Article

Fecal Incontinence Quality of Life Scale. Quality of life instrument for patients with fecal incontinence

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

This goal of this research was to develop and evaluate the psychometrics of a health-related quality of life scale developed to address issues related specifically to fecal incontinence, the Fecal Incontinence Quality of Life Scale. The Fecal Incontinence Quality of Life Scale is composed of a total of 29 items; these items form four scales: Lifestyle (10 items), Coping/Behavior (9 items), Depression/Self-Perception (7 items), and Embarrassment (3 items). Psychometric evaluation of these scales demonstrates that they are both reliable and valid. Each of the scales demonstrate stability over time (test/retest reliability) and have acceptable internal reliability (Cronbach alpha >0.70). Validity was assessed using discriminate and convergent techniques. Each of the four scales of the Fecal Incontinence Quality of Life Scale was capable of discriminating between patients with fecal incontinence and patients with other gastrointestinal problems. To evaluate convergent validity, the correlation of the scales in the Fecal Incontinence Quality of Life Scale with selected subscales in the SF-36 was analyzed. The scales in the Fecal Incontinence Quality of Life Scale demonstrated significant correlations with the subscales in the SF-36. The psychometric evaluation of the Fecal Incontinence Quality of Life Scale showed that this fecal incontinence-specific quality of life measure produces both reliable and valid measurement.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Частота заживления раны оценивалась визуально на 30 день после оперативного вмешательства. Для оценки качества жизни пациентов после ТЭМ использовали опросник FIQL (Fecal Incontinence Quality of Life), состоящий из 29 вопросов, который используется для оценки проблем, связанных с недержанием кала [17]. Эти вопросы относятся к 4 категориям: 1) образ жизни; 2) адаптация/ Рисунок 1. Патоморфологический препарат удаленной стенки кишки с опухолью Figure 1. ...
... 2). Обе группы были сопоставимы по возрасту, полу, расстоянию дистального края опухоли от края ануса, расположению опухоли по окружности, наибольшему размеру дефекта стенки кишки (при полной (17,6) 18 (36%) (22,8) 0,52 Частота развития инфекционных осложнений, n (%), 95% ДИ 11 (22%) (11,5-36,0) 16 (32%) (19,7) 0,27 Частота послеоперационных кровотечений, n (%), 95% ДИ 4 (8%) (2,(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)9) 2 (4%) (0,5-13,7) 0,7 ...
... 2). Обе группы были сопоставимы по возрасту, полу, расстоянию дистального края опухоли от края ануса, расположению опухоли по окружности, наибольшему размеру дефекта стенки кишки (при полной (17,6) 18 (36%) (22,8) 0,52 Частота развития инфекционных осложнений, n (%), 95% ДИ 11 (22%) (11,5-36,0) 16 (32%) (19,7) 0,27 Частота послеоперационных кровотечений, n (%), 95% ДИ 4 (8%) (2,(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)9) 2 (4%) (0,5-13,7) 0,7 ...
Article
INTRODUCTION: the wound following Transanal Endoscopic Microsurgery (TEM) is traditionally closed by suturing. However, some studies suggest that leaving the wound open after TEM might be a viable alternative. STUDY OBJECTIVE: to compare two methods of managing rectal wounds in patients after TEM. PATIENTS AND METHODS: patients were divided into 2 groups: the main group (open wound management) and the control group (suture wound management). The primary endpoint of the study was the morbidity rate. The secondary endpoints included the need and duration of antibacterial therapy, post-op hospital stay, the severity of the inflammatory response, the wound healing time and the quality of life. RESULTS: from November 2021 to November 2023, 177 patients were included in the randomized study: 68 in the open wound management group and 109 in the suture wound group. The analysis included 50 patients in eachgroup. It was found that the operation time in the main group was significantly shorter (30 (20; 40) minutes versus 55 (40; 60), p < 0.0001). The infectious complications rate was lower in the open wound management group: 11/50 (22 %) versus 16/50 (32 %), p = 0.26; the postoperative bleeding rate was higher: 4/50 (8 %) versus 2/50 (4 %), p = 0.7. Post-op hospital stay did not differ: 6 (4;7) days versus 6 (5; 7), p = 0.22. The duration of antibiotic therapy for infectious complications was longer in the open wound management group: 6 (5;6) days versus 5 (5;6.5), p = 0.02. In the case of infectious complication the inflammatory response was higher in the group of the open wound management: white blood cell counts (15.9 (14.3; 19.5) × 109/L versus 13.1 (12; 15.6) × 109/L, p = 0.01) and temperature (38.6 ± 0.7 °C versus 38 ± 0.6 °C, p = 0.02). Wounds in both groups healed by the 30 th day, and the quality of life did not differ between groups. CONCLUSION: the results of the randomized study demonstrated the efficacy and safety of open rectal wound management after TEM.
... O FIQL foi desenvolvido por Rockwood (2004), avalia a QdV em pessoas com IF (A't Hoen, Utomo, Schouten, Blok, & Korfage, 2017), validado para a população portuguesa em 2013, por Pereira (2013). Quanto às propriedades psicométricas, o questionário apresenta, uma consistência interna com valor de Alpha de Cronbach > 0,70 e uma confiabilidade (teste/reteste) que demonstra ser estável no tempo (Rockwood et al., 2000). É composto por 29 questões, distribuídas em 4 domínios: estilo de vida (10 itens), comportamento (9 itens), depressão (11 ou 7 itens) e constrangimento (3 itens). ...
... tilizou-se ainda como instrumento de medida para avaliação da QdV na IF, a FIQL, que demonstrou uma confiabilidade razoável e uma boa validade, apesar das suas limitações psicométricas (Fallon et al., 2008). O preenchimento desta escala ajudou a definir melhor a associação entre o exame físico objetivado e os sintomas relacionados (Pereira, 2013). Rockwood et at. (2000), no seu estudo utiliza e confirma a fiabilidade e validade da escala FIQL e refere-a como um instrumento de medida ideal para avaliara a QdV de pacientes com IF. ...
Article
Full-text available
Metodologia: estudo de caso com uma participante de 64 anos, professora, autónoma, com diagnóstico de IF devido a sequela de cirurgia a prolapso retal. Realizou-se um programa de Treino dos Músculos do Pavimento Pélvico (TMPP), de uma sessão/semana, durante 16 semanas, supervisionado por Biofeedback anorretal. Cada sessão demorou 45 minutos, dos quais 20 minutos para TMPP e o restante para o exame físico, terapia manual, massagem e ensinos/registos da doente: diário de sintomas, supervisão da gestão da alimentação, treino intestinal, técnicas/posturas de defecação e suporte emocional. Na primeira sessão (T0) e na última (T1), foi ainda efetuado a anamnese, Índice de Wexner, Bristol Stool Form Scale (BSFS) e Fecal Incontinence Quality of Life (FIQL). Os resultados evidenciaram ganhos na força dos MPP, que evoluíram de grau 2 para 4 na escala de Oxford modificada; na qualidade de vida (QdV), ausência de perdas fecais, as fezes passaram de consistência tipo 2 para 4 na BSFS. Conclusão: o programa de reabilitação uropélvica, mostrou-se eficaz na reeducação dos MPP e melhorou significativamente a QdV da participante.
