To the Editor—Thank you for the opportunity to comment on the letter and the use of the St. Mark’s incontinence scores. We have been using the simple 13-point score initially described by Lunniss, Kamm, and Phillips from St. Mark’s since the inception of our biofeedback program in 1994.1 We have published a randomized, controlled trial2 and multiple articles utilizing this simple 13-point score.3–7 Patients and investigators have been happy with the score, and it has achieved validity in our institution by its repeated use (>2,500 times) and demonstration that it is sensitive to change measured by both patients’ and clinicians’ perceptions of their continence, against quality of life (QOL) indicators, anal physiology measures and the Pescatori score. Nevertheless, we repeat that we believe that quantitative continence scores are not as sensitive to change and may not be as important to patients as QOL measures.5

In 1994, when our biofeedback program was initiated, there were limited choices of well-validated fecal incontinence scoring systems (in fact there were no properly validated instruments). We are currently recruiting in a new randomized, controlled trial, and Maeda, Vaizey, and Norton will be pleased to know that we are using the “new” Vaizey St Mark’s score as the primary incontinence score in this upcoming study, because we agree that it is a better instrument.8 Fortunately, it is backwards compatible with the “old” Lunniss St. Mark’s score, which will enable us to compare ongoing studies with our older studies.