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Development and Validation of a Bowel Diary for Fecal Incontinence: Comparison With a Questionnaire
Mohsin F Butt1, Satish S C Rao2, William E Whitehead3
1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Background And Aims:
Bowel diaries are used to characterize the severity of fecal incontinence (FI) but have not been adequately validated for this purpose. Our aims were to validate a new bowel diary and to compare the characteristics of FI as assessed with a bowel diary and a validated questionnaire.
Methods:
In this four-center prospective study, patients with a history of FI and asymptomatic controls completed a 28-day bowel diary and validated questionnaires to evaluate bowel habits and FI, quality of life related to FI (FIQoL), and PROMIS scales for anxiety, depression, and self-efficacy.
Results:
Among 59 participants with FI and 29 asymptomatic controls, the bowel diary was 97% sensitive and 93% specific for distinguishing between FI participants and controls. Over 28 days, FI participants experienced an average [SD] of 31.1 [50.7] FI episodes, consisting of staining (12.6 [14.9]), some stool (12.5 [20.3]), or a full bowel movement (4.4 [8.5]). Correlations between the questionnaire and diary were statistically significant for frequency (Spearman ρ = 0.5, p < 0.001), amount (ρ = 0.4, p < 0.001), and awareness of FI (ρ = 0.3, p = 0.04). In 71% of participants, there was agreement between the consistency of FI as reported in the questionnaire and the diary. More severe FI was associated with poorer FIQoL (p = 0.002). Anxiety, depression, and self-efficacy scores did not significantly affect the agreement between the frequency of FI reported in the diary and questionnaire.
Conclusion:
This bowel diary effectively discriminates between healthy participants and those with FI. There is significant, albeit modest, agreement between the characteristics of FI recorded with a diary and a questionnaire.
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