They become housebound and prefer to pass the day very close to the toilet to avoid losing feces. The exact incidence of FI is uncertain because of patients' hesitation to seek help from their physicians. Women seem to be at higher risk, mostly due to obstetric damage to the anal sphincters; however, during the last decade, an increasing interest has been dedicated to those forms of FI related to nontraumatic factors, which reach a relevant incidence (Bharucha, 2003). Older subjects are at very high risk, especially those with disabilities and those who are institutionalized. Moreover, young people are often affected. These factors create a significant economic impact for society, not only due to direct and indirect costs, but also due to intangible costs. FI may result from a variety of pathophysiological situations, and various risk factors can cause a wide range of inability to control feces passage. Therefore, an accurate diagnostic workup of each patient is fundamental. Although not fully agreed upon by all physicians, a multimodal diagnosis, using a multiparametric evaluation, seems to allow the most thorough understanding of FI pathophysiology and to indicate optimal treatment. These are really the most important and challenging aspects of FI management. Indeed, a wide range of therapeutic options is available, including conservative, rehabilitative, and surgical procedures. Highly variable rates of defecatory dysfunction and fecal incontinence have been reported, which most likely reflects the heterogeneity of the populations studied, the use of non-standardized questionnaires, a variety of definitions in terms of frequency of defecation or fecal loss, and patient reluctance to disclose these potentially embarrassing problems. Aging has been consistently identified as a major risk factor for the development of fecal incontinence, and the prevalence has been reported to approach 50% in nursing home residents (Cook and Mortensen 2002). A recent study of more than 3,000 community-dwelling women found a population-adjusted prevalence of 7.7% when fecal incontinence was defined as loss of liquid or solid stool at least monthly. The prevalence of fecal incontinence increased linearly with age (Melville et al., 2005). Many patients are reluctant to seek medical attention for bowel disorders because of embarrassment and social stigma. Primary care providers, including obstetricians and gynecologists, are therefore integral to the successful disclosure of such problems by routinely inquiring about bowel function during periodic health care visits.
The Research Problem
The problem with fecal incontinence is that it often goes undiagnosed and untreated in elderly patients mainly due to the social stigma attached to it. Not only are the patients reluctant to admit the problem, the physicians often fail to ask about the problem due to similar embarrassment that the patients feel or due to the fact that they think the problem to be insignificant. In the older age groups this is particularly significant since it is common in them. Large population surveys have revealed that above age 65, the prevalence is 3% to 7%. Many elderly people are forced to get admitted into nursing homes due to this problem so much so that the prevalence is as high as 50% (Perry et al., 2002). As highlighted by Bharucha et al. (2005), the financial