Last week, Australian athlete Joanna Wietrzyk experienced fecal incontinence during a HYROX race in Beijing. Wietrzyk continued competing and won the competition, but her athletic achievement was quickly eclipsed by images and videos of the accident. The public did not celebrate her strength or endurance; instead, it recoiled in disgust.
The HYROX incident raised legitimate concerns. Fecal matter on shared equipment creates a health risk. But the online response went far beyond a discussion of hygiene or race protocols. People circulated images and videos for entertainment. The athlete became a punchline and reportedly received abuse and online threats. Instead of recognizing a medical issue that race officials failed to manage appropriately, the public treated her as if she had committed a moral offense.
That reaction should concern us beyond the world of competitive sports. For millions of people living with fecal incontinence, the response to Wietrzyk’s accident reinforced the very stigma that prevents them from discussing their symptoms and seeking medical care.
Fecal incontinence is the involuntary loss of liquid or solid stool. It affects an estimated 8% of adults worldwide. In a large population-based survey, roughly one in seven people reported experiencing fecal incontinence, and these numbers likely underestimate just how many people it affects. Prevalence is higher in females and older adults and has profound effects on both physical and social well-being. It is associated with anxiety, depression, disability, and impaired functioning. People with fecal incontinence may plan every outing around access to bathrooms. They may carry extra clothing, avoid public transportation, or decline social outings. Some stop exercising, traveling, dating, or having sex.
Fecal incontinence has many potential causes. As seen in Wietrzyk’s case, sudden loss of bowel control during intense exercise may result from muscle fatigue and changes in bowel blood flow and motility. In contrast, chronic fecal incontinence results from factors such as obstetric injuries, pelvic floor dysfunction, chronic constipation, surgery, neurological disease, and aging-related changes, such as hormone fluctuations and decreased mobility, that may exacerbate underlying risk of developing incontinence. Management will depend on the underlying cause but may include strategies to address diarrhea or constipation through medication adjustments or diet, pelvic floor physical therapy including biofeedback, medical devices, or surgical interventions.
Despite the millions of individuals whose day-to-day lives are severely impacted by fecal incontinence, fewer than one-third seek care. Many people remain silent because of embarrassment and stigma, prefer for their clinician to initiate the conversation, or do not realize that fecal incontinence is a recognized medical condition with potentially effective treatments.
I believe part of the issue is that we’re simply not talking about the problem enough — not between clinicians and patients, not among family members or friends, and not in the mainstream media. And when we do, it’s through a viral spectacle that is riddled with shame and criticism, as seen with the HYROX incident. It's no surprise that such responses discourage people from seeking help.
The first step is greater public awareness. People need to recognize fecal incontinence as a medical condition that impacts millions of individuals. Physicians must also initiate these conversations instead of placing the entire burden on the patients. Asking a simple, direct question such as, “Do you ever experience accidental leakage of stool?” can make it safer for someone to disclose symptoms they may have concealed for years.
We also need more research to deepen our understanding of the condition and improve treatment modalities.
Perhaps the most urgent change is the narrative surrounding the condition. Fecal incontinence is not a character flaw, a lack of discipline, or evidence that someone is unclean. It can affect elite athletes, people recovering from childbirth, those living with gastrointestinal or neurological disease, or older adults. It can happen once under extraordinary circumstances or quietly shape someone’s life for years.
We should use this moment not to shame one athlete, but to begin a more honest and compassionate conversation for the millions of people who have been too embarrassed to start one themselves.
Originally published on MedPage.