... В научных трудах всего мира можно найти огромное количество опросников и шкал, оценивающих качество жизни как в целом, так и в отношении отдельно взятых аспектов повседневной жизни. Так, например, в колоректальной хирургии и хирургическом лечении травматического анального недержания (АН) для планирования лечения и оценки его эффективности в международной практике наиболее часто применяются такие инструменты, как Wexner Incontinence Score (Cleveland Clinic Fecal Incontinence Severity Score), PISQ-12 и Fecal incontinence quality of life scale (FIQL) [1][2][3]. ...
... Опросник был разработан и впервые увидел свет в 2000 г. Todd H. Rockwood (Clinical Outcomes Research Center, University of Minnesota, Minneapolis, USA) [1] с соавт., экспертами в области колоректальной хирургии и системы организации здравоохранения из разных учреждений Соединенных Штатов Америки, выявили основные аспекты качества жизни пациентов с анальным недержанием: изменение пищевого поведения, нарушения поведенческой адаптации в обществе, эмоциональные изменения, такие как чувство тревоги, смущения, стыда. Опираясь на эти отправные точки, был сформирован опросник, состоящий из 29 пунктов, разделенных на 4 раздела (табл. ...
Article
Aim . To evaluate the effectiveness of the cultural and linguistic adaptation of the Fecal Incontinence Quality of Life Scale (FIQOL) for the Russian-speaking population. Methods : A cultural and linguistic adaptation of the FIQL questionnaire was performed in accordance with international guidelines. This process included several key steps: professional translation of the questionnaire, back translation, and critical discussion within an interdisciplinary council comprising translators, linguists, psychologists, doctors, and patients. Preliminary testing and reliability assessment were also conducted. The results of the preliminary testing are presented in this article. A total of 26 patients who had undergone surgical treatment for anal incontinence (sphincterolevatoroplasty) between 2016 and 2022 participated in the preliminary testing phase. Results . The result of the cultural adaptation is the Russian language version of the Fecal Incontinence Quality of Life Scale (FIQOL), which has undergone all the aforementioned stages with corrections and comments in the order of the council of doctor-translator-psychologist-patient. The average time elapsed from the moment of surgery to the survey was 32 months (SD = 20). The average overall score of the questionnaire was 3.2 (SD = 0.62), the average score on the ‘Lifestyle’ scale was 3.3 (SD = 0.74), the average score on the ‘Behaviour, daily worries’ scale was 3.2 (SD = 0.65), the average score on the ‘Depression and self-perception scale was 3.4 (SD = 0.91) and the average score on the ‘Shame’ scale was 3.2 (SD = 0.71). The assessment of the reliability of the questionnaire, as shown by the alpha-Kronbach coefficient, was 0.94, which corresponds to the assessment of ‘very good reliability’. Conclusion . The presented data show that the Russian version of the Fecal Incontinence Quality of Life Scale (FIQOL) is adapted for use by Russian-speaking patients and specialists, is reliable, and can be used as a primary tool for assessing the quality of life of patients with anal incontinence.
... The Wexner score, also known as the Cleveland Clinic Florida Fecal Incontinence Severity Scoring System (CCFIS), is a classification system used to categorize the severity of fecal incontinence [11]. We utilized the FIQL scale, a Likerttype questionnaire that evaluates the negative impact fecal incontinence has on quality of life [12]. It is divided into 4 domains: lifestyle, coping/behavior, depression/self-perception, and embarrassment [12]. ...
... We utilized the FIQL scale, a Likerttype questionnaire that evaluates the negative impact fecal incontinence has on quality of life [12]. It is divided into 4 domains: lifestyle, coping/behavior, depression/self-perception, and embarrassment [12]. Patients were consented for phone surveys prior to or after their surgery. ...
Article
Full-text available
Purpose Surgery for anal fistulas can result in devastating complications, including reoperations and fecal incontinence. There is limited contemporary evidence comparing outcomes since the adoption of the ligation of intersphincteric fistula tract procedure into mainstream practice. The purpose of this study is to compare recurrence rates and long-term outcomes of anal fistula following repair. Methods Data was collected from the electronic medical records or patient reported outcomes from patients aged 18 or older with a primary or recurrent cryptoglandular anal fistula. Primary outcome was recurrence defined as the identification of at least one fistula os or a high clinical suspicion of anal fistula. Secondary outcomes included fecal incontinence and postoperative quality of life. Results A total of 171 patients underwent definitive surgical repairs for their anal fistula. So 66.5% had a simple fistula, and 33.5% had a complex fistula. Of the 171 patients, 12.5% had a recurrence. The recurrence rates were 5.9% for simple fistula and 25.4% for complex fistula. Predictors of recurrence included diabetes mellitus, history of anorectal abscess, complex fistula, and sphincter sparing surgery. LIFT or plug/biologic procedures were both associated with a 50% or greater recurrence rate. No significant differences were found in fecal incontinence or associated quality of life between sphincter sparing or non-sphincter sparing surgical resections. Conclusion The study provides insights into the long-term outcomes of surgical repair for anal fistula. We demonstrate that sphincter sparing operations are associated with increased recurrence, meanwhile, non-sphincter sparing surgeries did not increase the risk of fecal incontinence or worsen quality of life.
... At the time of the first evaluation, the patient's Cleveland Clinic Incontinence Score (CCIS) was 15 [6]. We used the Fecal Incontinence Quality of Life (FIQoL) questionnaire to assess the impact of the patient's condition on her everyday activities (Table 1) [7]. Table 1. ...
Article
Full-text available
Background and Clinical Significance: Recto-vaginal fistulae (RVF) and fecal incontinence (FI) pose significant challenges for colorectal surgeons. Various therapeutic options have been proposed for each condition over time. Despite its procedural complexity and the risk of complications, graciloplasty remains a viable therapeutic option for both conditions, with favorable long-term results. To our knowledge, this is the first report of a case where the need to treat both conditions concurrently arose. Case Presentation: We report the case of a 54-year-old woman with severe FI and repeatedly operated on recurrent recto-vaginal fistula. The patient underwent graciloplasty to provide healthy tissue with an adequate vascular supply to both enhance the healing process of the fistula and reshape the anal canal with a circular muscular structure. Following the procedure, the patient experienced prompt symptom resolution and good clinical and functional recovery at a 1-year follow-up evaluation. Conclusions: This case report highlights the safety and effectiveness of an overlooked procedure for the treatment of large sphincter defects and concurrent recto-vaginal or recto-vaginal tears.
... • Other bowel diary measures: urgency, urge and passive faecal incontinence episodes, use of loperamide and social functioning. • Summative questionnaire assessments: St Mark's continence score; 40 OAB-q SF score, FI QoL score; 41 International Consultation on Incontinence Bowel (SF-ICIQ-B) questionnaire. 42 • Viscerosensory bowel diary recording quality, site and intensity of defacatory urge. ...
