A comparison of faecal incontinence scoring systems

Area of Science:

• Gastroenterology
• Urology
• Gynecology

Background:

• Faecal incontinence (FI) severity is commonly assessed using multiple questionnaires for symptom evaluation across various settings and studies.
• The Pelvic Floor Disorders Consortium recommends using several questionnaires, despite potential question overlap.

Purpose of the Study:

• To evaluate the consistency of patient responses when completing multiple faecal incontinence questionnaires simultaneously.
• To determine if current practices of using multiple FI assessment tools yield reliable and comparable data.

Main Methods:

• A retrospective analysis of 193 patients with FI who completed three specific questionnaires (Fecal Incontinence Severity Index, Cleveland Clinic Florida Incontinence Score, St Mark's Incontinence Score) concurrently.
• Categorized incontinence episodes (solid stool, liquid stool, gas) into five levels for direct comparison across questionnaires.
• Defined response agreement as equivalent, slightly different (adjacent category), or very different (greater difference).

Main Results:

• Statistically significant differences (p < 0.005) were found in responses regarding the frequency of solid stool, liquid stool, and gas incontinence across all three questionnaires.
• Between 58.0% and 69.9% of responses were equivalent.
• 14.1%-34.0% of answers were slightly different, and 8.0%-18.8% were very different.

Conclusions:

• Patient responses to similar questions on different faecal incontinence questionnaires are frequently inconsistent, even when completed concurrently by the same individual.
• The clinical utility of employing multiple faecal incontinence questionnaires simultaneously for assessing symptoms should be critically re-evaluated.
• Findings question the reliability of combined FI questionnaire data in clinical practice.