I read "Self-Management of Urinary and Fecal Incontinence" (January) and am concerned about any recommendation to decrease fluid intake. Patients often hear this and stop drinking altogether.

Also, the use of antidiarrheal medications isn't usually recommended without first conducting a rectal exam and ordering an abdominal flat plate X-ray, as losing stool can be a sign of impaction. These agents can make constipation much worse, resulting in obstipation, megacolon, intestinal rupture, and even death.1-3

Incontinence is an important topic for the public to become aware of, as it decreases quality of life. Bowel and bladder training is crucial if we are to help older and disabled patients to maintain their independence.

Sheree L. Loftus, PhD, MSN, GNP-BC, CRRN

New York City

Authors Mary H. Wilde and Donna Z. Bliss respond: We wrote this article with a diverse patient population in mind. The issue of fluid management in people with incontinence is complex, and we thought about this a great deal. We agree that fluids shouldn't be restricted in the elderly. However, many with incontinence are not elderly, and managing fluids is a key issue requiring information about what an individual is drinking, including the amount and type of fluid. We were unable to include this detail in our manuscript.

Our recommendations for antidiarrheal medications assume best practices have been followed.

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