Article
Full-text available
Trial design Randomised, multicentre, double-blind crossover trial (with 2 × 16-week periods) of active neurostimulation versus sham stimulation with subsequent open-label follow-up to 58 weeks. Embedded mechanistic sub-study using magnetoencephalography to study bidirectional functional connectivity between brain and anorectum. Methods Participants: adults aged 18–80 years, with chronic symptoms of faecal incontinence refractory to first-line treatments (and meeting national criteria for sacral neuromodulation). Interventions: active : chronic, subsensory (low amplitude) stimulation of a mixed sacral nerve (usually S3) using a commercially available surgically implanted pulse generator; sham : identical implant but turned off (or to 0.05 V). Patient-chosen sub- or supra-sensory open-label stimulation from week 32 to week 58. Primary objectives: (1) to determine whether sub-sensory sacral neuromodulation led to a reduction in total faecal incontinence episodes per week compared to sham stimulation; (2) to identify whether clinical responses to sub-sensory sacral neuromodulation were biologically related to changes in evoked and induced activity between the brain and anorectum. Primary outcome: total faecal incontinence episodes per week based on paper bowel diary performed in the final 4 weeks of each crossover period (allowing 12-week washout). Randomised allocation (1 : 1) to arm 1 (sacral neuromodulation/sham) or arm 2 (sham/sacral neuromodulation) at time of surgery was stratified by sex and centre. Blinding: participants, surgeons and assessors; tamper-proof tape masked stimulation settings. Statistical methods: Poisson regression models failed to converge for the count outcomes, hence paired t -tests were used, and treatment effects summarised by mean differences [with 95% confidence intervals (CIs)]. Sample size: a total of 90 patients (45 per group) were required to detect a 30% reduction in episodes, allowing for 10% loss to follow-up (alpha = 0.05; power 90%). Results Recruitment: a total of 39 patients of 220 screened and 65 pre-enrolled (arm 1: N = 17; arm 2: N = 22) were recruited to the crossover trial at nine sites from the United Kingdom and one site from Ireland between February 2018 and July 2022, of whom only 16 (arm 1: N = 9; arm 2: N = 7) had complete primary outcome data. Nineteen completed follow-up to 58 weeks. Trial delivery was severely affected and terminated early due to COVID-19. Main barriers were the inability to continue face-to-face patient visits, redeployment of research staff to COVID-19 facing clinical roles and cancelling of sacral neuromodulation procedures due to lack of priority for non-urgent surgery. A total of 25 patients underwent magnetoencephalography studies compared to 20 healthy volunteers. Primary outcome ( N = 16): sacral neuromodulation conferred a non-significant reduction in mean faecal incontinence episodes per week compared to sham (−0.7, 95% CI −1.5 to 0.0; p = 0.06). Secondary outcomes: in participants who also used the e-event recorder to record the number of faecal incontinence episodes in both periods ( n = 7), estimate of effect size was greater but less precise (−1.5, −3.5 to +0.5; p = 0.12). Data suggested successful allocation concealment. Improvements were observed in faecal incontinence symptoms in the follow-up cohort (at 58 weeks) compared to baseline (approx. 3 fewer faecal incontinence episodes per week). A small number of expected adverse events all resolved. Magnetoencephalography studies demonstrated bidirectional afferent evoked cortical and efferent induced anal activity that did not vary greatly from control subjects ( n = 20) and appeared unchanged by sacral neuromodulation. Conclusions Due to under-recruitment it is important to interpret the findings on the experimental efficacy of sacral neuromodulation as exploratory. Effects on symptoms observed during double-blinded crossover point to some efficacy over sham, though not large in comparison with placebo responses. The magnitude of effect was highly dependent on method and interpretation of event recording. Study registration Current Controlled Trials ISRCTN98760715. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation (EME) programme (NIHR award ref: 14/144/08) and is published in full in Efficacy and Mechanism Evaluation ; Vol. 11, No. 19. See the NIHR Funding and Awards website for further award information.
... The score for each item is given as a value from 1 to 4, with the exception of questions 1 (values from 1 to 5) and 4 (values from 1 to 6). To calculate the total score for each domain, it is necessary to calculate the average of its items, with the total score being equivalent to 5 (Rockwood et al., 2000). ...
Article
Full-text available
Objective: To describe a protocol comparing the effects of free dance, hatha yoga, and a control group on quality of life, motor and non-motor symptoms in people with Parkinson's disease (PwP). Methods: This is a randomized three-arm study. Inclusion criteria will be people with clinically diagnosed Parkinson's disease (PD), ≥ 45 years old, and in stages I to IV of the Hoehn and Yahr Disability Scale (HY). Who do not reach the cut-off point of the Montreal Cognitive Assessment (MoCA) and classified in stage V of the HY will be excluded. The interventions will last 60 minutes, twice a week, progressing from light to vigorous intensity. The primary outcome will be quality of life assessed by the Parkinson's Disease Questionnaire (PDQ39). Secondary outcomes will include the Unified Parkinson's Disease Rating Scale (UPDRS), the evaluation of motor and physical function such as shoulder and hip range of motion (goniometer), cardiorespiratory fitness (six-minute walk test), balance (MiniBESTest), as well as non-motor aspects such as anxiety (Beck Anxiety Inventory), self-esteem (Rosenberg Self-Esteem Scale), cognition (MoCA), hope (Herth Hope Scale), fecal incontinence (Fecal Incontinence Quality of life), urinary incontinence (International Consultation on Incontinence Questionnaire - Short Form), and depressive symptoms (Beck Depression Inventory). Data will be collected at baseline and post-intervention. Discussion: If study interventions are deemed effective compared to standard of care (i.e. control group), the present study will advance current knowledge on non-pharmacological therapeutic strategies for People with Parkinson. Study registered RBR-54s92mh on 02/29/24.
... The main limitations of this study are the small sample size and the lack of a qualityof-life evaluation using standardised international scoring systems [30][31][32]. However, this limitation was partially addressed by the use of a VAS assessment, which provided a subjective measure of patients' perceived continence. ...
Article
Full-text available
Introduction: Although several treatments for faecal incontinence are available, gas incontinence (GI) and soiling are difficult to manage. The aim of this study is to evaluate Gatekeeper™ for this subtype of faecal incontinence. Methods: Prospective single-centre case series. Patients with mainly soiling and/or GI were treated with polyacrylonitrile prostheses. An evaluation was performed with a 3-week continence diary. St. Mark’s score and a Visual Analogue Scale (VAS) were used to study the patient’s continence perception and surgical satisfaction, at baseline and 1, 3, 6, 12, and 24 months postoperatively. 3D-Endoanal Ultrasound and Anorectal Manometry were performed at baseline and postoperatively. Results: A total of 13 patients were enrolled (11 women), aged (median (IQR)) 62 (13) years, and all implants were uneventful. A significant reduction in soiling and GI episodes was documented at 1 year, 7 (18) baseline days of soiling/3 weeks vs. 2 (4) (p = 0.002); 13 (13) baseline episodes of GI/3 weeks vs. 4 (10) (p = 0.01). This improvement was correlated with a significant increase in VAS (0–10), 3 (2, 5) baseline vs. 7 (1, 5) (p = 0.03), and maintained throughout the follow-up. There was complete remission or significant improvement defined as >70% reduction in gas and soiling days in 6 patients at 2 years follow-up. Soiling episodes were reduced ≥70% in 8/11 patients (72.7%). Nine (70%) patients would repeat the treatment. Conclusions: Gatekeeper™ is a safe, minimally invasive treatment for soiling and GI. A significant reduction in soiling and GI was observed in our series, with a better response to soiling. Most of the patients would repeat the treatment. Other studies are needed to confirm these findings in this subgroup of FI patients.
