skin irritation, BI is associated with anxiety, loss of dignity, anger, shame, depression, loneliness, and a high financial burden. Though BI often reduces quality of life, most people do not speak with their health care providers about their condition. An estimated 70 percent of people surveyed said they did not talk about their condition with their doctors, often because they were either too embarrassed to discuss it, or because they believed there was nothing their doctors could do to help them. Among people who did speak to their providers, they were more likely to do so with their primary care provider. Since screening for bowel inconti- nence in clinical practice is rare, particularly among primary care providers, most patients live silently with the condition. KPCOM clinical faculty members have a great opportunity to continue raising awareness among their trainees—students, residents, and fellows—about bowel incontinence. In KPCOM clinics, trainees are taught to regularly and actively question their patients about bowel and bladder incontinence, which are frequently linked. Faculty members also discuss evidence-based clinical guidelines from the American College of Gastroenterology and the American Geriatrics Society with trainees, which emphasize the core principles of managing patients with BI. These include treating underlying causes as appropriate, reducing symptoms, decreasing frequency and severity of episodes, improv- ing quality of life, and giving attention to patient-cen- tered goals of care. Trainees need exposure and guidance in having these discussions with their patients early in their medical education. One initiative implemented to try to improve generalized knowledge about BI is the Fecal Incon- tinence in Primary Care Consortium, which was funded from 2016–2018 by the Patient-Centered Outcomes Research Institute. Through the consor- tium, faculty members engaged patients, caregivers, researchers, providers, and other stakeholders to learn about knowledge gaps that align with their priorities. Time to Talk Stigmatizing Disorder Demands Attention BY NICOLE COOK, PH.D., M.P.A., AND ELIZABETH HAMES, D.O., CMD PEOPLE WITH BI OFTEN SUFFER emotionally physically socially