Fecal incontinence and quality of life assessment through questionnaires

Abstract

Background: Fecal incontinence causes a big impact on patient's quality of life. Our study analyzed the main questionnaires about fecal incontinence available internationally, aiming to delineate vantages and limitations of these instruments and their application, to mention the cultural aspects involved in the process of development and validation, as well as to suggest a reflection about the complexity of this matter. Results: Four of the instruments (Pescatori score, FISI, MSKCC bowel function instrument, and LARS score) do not include quality of life, working only as diagnostic tools. Two others, ‘Jorge and Wexner Fecal Incontinence score’, and ‘St Marks’ Fecal incontinence grading system’ can diagnose and grade fecal incontinence, however they are very subtle in assessing quality of life. The ‘EORTC Colorectal Cancer-specific’, on the other hand, focuses exclusively on quality of life. Although the ‘FIQL’ questionnaire assesses quality of life related to fecal incontinence, it does not measure leakage. Lastly, the ‘RAFIS’ assesses both aspects but too superficially. Conclusion: None of the questionnaires analyzed were able to simultaneously assess both fecal incontinence and quality of life successfully. Furthermore, the concepts related to fecal incontinence have different meanings depending on the cultural and psychosocial context. These differences are even greater when individuals of developed countries like the ones where these questionnaires were developed are compared to the ones of developing countries, such as Brazil, which makes its very hard for these instruments to be used universally.

Long Term Results of Modified Intersphincteric Resections for Low Rectal Cancer: A Single Center Experience

“…Quality of life can be assessed using various questionnaires, but all depend on numerous factors such as region, population background, etc. [39]. The Wexner score remains, in our opinion, the easiest to use for both surgeon and patient.…”

“…Numerous studies have sought to discover the best score to use following rectal surgery, but a consensus has yet to be reached, particularly for evaluation of quality of life [37,38]. The Wexner score has established itself as a good instrument in diagnosing and grading fecal incontinence [39].…”

Survival and functional and oncological outcomes following intersphincteric resection for low rectal cancer: short-term results

“…We consider the Wexner score system to be the easiest to use, and it has the best correlation between the patient’s subjective perception of continence and the clinical assessment made by the surgeon. 7 – 11 …”

Quality of Life Following Intersphincteric Resections for Low Rectal Cancer: Early Results

“…There are numerous ways to evaluate the continence (FIQL, RAFST etc. ), but we consider the Wexner score to be the easiest to accomplish and having the best correlation between the patient's perception of continence and the clinical assessment of the surgeon [22][23][24].…”