... Participants were drawn from NHANES records from mid-2005-2010, as these were the only three cycles in which the bowel health portion of the Mobile Examination Center (MEC) interview provided personal interview data on fecal incontinence and bowel function in adults aged 20 years and older (24). We extracted data from 20,134 participants in the NHANES dataset from 2005 to 2010; among them, 17,132 adults (≥20 years old) completed the gastrointestinal health questionnaire. ...
Article
Full-text available
Background Alcohol consumption, depression, and chronic diarrhea are all public health issues of concern, with irreversible consequences for individual health and significant economic burdens on health care systems. Previous studies have shown that depression increases the risk of developing chronic diarrhea, but few studies have explored whether alcohol consumption has an effect on the relationship between depression and chronic diarrhea. Objective To explore the effect of alcohol consumption on the relationship between depression and chronic diarrhea. Methods 12,538 adults (≥20 years) in NHANES from 2005-2010 were analyzed. Participants were stratified according to drinking status, and differences between the risk of depression and chronic diarrhea among participants who drank alcohol or not were assessed using multiple regression analysis and likelihood ratio tests. Results In this cross sectional, after adding possible confounders, the prevalence of depression with chronic diarrhea was higher in the drinking population than in the non-drinking population (OR,2.34, 95%CI:1.84-2.98 and 1.26, 95%CI:0.85-1.86), with a likelihood ratio test of P=0.024. Conclusion Our findings suggest that there is a significant association between depression and chronic diarrhea and that alcohol consumption may increase the correlation between depression and chronic diarrhea. However, these findings require further prospective studies to provide more evidence.
... Thus, our findings cannot be extrapolated 1:1 to the general IBD population. In addition, both surveys (patient and physician questionnaires) were newly developed for the purpose of this study and therefore do not represent standardized or validated instruments.This strategy was chosen to keep the surveys as simple as possible.However, the absence of validated instruments such as the urgency numerical rating scale or fecal incontinence quality of life could have impacted robustness and generalizability of our results.14,26 The patient questionnaire did not ask for the presence of irritable bowel syndrome (IBS) as a comorbidity; thus, we cannot exclude that concomitant IBS contributed to the presence of fecal urgency or incontinence. ...
Article
Full-text available
Introduction Although increasingly appreciated, little is known about the prevalence of fecal urgency, fecal incontinence and differences between patients' and physicians' perception in inflammatory bowel disease (IBD). Methods We performed an online patient and physician survey to evaluate the assessment, prevalence and impact of fecal urgency and incontinence in IBD. Results A total of 593 patients (44.0% ulcerative colitis (UC), 53.5% Crohn's disease (CD), 2.2% indeterminate colitis, 2 not specified) completed the survey (65.8% females, mean age 47.1 years). Fecal urgency was often reported (UC: 98.5%, CD: 96.2%) and was prevalent even during remission (UC: 65.9%, CD: 68.5%). Fecal urgency considerably impacted daily activities (visual analog scale [VAS] 5, IQR 3–8). Yet, 22.8% of patients have never discussed fecal urgency with their physicians. Fecal incontinence was experienced by 44.7% of patients and 7.9% on a weekly basis. Diapers/pads were required at least once a month in 20.4% of patients. However, 29.7% of patients never talked with their physician about fecal incontinence. UC was an independent predictor for the presence of moderate‐severe fecal urgency (OR 1.65, 95% CI 1.13–2.41) and fecal incontinence (OR 1.77, 95% CI 1.22–2.59). All physicians claimed to regularly inquire about fecal urgency and incontinence. However, the impact of these symptoms on daily activities was overestimated compared with the patient feedback (median VAS 8 vs. 5, p = 0.0113, and 9 vs. 5, p = 0.0187). Conclusions Fecal urgency and incontinence are burdensome symptoms in IBD, with a similar prevalence in UC and CD. A mismatch was found between the physician and patient perception. These symptoms should be addressed during outpatient visits.
... It may be related to irritable bowel, diabetes and bacterial overgrowth. Management of diarrhea benefits most patients with FI. 25 This study has several limitations. Being a cross-sectional study, it cannot determine causal associations. ...
Article
Aim The aim of this study was to determine the prevalence of fecal incontinence (FI) in post-menopausal women and its risk factors. Methods This cross-sectional study was carried out from May 2022 to May 2023. All women in the post-menopausal age group attending outpatient services were given a simple questionnaire to assess the presence of FI and likely risk factors. Results A total of 728 women formed the study group (median age 58, range 45-84 years). FI was reported by 10.1 % of respondents. Women with FI were significantly more likely to have vaginal delivery ( P < .0001), presence of one or more comorbid diseases ( P = .0001), previous abdominal surgery ( P = .01), and diarrheal stools ( P = .0009). The odds of developing FI were highest for vaginal delivery, followed by the presence of co-morbid diseases. Conclusion The prevalence of FI was 10.1%. History of vaginal delivery, previous abdominopelvic surgery, diarrheal stools, and comorbid diseases were significantly associated with FI.
... However, our study reveals a contrasting perspective, with patients emphasizing the importance of non-physical outcomes and not only physical ones. Established QoL assessments, such as the Faecal Incontinence Quality of Life Scale (FIQL), cover several aspects emphasised as important during these patient interviews [21]. ...
Article
Full-text available
Purpose Faecal incontinence (FI) is a prevalent and debilitating anorectal problem causing embarrassment, anxiety, and social isolation, diminishing quality of life. At present there is no optimal treatment option for FI. Consequently, treatments primarily focus on symptom reduction and improving quality of life. Understanding patient experiences and outcomes they seek from treatment is crucial for improving care. This study aims to explore how FI impacts patients’ lives and identify important treatment outcomes as part of the development of a Core Outcome Set (COS). Methods Patients with FI were recruited from outpatient clinics in the Netherlands. Semi-structured interviews were performed, audio recorded, transcribed per verbatim and coded. Thematic analysis was performed to identify (sub)themes and categories relevant to the patients. Results Twelve interviews were conducted before saturation was reached (75% female, 25% male, mean age 63, range 39–83 year). Four main themes emerged ‘Physical symptoms’, ‘Impact on daily life’, ‘Emotional impact’ and ‘Coping’. Patients expressed how FI severely limits daily activities and emotional wellbeing. Treatment priorities centred on resuming normal activities rather than solely on symptom reduction. Conclusion The impact of FI extends far beyond uncontrolled loss of faeces, affecting psychological, emotional, and social wellbeing. Patients prioritise outcomes focussed on reclaiming normalcy and independence rather than focusing on physical symptoms alone. Integrating these patient-centered outcomes in future studies could enhance treatment satisfaction and patient-perceived treatment success. Furthermore, the outcomes identified in this study can be included in a Delphi survey alongside other relevant outcomes, paving the way for the development of a COS.
... We included patients up to 21 [22][23][24][25][26] We documented any complications and repeated assessment of symptoms and quality of life from each follow-up visit. ...
