To compare the current clinical scoring systems used to quantify the severity of symptoms of faecal incontinence (FI) to patients' subjective scoring of parameters of psychosocial wellbeing.
Methods: Patients referred to six European centres for investigation or treatment of symptoms of FI between June 2017 and September 2019 completed a questionnaire that captured patient demographics, incontinence symptoms using St. Mark's Incontinence score (SMIS) and ICIQ-B, psychological wellbeing (HADS: Hospital Anxiety and Depression Scale), and social interaction (a threeitem loneliness scale).Results: 318 patients completed questionnaires (62 men, mean age 58.7). 60% of the respondents were aged under 65. Median SMIS was 15 (11-18), ICIQ-B bowel pattern was 8 (6-11) and bowel control was 17 (13-22), similar across all demographic groups; however younger patients were more likely to experience symptoms of depression and anxiety (HADS score>10: 65.2% of patients age < 65 vs 54.9% of those age >= 65, p=0.03) with lower quality of life (ICIQ-B QoL: median score 19 (14-23)) vs age over 65 (16 (11-21)[p<0.005]. On loneliness score 25.5% reported often feeling isolated from others. One of the most significant concerns by patients was the fear and embarrassment related to unpredictable episodes of incontinence.
Conclusion:The SMIS remains a useful tool for quantifying incontinence symptoms but may underestimate the psychosocial morbidity associated with unpredictable episodes of incontinence.Interventions aimed at decreasing anxiety and to address feelings of disgust may be helpful for a significant number of patients requiring treatment for FI.
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