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Patients’ experience compared with physicians’ recommendations for treating fecal incontinence: a qualitative approach

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Abstract

Introduction and hypothesis

Using qualitative methods, we compared physician-recommended treatment options for fecal incontinence to patient knowledge of treatment options. Our hypothesis was that physician recommendations were not being communicated well to patients and that this impaired patients’ ability to cope with fecal incontinence.

Methods

Cognitive interviews were conducted with physicians who routinely care for women with fecal incontinence. Physicians were asked to describe their typical nonsurgical treatment recommendations and counseling for fecal incontinence. Women with bothersome fecal incontinence were recruited to participate in focus groups and asked about personal experience with fecal incontinence symptoms and treatment options. For both physician interviews and patient focus groups, qualitative data analysis was performed using grounded-theory methodology.

Results

Physicians identified several barriers patients face when seeking treatment: lack of physician interest toward fecal incontinence, and patient embarrassment in discussing fecal incontinence. Physicians universally recommended fiber and pelvic floor exercise; they felt the majority (approximately 70–80 %) of patients will improve with these therapies. Collectively, patients were able to identify all treatment recommendations given by physicians, although many had discovered these treatments through personal experience. Three concepts emerged regarding treatment options that physicians did not identify but that patients felt were important in their treatment: hope for improvement, personal effort to control symptoms, and encouragement to go on living life fully.

Conclusions

Whereas physicians had treatment to offer women with fecal incontinence, women had already found the best treatments through personal research and effort. Women want to hear a message of hope and encouragement and perceive personal effort from providers.

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Acknowledgements

This study was supported by a pilot grant from the Clinical and Translational Science Center at the University of New Mexico. Supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences through grant number UL1- TR000041. Rebecca G. Rogers is DSMB chair for American Medical Systems TRANSFORM trial.

Conflicts of interest

None.

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Authors and Affiliations

  1. Fellow Female Pelvic Medicine & Reconstructive Surgery, 1 University of New Mexico, MSC 10-5580, Albuquerque, NM, 87131-0001, USA

    Sara B. Cichowski & Rebecca G. Rogers

  2. Division of Urogynecology, 1 University of New Mexico, MSC 10-5580, Albuquerque, NM, 87131-0001, USA

    Gena C. Dunivan, Rebecca G. Rogers & Yuko M. Komesu

Authors
  1. Sara B. Cichowski
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  2. Gena C. Dunivan
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  3. Rebecca G. Rogers
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  4. Yuko M. Komesu
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Corresponding author

Correspondence to Sara B. Cichowski.

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Cichowski, S.B., Dunivan, G.C., Rogers, R.G. et al. Patients’ experience compared with physicians’ recommendations for treating fecal incontinence: a qualitative approach. Int Urogynecol J 25, 935–940 (2014). https://doi.org/10.1007/s00192-013-2322-5

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  • DOI: https://doi.org/10.1007/s00192-013-2322-5

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