Article
Full-text available
Background Our objective was to evaluate long‐term outcomes of sacral nerve stimulation (SNS) for children with functional and organic defecation disorders. Methods We performed a prospective study of children <21 years of age who started SNS treatment between 2012 and 2018. We recorded demographics, medical history, and diagnostic testing. We obtained measures of symptom severity and quality of life at baseline and follow up at 1, 6, 12, 24, 36, 48, and ≥60 months. Successful response was defined as bowel movements >2 times/week and fecal incontinence (FI) <1 time/week. Families were contacted to administer the Glasgow Children's Benefit Inventory and to evaluate patient satisfaction. Key Results We included 65 patients (59% female, median age at SNS 14 years, range 9–21) with median follow‐up of 32 months. Thirty patients had functional constipation (FC), 15 had non‐retentive FI (NRFI), and 16 had an anorectal malformation (ARM). The percentage with FI <1 time/week improved from 30% at baseline to 64% at 1 year (p < 0.001) and 77% at most recent follow‐up (p < 0.001). Patients with FC, NRFI, and ARM had sustained improvement in FI (p = 0.02, p < 0.001, p = 0.02). Patients also reported fewer hard stools (p = 0.001). Bowel movement frequency did not improve after SNS. At most recent follow‐up, 77% of patients with a functional disorder and 50% with an organic disorder had responded (p = 0.03). Nearly all families reported benefit. Conclusions and Inferences SNS led to sustained improvement in FI regardless of underlying etiology, but children with functional disorders were more likely to respond than those with organic disorders.
... This study employed objective health indicators such as the number of days with leaks per week, the Wexner score [32], and the LARS score [33]. It also utilized subjective utility measures, including Fecal Incontinence Quality of Life (FIQL) scores [34,35] and the score index and visual analog scale (VAS) of the Euro-Qol-5D (EQ-5D) tool [36,37]. The LARS score and EQ-5D questionnaire were incorporated over time. ...
Article
Purpose: This study assessed the long-term outcomes and quality of life in patients who underwent sacral neuromodulation (SNM) due to low anterior resection syndrome (LARS).Methods: This single-center retrospective study, conducted from 2005 to 2021, included 30 patients (21 men; median age, 70 years) who had undergone total mesorectal excision with stoma closure and had no recurrence at inclusion. All patients were diagnosed with LARS refractory to conservative treatment. We evaluated clinical and quality-of-life outcomes after SNM through a stool diary, Wexner score, LARS score, the Fecal Incontinence Quality of Life (FIQL) questionnaire, and EuroQol-5D (EQ-5D) questionnaire.Results: Peripheral nerve stimulation was successful in all but one patient. Of the 29 patients who underwent percutaneous nerve evaluation, 17 (58.62%) responded well to SNM and received permanent implants. The median follow-up period was 48 months (range, 18–153 months). The number of days per week with fecal incontinence episodes decreased from a median of 7 (range, 2–7) to 0.38 (range, 0–1). The median number of bowel movements recorded in patient diaries fell from 5 (range, 4–12) to 2 (range, 1–6). The median Wexner score decreased from 18 (range, 13–20) to 6 (range, 0–16), while the LARS score declined from 38.5 (range, 37–42) to 19 (range, 4–28). The FIQL and EQ-5D questionnaires demonstrated enhanced quality of life.Conclusion: SNM may benefit patients diagnosed with LARS following rectal cancer surgery when conservative options have failed, and the treatment outcomes may possess long-term sustainability.
... Each item was graded on a four-point scale: 1: most of the time, 2: some of the time, 3: a little of the time, and 4: never. For calculation of the total FIQL score, a higher score indicated lower severity of the impact of incontinence on patients' quality of life (QOL) [11]. ...
... La mejoría significativa del número de episodios de incontinencia y de las puntaciones en las escalas severidad de Wexner y de calidad de vida (FIQoL), ha sido demostrada en diversos estudios. 1,[4][5][6]10,15,16,19,[21][22][23] En nuestra serie, la escala de Wexner disminuyó considerablemente (p < 0.001), después uno, tres y seis meses posteriores al tratamiento. En 2006, Queralto reporta una disminución de la escala de Wexner de más de 60% tras el primer mes de neuroestimulación tibial. ...
... This questionnaire also measured incontinence according to a 4-point scale (0-never, 1-occasional (< 1/week), 2-minor (2-3/week), and 3-major (> 3/week). Quality of life assessment was performed at the time of each study utilizing the validated Rockwood Fecal Incontinence Quality of Life Scale (FIQL) (Lifestyle, Coping, Depression and Embarrassment ) [13]. ...
Preprint
Full-text available
Purpose This study aims to investigate the phenomenon of high amplitude pouch contractile waves and their impact on functional results in patients undergoing ileal pouch-anal anastomosis following total proctocolectomy for ulcerative colitis. Methods This is a retrospective review of a colorectal database at a single academic center. Patients underwent pouch manometric evaluation at an early (Study 1, <6mo s/p ileostomy closure) and delayed (Study 2, > 5 months after study 1) timepoint. High amplitude contractions were defined as peaks ≥ 20 mmHg over baseline. Pouch functional measures and quality of life outcomes were correlated with contractile amplitude and frequency. Results 33 patients were included in this study. Contractile frequency decreased from Study 1 to Study 2 (0.14 vs 0.07 contractions/min). Peristaltic contractility was absent in 18/33 patients (55%) on their early examination (Study 1) after stoma takedown and 23/33 patients (70%) on Study 2. A significant association was observed between increased pouch contraction and nighttime spotting (p = 0.05) during Study 1. Increased amplitude was associated with increased nighttime spotting (p = 0.03) and an increased number of 24-hour bowel movements (p = 0.038) during Study 1. There were no significant associations with pouch function with Study 2. Contractions had no significant impact on quality-of-life outcomes. Conclusions Nighttime spotting is associated with increased contractile frequency and amplitude early in pouch life following ileostomy takedown. Contractility decreases over time, with no evidence of contractile waves in the majority of patients at greater than one-year post-IPAA. High amplitude contractility is an additional factor contributing to early pouch functional results.
Article
Patients with pelvic organ prolapse (POP) often have simultaneous defecation disorders in the form of obstructive defecation syndrome (ODS) or anal incontinence. The underlying causes include functional pelvic floor dyssynergia, spasms of the pelvic floor muscles and anatomical changes such as rectocele, enterocele, rectal intussusception and external rectal prolapse. Although conservative and surgical treatment of POP alone often leads to an improvement in bowel function, these symptoms can persist or worsen postoperatively. Therefore, in patients with combined symptoms, interdisciplinary diagnostics and treatment planning are advisable in order to provide a multimodal treatment concept consisting of interprofessional conservative strategies and joint surgical planning adapted to the existing disorders.
Chapter
In this chapter, we focus on the various digestive symptoms that may, alone or in combination with each other, contribute to significant clinical problems and alterations in the quality of life of patients with gut PD. Our emphasis highlights what triggers these symptoms and what needs to be done about them.
