Garg P, Sudol-Szopinska I, Kolodziejczak M, Bhattacharya K, Kaur G. New objective scoring system to clinically assess fecal incontinence. World J Gastroenterol 2023; 29(29): 4593-4603 [PMID: 37621752 DOI: 10.3748/wjg.v29.i29.4593]
Corresponding Author of This Article
Pankaj Garg, MS, CEO, Chief Colorectal Surgeon, Colorectal Surgery, Garg Fistula Research Institute (GFRI), 1042, Sector-15, Panchkula 134113, Haryana, India. drgargpankaj@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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 Processing time: 96 Days and 16.7 Hours
ARTICLE HIGHLIGHTS
Research background
Fecal incontinence (FI) is a common problem. Its assessment is difficult, and an objective scoring system needs to be developed so that FI can be evaluated uniformly all across the globe.
Research objectives
To develop a new effective, and scientifically sound scoring system in which the shortcomings of the existing scoring systems are removed.
Research motivation
The existing scoring systems had many lacunae, due to which they were not scientifically accurate.
Research methods
A proforma was made in simple language in which all definitions of FI were included so that the study participants (patients and laypersons) could understand them. The study participants were then assigned disability scores (ranging from 0 to 100) for each type of FI based on a modified EQ-5D+ (EuroQol) descriptive system. The average score of each type of FI was calculated, divided by 10, and rounded off to determine the weight of each 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 that of the patients and laypersons.
Research results
One hundred participants (50 patients and 50 laypersons) were included in the study. A new scoring system was formulated in which the maximum possible score was 80 (total incontinence), and the least 0 (no incontinence). The surgeons’ ranking of FI severity differed significantly from the patients’ and the laypersons’ rankings, highlighting that the surgeons and the patients may perceive the severity of different FIs differently.
Research conclusions
A new scoring system for FI was formulated, which was simple, logical, comprehensive, and easy to use. The perceptions of patients and surgeons regarding the severity of different FIs differed significantly.
Research perspectives
The new scoring system would be useful for clinicians worldwide to objectively assess FI in the clinical setting.
