Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2023; 29(29): 4593-4603
Published online Aug 7, 2023. doi: 10.3748/wjg.v29.i29.4593
New objective scoring system to clinically assess fecal incontinence
Pankaj Garg, Iwona Sudol-Szopinska, Małgorzata Kolodziejczak, Kaushik Bhattacharya, Gurleen Kaur
Pankaj Garg, Colorectal Surgery, Garg Fistula Research Institute (GFRI), Panchkula 134113, Haryana, India
Pankaj Garg, Colorectal Surgery, Indus International Hospital, Mohali 140507, Punjab, India
Iwona Sudol-Szopinska, Department ofRadiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw 02-637, Poland
Małgorzata Kolodziejczak, Department of Proctology, Proctologic Center, St. Elizabeth Hospital, Warsaw 02-616, Poland
Kaushik Bhattacharya, Department of Surgery, MGM Medical College and LSK Hospital, Kishanganj 855107, Bihar, India
Gurleen Kaur, Department of Pharmacology, Adesh Medical College and Hospital, Shahbad 136143, Haryana, India
Author contributions: Garg P conceived and designed the study, collected and analyzed the data, revised the data, and finally approved and submitted the manuscript (Guarantor of the study); Sudoł-Szopińska I collected and analyzed the data, revised the data, finally approved and submitted the manuscript; Kołodziejczak M critically analyzed the data, reviewed and edited the manuscript, finally approved and submitted the manuscript; Bhattacharya K analyzed the data, revised the data, finally approved and submitted the manuscript; Kaur G analyzed the data, revised the data, and finally approved and submitted the manuscript.
Institutional review board statement: The study was approved by the Ethics Committee of Adesh Medical College and Hospital (Approval No. AMCH/IEC/2022/02/04).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at drgargpankaj@gmail.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pankaj Garg, MS, CEO, Chief Colorectal Surgeon, Colorectal Surgery, Garg Fistula Research Institute (GFRI), 1042, Sector-15, Panchkula 134113, Haryana, India. drgargpankaj@gmail.com
Received: April 27, 2023
Peer-review started: April 27, 2023
First decision: June 7, 2023
Revised: June 9, 2023
Accepted: July 11, 2023
Article in press: July 11, 2023
Published online: August 7, 2023
Abstract
BACKGROUND

Several scoring systems are used to assess fecal incontinence (FI), among which, the most commonly used are Wexner and Vaizey’s scoring systems. However, there are significant lacunae in these scoring systems, due to which they are neither accurate nor comprehensive.

AIM

To develop a new scoring system for FI that is accurate, comprehensive, and easy to use.

METHODS

A pro forma was made in which six types of FI were included: solid, liquid, flatus, mucous, stress, and urge. The weight for each FI was determined by asking a group of patients and laypersons to give a disability score to each type of FI from 0 to 100 (0- least, 100- maximum disability). The disability was assessed on a modified EQ-5D+ (EuroQol) description system, 4D3L (4 dimensions and 3 levels) for each FI. The average score of each FI was calculated, divided by 10, and rounded off to determine the weight of each FI type. The scores for the three levels of frequency of each FI were assigned as never = 0 (No episode of FI ever), occasional = 1 (≤ 1 episode of FI/ wk), and common = 2 (> 1 episode of FI/ wk), and was termed as frequency score. The score for each FI would be derived by multiplying the frequency score and the weight for that FI type. In the second phase of the study, a group of colorectal surgeons was asked to rank the six FI types in order of severity, and their ranking was compared with the patient and laypersons’ rankings.

RESULTS

Fifty patients and 50 laypersons participated in the study. The weight was assigned to each FI (solid-8, liquid-8, urge-7, flatus-6, mucus-6, and stress-5), and an new scoring system was formulated. The maximum possible score was 80 (total incontinence), and the least 0 (no incontinence). The surgeons’ ranking of FI severity did not correlate well with patients’ and laypersons’ rankings of FI, highlighting that surgeons and patients may perceive the severity of FI differently.

CONCLUSION

A new scoring system for FI was formulated, which was simple, logical, comprehensive, and easy to use, and eliminated previous shortcomings. Patients’ and surgeons’ perceptions of FI severity of FI did not correlate well.

Keywords: Feal incontinence, Scoring system, Urge, Stress, Flatus

Core tip: There are several scoring systems to assess fecal incontinence (FI), among which, the most commonly used are Wexner’s, Vaizey’s, and FI Severity Index scoring systems. However, there are major lacunae and shortcomings in these scoring systems, due to which, they are neither accurate and scientific nor comprehensive. We have developed a new scoring system to assess FI, which is better and more accurate than the existing scoring systems. The new system is more comprehensive and simple and easy to use, and most shortcomings of previous scoring systems have been addressed.