Article
Background The management of individuals with familial adenomatous polyposis (FAP) includes invasive prophylactic surgery and intensive endoscopic surveillance to reduce their risk of colorectal cancer. FAP patients frequently ask for dietary recommendations to alleviate bowel disturbances after prophylactic colectomy, and to prevent the formation and growth of new adenomas. We have enriched the multidisciplinary outpatient clinic for FAP with nutritional support. This paper presents the results of the first six months of this nutritional activity. Methods Sixty-eight individuals with FAP, >18 years of age, who underwent a prophylactic total colectomy, entered in this observational study. At the baseline visit, participants underwent anthropometric measurements, answered the Mediterranean Diet Adherence Screener (MEDAS), the Faecal Incontinence Quality of Life (FIQL) questionnaire, and reported the number of their diarrhoeal discharges per day. They received dietary recommendations including specific information about the inflammatory food to reduce (red/processed meat, sugar, sweets), and the Mediterranean food to increase (vegetables, fruits, whole grain cereal in cream and legumes’ hummus). Results After six months, participants repeated the same baseline measurements. Fifty-three individuals with FAP completed the six-month follow-up. The before-after analysis showed significant improvements in patients’ body composition measurements and MEDAS score. Participants significantly reduced the number of diarrhoeal discharges per day. FIQL results showed improvements in lifestyle, behaviour, and depression scores. Conclusions These results suggest that targeted low-inflammatory Mediterranean dietary recommendations are effective in improving anthropometric parameters, diet quality, and various aspects of quality of life related to bowel function in individuals with FAP.
Article
Background Chronic constipation is a common and complex condition that significantly impairs the quality of life and health care costs. Identifying the underlying cause is crucial for effective management, and hypothyroidism is frequently implicated. Nevertheless, extensive studies are scarce regarding this correlation. The research aims to examine the association between indices of thyroid hormone resistance, particularly the Thyroid Feedback Quantile-based Index of Free Thyroxine (TFQIFT4), and the occurrence of constipation among the population of the United States. Methods The analysis examined data collected from 6354 participants in the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2010. Chronic constipation was determined as the Bristol Stool Form Scale (BSFS) types of 1 to 2 or <3 bowel movements weekly. Thyroid hormone resistance was assessed using various indices. The statistical analysis comprised weighted logistic regression, restricted cubic splines (RCS), subgroup analysis, and sensitivity analysis. Results Chronic constipation was diagnosed in 10% of participants, displaying distinct characteristics. A nonlinear association between TFQIFT4 and constipation was observed, with inflection points at −0.25 and 0.376. Above a TFQIFT4 value of −0.25, a significantly negative association with constipation was found, primarily in females (OR=0.21; 95% CI: 0.10-0.44). No such association was found in males. Conclusions The study elucidates a complex correlation between thyroid hormone resistance, particularly TFQIFT4, and constipation. Gender-specific correlations were evident, with TFQIFT4 demonstrating a negative association with constipation, primarily in females. These findings underscore the need for further investigation into the underlying mechanisms involving central thyroid resistance and constipation across genders.
Article
Transanal irrigation (TAI) effectively addresses fecal incontinence and improves quality of life in individuals with spina bifida. Given the scarcity of follow-up studies lasting > 5 years and reports of numerous TAI discontinuations, we assessed the enduring effectiveness and impact of TAI > 10 years after its initiation on the quality of life in individuals with spina bifida. We recruited individuals with spina bifida enrolled in a bowel management program who initiated TAI in 2010 and participated in 4-month and 3-year follow-up studies at a spina bifida clinic. Raw data on bowel-related characteristics at baseline and after 4 months and 3 years of TAI were collected, and new survey-based demographic information, bowel-related characteristics, and the Fecal Incontinence Quality of Life scale scores were analyzed alongside extant datasets. Among 34 participants (age, mean [standard deviation] 17.7 [3.2] years), the mean follow-up was 11.8 (0.3) years; 21 participants persistently used TAI (persistent users), 12 discontinued TAI (discontinued users), and 1 used TAI and antegrade continence enema at the time of analysis. The fecal incontinence rate among persistent users decreased from 76.2% at baseline to 14.3% at the time of analysis; 11 (91.7%) discontinued users had fecal incontinence before TAI initiation, and the majority of discontinued users (66.7%) discontinued TAI because of improved bowel function. The fecal incontinence rate and quality of life did not differ significantly between discontinued users and persistent users. TAI effectively alleviated fecal incontinence among persistent users. One-third of users discontinued TAI but had improved fecal continence. We recommend periodic bowel function evaluation in TAI users and to reevaluate the necessity for TAI maintenance.
Article
Full-text available
Aim: To investigate the role of bleeding risk scores, personal and family medical history, and previous bleeding incidents in assessing the impact on the risk of all possible complications, including mortality, in adult patients following cardiac surgery. Methods. The search for publications was conducted using the PubMed, Transfusion Evidence Library, and eLibrary.ru databases, covering the period from 2019 to 2023. Search terms included: ‘bleeding risk assessment scales in adult cardiac surgery’, ‘preoperative anemia in adult cardiac surgery’, and ‘transfusion of red blood cell-containing components in cardiac surgery adults’. Duplicate articles were manually excluded. An additional search was performed among the reference lists of selected publications. Results. A total of 2,011 publications were found. In the first stage of selection, clinical studies, meta-analyses, randomized controlled trials, reviews, and regular reviews without language restrictions were considered based on the content of the abstract. In the second stage, for studies that passed the initial screening, decisions were made based on an assessment of the full-text versions, which presented the consequences of preoperative anemia, postoperative bleeding, and transfusion therapy in adult cardiac surgery patients. Ultimately, 40 publications were included in the review. Conclusion. Preoperative bleeding risk assessment is a multimodal, interdisciplinary challenge that necessitates a patient-centered approach. It should commence at the preparatory stage and involve primary care physicians, cardiologists, surgeons, anesthesiologists, laboratory diagnostic specialists, and transfusiologists. The cornerstone of this process is the thorough collection of individual and family medical histories. Obtaining detailed information through patient involvement, utilizing bleeding risk rating scales, reviewing previous bleeding incidents, and supporting these findings with laboratory test data represent the most scientific approach to developing an individualized management plan for patients at risk of bleeding. Keywords: preparing the patient for surgery, preoperative assessment of the risk of bleeding, transfusion, blood components Conflict of interest: The author declares no conflict of interest.
Article
BACKGROUND Fecal incontinence has a devastating impact on quality of life and imposes a substantial socioeconomic burden. Best medical therapy including biofeedback therapy improves mild symptoms, with minimal impact on moderate to severe symptoms. Surgical management for incontinence carries a degree of morbidity resulting in low uptake and acceptability. While acupuncture is common practice in Singapore for numerous medical conditions, its role in fecal incontinence is relatively novel. In our local context, however, acupuncture is accessible, inexpensive, and potentially well-accepted as a treatment strategy. OBJECTIVE To determine the effectiveness of Traditional Chinese Medicine acupuncture, compared to biofeedback therapy in the treatment of fecal incontinence. The secondary aim is to investigate the differences in quality of life following treatment. DESIGN Randomized controlled trial SETTING Prospective, single institution study PATIENTS Patients with ≥2 episodes of fecal incontinence/week, or St Mark’s incontinence score of ≥5 were recruited. Patients were randomized into biofeedback therapy which included 3 sessions over 10 weeks, or 30 sessions of acupuncture over 10 weeks. MAIN OUTCOME MEASURES Incontinence episodes, St. Mark’s Score and Fecal Incontinence Quality of Life scale. RESULTS Eighty-five patients were randomized into biofeedback therapy (n=46) or acupuncture (n = 39). Demographics and baseline clinical characteristics were not different (p > 0.05). Overall median incontinence episodes were reduced in both, with the acupuncture arm reporting significantly fewer at week 15 (p < 0.001). Acupuncture also improved quality of life, with improvement in lifestyle, coping, depression, and embarrassment at week 15 (p < 0.05). While the St. Mark’s score was significantly reduced in both arms at week 15 (p < 0.001), the acupuncture arm’s score was significantly lower (p = 0.002). LIMITATIONS Longer follow-up required. CONCLUSIONS Acupuncture is clinically effective and improves quality of life in patients with fecal incontinence. See Video Abstract Clinical Trial Registration Clinicaltrials.gov: NCT04276350.
