Training and Comfort in the Management of Fecal Incontinence

Area of Science:

• Urogynecology
• Female Pelvic Medicine and Reconstructive Surgery
• Gastroenterology

Background:

• Fecal incontinence (FI) is a prevalent condition that is frequently underdiagnosed and undertreated.
• Gaps in training, comfort, and confidence among urogynecology clinicians managing FI can impede patient access to quality care.

Purpose of the Study:

• To assess clinical exposure, didactic training, and self-reported comfort levels in managing FI among urogynecology fellows and attending physicians in the United States.

Main Methods:

• An anonymous electronic survey was distributed to U.S. physician members of the American Urogynecologic Society (AUGS).
• The survey evaluated demographics, FI exposure, availability of diagnostic/procedural tools, education, and comfort with FI management.
• Descriptive statistics and one-way ANOVA were used to analyze the data.

Main Results:

• 202 respondents (35 fellows, 167 attendings) completed the survey.
• Most respondents evaluated patients with FI weekly, but fewer than half felt comfortable performing or interpreting key diagnostic procedures like anorectal manometry or endoanal ultrasound.
• Only 8.6% of fellows and 31.1% of attendings reported feeling very comfortable with FI management, though overall comfort increased with training and practice experience.

Conclusions:

• Clinical and didactic exposure to FI management varies significantly within urogynecology training and practice.
• Limited procedural experience contributes to persistent discomfort among clinicians, highlighting a need for improved training.
• Standardizing fellowship education and enhancing interdisciplinary training are recommended to improve clinician confidence and patient outcomes.