Fecal incontinence.

A 74-year old woman with a medical history of hypertension, diabetes, and urinary incontinence comes for an annual exam. She feels well, has no physical complaints, and has been healthy since her last visit. She reports her urinary incontinence has improved, but mentions that she sometimes has “accidents” with stool. Her obstetrical history is significant for 3 vaginal deliveries, one with a 3 degree tear. She had no difficulties with fecal control when she was younger. She reluctantly admits this has been going on for many years but she has been too embarrassed to talk about it. When asked how often this happens, she says often enough that she has adjusted her lifestyle. She tries to stay home as much as she can, has her friends come to her, and avoids going any place where a bathroom is not readily accessible.