Article
Low anterior resection syndrome (LARS) describes a symptom complex that frequently occurs after anterior rectal resection but is not exclusive to this situation. The LARS is closely correlated with the quality of life of those affected. Scores are required to describe the severity of symptoms. This narrative review uses a pragmatic, practice-based approach to examine scores and quality of life assessments relevant to LARS. Established incontinence scores or specific questions on continence were frequently used to describe anorectal dysfunction following anterior resection of the rectum. There are two validated scores specifically for LARS, the Memorial Sloan Kettering Cancer Center (MSKCC) function instrument and the LARS score. The latter has become established as an international standard due to its high practicability. The modular system of the European Organization for Research and Treatment of Cancer (EORTC) is most commonly used as a general and specific quality of life questionnaire. Despite some inherent limitations of the scores and quality of life questionnaires listed, the LARS score and the EORTC quality of life questionnaires are valid instruments for recording LARS. In particular, they also enable international comparability.
Article
Full-text available
Aims To describe the prevalence of faecal incontinence in patients with inflammatory bowel disease, assess its severity, and correlation with quality of life. We adhered to relevant EQUATOR guidelines, STROBE method. Design Correlational‐descriptive study. Methods Hebrew‐speaking patients seen at an inflammatory bowel disease clinic in a large tertiary medical center in Jerusalem between February 2020 and December 2020 completed the Faecal Incontinence Severity Index and the Faecal Incontinence Quality of Life Scale. Results Ninety‐six patients participated in the study, of which 70 (72.9%) had Crohn's disease, and 26 (27.1%) had ulcerative colitis. Eighty‐five (88.5%) reported faecal incontinence with an overall Faecal Incontinence Severity Index mean of 27.66 (SD 15.99), yet only 14 (14.7%) reported that their physician or nurse inquired about faecal incontinence. Quality of life scores for patients with faecal incontinence was the lowest on the coping/behaviour scale (M = 2.44; SD 0.94) and the highest on the depression/self‐perception scale (M = 2.86; SD 1.04). Significant correlations were found between faecal incontinence severity and quality of life in all scales except for self‐embarrassment. Moderate correlations in the same scales were noted in patients with Ulcerative Colitis, while no significant correlations were found in the Crohn's Disease group. Conclusion A high proportion of inflammatory bowel disease patients reported faecal incontinence associated with impaired quality of life. Only a few were questioned about faecal incontinence by their physician or nurse. Impact There is limited literature regarding the prevalence and severity of faecal incontinence in inflammatory bowel disease patients. A high proportion of patients reported faecal incontinence, which negatively correlated with quality of life. Physicians and nurses must inquire about faecal incontinence to improve patient care. Patient or Public Contribution No patient or public contribution.
Article
Objective To investigate fecal incontinence and defecatory, urinary, and sexual functional outcomes after taTME. Summary Background Data Proctectomy for rectal cancer may result in alterations in defecatory, urinary, and sexual function that persist beyond 12 months. The recent multicenter Phase II taTME trial demonstrated the safety of taTME in patients with stage I-III tumors. Methods Prospectively registered self-reported questionnaires were collected from 100 taTME patients. Fecal continence (FIQL, Wexner), defecatory function (COREFO), urinary function (IPSS), and sexual function (FSFI-female, IIEF-male) were assessed preoperatively (PQ), 3-4 months post-ileostomy closure (FQ1), and 12-18 months post-taTME (FQ2). Results Among 83 patients who responded at all three time points, FIQL, Wexner, and COREFO significantly worsened post-ileostomy closure. Between FQ1 and FQ2, FIQL lifestyle and coping, Wexner, and COREFO incontinence, social impact, frequency, and need for medication significantly improved, while FIQL depression and embarrassment did not change. IPSS did not change relative to preoperative scores. For females, FSFI declined for desire, orgasm, and satisfaction between PQ and FQ1, and did not improve between FQ1 and FQ2. In males, IIEF declined with no change between FQ1 and FQ2. Conclusions Although taTME resulted in initial decline in defecatory function and fecal continence, most functional domains improved by 12 months after ileostomy closure, without returning to preoperative status. Urinary function was preserved while sexual function declined without improvement by 18 months post-taTME. Our results address patient expectations and inform shared decision-making regarding taTME.
Chapter
The clinical care of colorectal disease has not stood still since 2000 when Dr. Byron Gathright published our first 100 years of history. It is an honor to gather reports of clinical advances from our specialty over the last 25 years. The editors have elected to present the particular advances in the areas of surgery for Anorectal Disease, Colon Cancer, Diverticular Disease, Inflammatory Bowel Disease, Pelvic Floor, Ostomy Construction and Rectal Cancer and Surgical Guidelines for Rectal Cancer Surgery, the development of Minimally Invasive Colorectal Surgery and Perioperative Management of Colorectal Surgical Patients. We have asked the experts in these areas to give us insights into the history and latest state-of-the-art update. It will be important to look back at our next update to see the continued progress in each of these areas and to discuss any unexpected new areas of progress.
Chapter
Patient Reported Outcomes (PROs) and Measures (PROMs) are important tools for assessing and monitoring the physical, psychological, and social impact of childbirth on pelvic floor function and associated quality of life. A range of PROMs have been developed and are in use across many domains of pelvic floor and associated function, however, it is important to understand whether they have been validated, and in what cohorts, to ensure the PROMs are relevant, valid and provide meaningful information, whether used in a research or clinical setting. This chapter reviews the role and validation process for PROMs in childbirth-related pelvic floor trauma (CBRPFT), the domains of postpartum function included in the currently available PROMs and guidance for their use.
Chapter
Anal incontinence (AI) is an embarrassing problem for many women following childbirth. This condition affects physical, psychological, social, and sexual well-being. This is particularly challenging in the immediate postpartum when woman are caring for a new-born baby. During the immediate postpartum time, the mainstay treatments for AI are conservative measures to allow management of symptoms. A thorough assessment is needed to establish a differential diagnosis and, ultimately, a plan of care for each individual can be established. Women should be educated on what is the likely aetiology of their symptoms and what treatments are available including the following: dietary modifications, pelvic floor exercises, bowel emptying techniques, medications, the use of bowel products, and low or high-volume irrigation. This chapter examines conservative management strategies for women with AI, as usually this is the first line treatment for this problem. It will detail what lifestyle aspects can affect AI such as body mass index, smoking, diet, fluid intake, and physical activity. It will then go on to look at the importance of a detailed assessment; this ensures that the treatment delivered is appropriate for each individual patient, as no one treatment plan fits all. Following on from this, the conservative treatments will be discussed.
