Skip to main content

Advertisement

Log in

Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence

The fecal incontinence severity index

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: The purpose of this research was to develop and evaluate a severity rating score for fecal incontinence, the Fecal Incontinence Severity Index. METHODS: The Fecal Incontinence Severity Index is based on a type × frequency matrix. The matrix includes four types of leakage commonly found in the fecal incontinent population: gas, mucus, and liquid and solid stool and five frequencies: one to three times per month, once per week, twice per week, once per day, and twice per day. The Fecal Incontinence Severity Index was developed using both colon and rectal surgeons and patient input for the specification of the weighting scores. RESULTS: Surgeons and patients had very similar weightings for each of the type × frequency combinations; significant differences occurred for only 3 of the 20 different weights. The Fecal Incontinence Severity Index score of a group of patients with fecal incontinence (N = 118) demonstrated significant correlations with three of the four scales found in a fecal incontinence quality-of-life scale. CONCLUSIONS: Evaluation of the Fecal Incontinence Severity Index indicates that the index is a tool that can be used to assess severity of fecal incontinence. Overall, patient and surgeon ratings of severity are similar, with minor differences associated with the accidental loss of solid stool.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Smith M. Severity. In: Kane RL, ed. Understanding health care outcomes research. Gaithersburg: Aspen Publishers, 1997:129–52.

    Google Scholar 

  2. Jamieson JR, Stein HJ, DeMeester TR,et al. Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility [see comments]. Am J Gastroenterol 1992;87:1102–11.

    Google Scholar 

  3. Shelton A, Madoff R. Defining anal incontinence: establishing a uniform continence scale. Semin Colon Rectal Surg 1997;8:54–60.

    Google Scholar 

  4. Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SG. Anorectal function investigations in incontinent and continent patients. Differences and discriminatory value. Dis Colon Rectum 1990;33:479–85; discussion 485–6.

    Google Scholar 

  5. Rogers, J, Henry MM, Misiewicz JJ. Combined sensory and motor deficit in primary neuropathic faecal incontinence. Gut 1988;29:5–9.

    Google Scholar 

  6. Tjandra J, Sharma B, McKirdy H,et al. Anorectal physiology testing in defecatory disorders: a prospective study. Aust N Z J Surg 1994;64:322–6.

    Google Scholar 

  7. Gilliland R, Altomare DF, Moreira H Jr,et al. Pudendal neuropathy is predictive of failure following anterior overlapping sphincteroplasty. Dis Colon Rectum 1998;41:1516–22.

    Google Scholar 

  8. Bartram C, Law P. Anal endosonography: technique and application. Adv Gastrointest Radiol 1991;1:101–15.

    Google Scholar 

  9. Brodén G, Dolk A, Holmström B. Recovery of the internal anal sphincter following rectopexy: a possible explanation for continence improvement. Int J Colorectal Dis 1988;3:23–8.

    Google Scholar 

  10. Corman ML. Gracilis muscle transposition for anal incontinence: late results. Br J Surg 1985;72(Suppl):S21–2.

    Google Scholar 

  11. Rainey, JB, Donaldson DR, Thomson JP. Postanal repair: which patients derive most benefit? J R Coll Surg Edinb 1990;35:101–5.

    Google Scholar 

  12. Rudd WW. The transanal anastomosis: a sphincter-saving operation with improved continence. Dis Colon Rectum 1979;22:102–5.

    Google Scholar 

  13. Womack NR, Morrison JF, Williams NS. Prospective study of the effects of postanal repair in neurogenic faecal incontinence. Br J Surg 1988;75:48–52.

    Google Scholar 

  14. Kelly JH. Cine radiography in anorectal malformations. J Pediatr Surg 1969;4:538–46.

    Google Scholar 

  15. Holschneider AM. Treatment and functional results of anorectal continence in children with imperforate anus. Acta Chir Belg 1983;82:191–204.

    Google Scholar 

  16. Lunniss PJ, Kamm MA, Phillips RK. Factors affecting continence after surgery for anal fistula. Br J Surg 1382;81:1382–5.

    Google Scholar 

  17. Rothenberger D. Anal incontinence. In: Cameron JL, ed. Current surgical therapy. Philadelphia: Decker Mosby, 1984:185–94.

    Google Scholar 

  18. Miller R, Bartolo DC, Locke-Edmunds JC, Mortensen NJ. Prospective study of conservative and operative treatment for faecal incontinence. Br J Surg 1988;75:101–5.

    Google Scholar 

  19. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97.

    Google Scholar 

  20. Pescatori M, Anastasio G, Bottini C, Mentasti A. New grading and scoring for anal incontinence: evaluation of 335 patients. Dis Colon Rectum 1992;35:482–7.

    Google Scholar 

  21. Rockwood TH, Church JM, Fleshman JW,et al. FIQL: a quality of life instrument for patients with fecal incontinence. Dis Colon Rectum (in press).

  22. Kane R, Rockwood T, Finch M, Philp I. Consumer and professional ratings of the importance of functional status components. Health Care Financing Rev 1997;19:11–22.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Supported by a contract between the University of Minnesota Clinical Outcomes Research Center and The American Society of Colon and Rectal Surgery and the Minnesota Colon and Rectal Foundation.

About this article

Cite this article

Rockwood, T.H., Church, J.M., Fleshman, J.W. et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence. Dis Colon Rectum 42, 1525–1531 (1999). https://doi.org/10.1007/BF02236199

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02236199

Key words

Navigation