Chapter
Obstetric anal sphincter injuries (OASIS) increase the risk of anal incontinence (AI), thus potentially affecting a woman’s quality of life. Recent systematic reviews show limited effects of pelvic floor muscle training (PFMT) in treating postpartum AI. However, few studies are actually designed to detect changes in AI. Similarly, quantitative assessment of pelvic floor muscle function and activity tend to be lacking in previous studies, and many interventions include only verbal instruction of PFMT. There is little or no focus on dose-responses and progression in the PFMT protocols. However, studies of postpartum women that identify AI as the main outcome measure and focus on the principles of strength training show promising clinical results: reduced AI symptoms and improved pelvic floor muscle strength are reported. Not surprisingly, women with reduced function or large defects of the pelvic floor muscles and anal sphincter complex have worse outcomes than women with no or minimal defects and confirmed ability to contract their pelvic floor muscles. Furthermore, AI involves a complex interplay of muscular function, stool consistency and bowel function, and women with co-existing symptoms such as constipation, soiling or bowel evacuation problems may improve their symptoms and quality of life if treated using a combination of treatment modalities such as PFMT, laxatives and bulking agents.
Article
Low anterior resection syndrome (LARS) causes devastating symptoms and impairs the quality of life (QOL). This study investigated the incidence and risk factors of LARS and their association with the QOL in patients with lower rectal tumors. Patients who underwent anus-preserving surgery for lower rectal tumors between 2014 and 2019 and who had anal defecation between 2020 and 2021 were surveyed. The LARS score measured severity, and the QOL was evaluated using the Japanese version of the Fecal Incontinence Quality-of-Life Scale (JFIQL). The primary endpoint was the incidence of Major LARS, and the secondary endpoints were risk factors and association with the JFIQL. Of 107 eligible patients, 82 (76.6%) completed the LARS survey. The incidence of Major LARS was 48%. Independent risk factors included neoadjuvant chemoradiotherapy (CRT) and a short interval (< 24 months after surgery; odds ratio, 4.6; 95% confidence interval: 1.1–19, both). The LARS score was moderately correlated with the JFIQL generic score (correlation coefficient: − 0.54). The JFIQL scores were significantly worse in the Minor and Major LARS groups than in the No LARS group. Major LARS was found in 48% of lower rectal tumors, and independent risk factors include neoadjuvant CRT and a short interval. The QOL was significantly impaired in patients with both Minor and Major LARS.
Article
Aim Sacral neuromodulation (SNM) is approved for the treatment of faecal incontinence (FI) in a two‐stage technique. With standardized implantation, approximately 90% of patients undergo successful Stage I operation and proceed to a permanent implant (Stage II). The aim of this work was to explore the feasibility of SNM as a one‐stage procedure and report the 24‐week efficacy. Method This study included patients diagnosed with idiopathic FI or FI due to an external anal sphincter defect ≤160° and one or more episodes of FI per week despite maximal conservative therapy. Patients were offered a one‐stage procedure if a motor response of the external anal sphincter was achieved in three or more poles with at least one at ≤1.5 mA at lead placement. Patients were followed for 24 weeks. Their evaluation included the Wexner/St Mark's Incontinence Score, Faecal Incontinence Quality of Life score (FIQoL), a visual analogue scale (VAS) for assessing patient satisfaction and a bowel habit diary. Results Seventy‐three patients with a median age of 60 years (interquartile range 50–69 years) completed this prospective study. Episodes of FI were significantly reduced at the 24‐week follow‐up, from 13 (8–23) at baseline to 2 (0–5) ( p ‐value = 0002). A ≥50% reduction in the number of FI episodes was achieved in 92% of participants. The Wexner score improved significantly from 16 (14–17) at baseline to 9 (5–13) ( p ‐value < 0.001), and the St Mark's score improved significantly from 18 (16–20) to 11 (7–16) ( p ‐value < 0.001). All domains in the FIQoL score and VAS for patient satisfaction improved significantly following the one‐stage procedure. Conclusion A one‐stage implantation procedure is feasible in selected patients with FI, significantly improving continence, quality of life and patient satisfaction after 24 weeks of follow‐up.
Article
Introduction: Multiple reconstructive techniques have been described for reconstruction after a low anterior resection for carcinoma rectum. Colonic J pouch (CJP), Side to end anastomosis (SEA), transverse coloplasty pouch (TCP) and Straight Colo-rectal/anal anastomosis were the most widely studied. Evidence acquisition: PubMed, Embase and Cochrane data base were searched for randomized, non-randomized studies and systematic reviews from inception of the databases till July 31st, 2023. Evidence synthesis: Considerable heterogeneity existed among different study findings. Reservoir techniques, including CJP, SEA, and TCP, exhibited reduced stool frequency, decreased urgency, and improved continence status compared to SCA, particularly in the short term. CJP maintained this advantage into the intermediate term. Other functional outcomes were similar among the techniques. However, these functional improvements did not translate into enhanced Quality of Life (QoL). TCP was associated with an elevated risk of anastomotic leaks. Other surgical outcomes remained comparable across all four techniques. Sexual outcomes also exhibited no significant variation. Some studies suggested that the size of the side limb in CJP or SEA may not significantly impact functional outcomes, implying that neorectum capacity may not be the primary determinant of improved function. The precise physiological mechanism underlying these findings remains unknown. Conclusions: In the short and intermediate terms, reservoir techniques demonstrated superior functional outcomes, but long-term performance was comparable among all techniques. Notably, enhanced functional outcomes did not translate to improved Quality of Life. TCP, while effective, is linked to an increased risk of anastomotic complications, necessitating cautious utilization.
Article
Full-text available
The main aim of this editorial is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023; 29: 4593-4603. This original research presents a new scoring system for fecal incontinence. Fecal incontinence is a chronic disease with a severe impact on the quality of life of the patients. Substantial social stigmatization often leads to significant underreporting of the condition even during visits to a specialist and could lead to further mismanagement or non-existent management of the disease. An important fact is that patients are often unable to describe their condition when not asked precisely defined questions. This problem is partially resolved by scoring questionnaires. Several scoring systems are commonly used; however, each of them has their shortcomings. For example, the absence of different kinds of leakage besides flatus and stool could further lead to underscoring the incontinence severity. Therefore, there has long been a call for a more precise scoring system. The correct identification of the presence and severity of fecal incontinence is paramount for further diagnostic approach and for choosing the appropriate therapy option. This editorial describes fecal incontinence, its effect on quality of life in general and further evaluates the diagnostic approach with a particular focus on symptom scoring systems and their implications for clinical practice.
Article
BACKGROUND The Delphi consensus identified eight symptoms and eight consequences as the highest priorities for defining low anterior resection syndrome. OBJECTIVE To describe an exploratory scoring instrument that correlates the Delphi consensus on low anterior resection syndrome with functional and quality-of-life scores following intersphincteric resection for ultralow rectal cancer. DESIGN This was a prospective pilot study. In accordance with the Wexner incontinence score, five frequency responses ranging from never (score 0) to always (score 4) were used to measure the severity of symptom- and consequence-specific variables. SETTINGS Colorectal surgery referral center. PATIENTS Among 161 eligible patients, 137 (85%) participants completed an electronic self-assessment survey regarding function and quality-of-life at scheduled follow-up, including 3 to 6, 12, and ≥ 24 months after ileostomy reversal. MAIN OUTCOME MEASURES Outcome measures included patient-reported severity of these priorities, as well as its correlation with condition-specific quality-of-life. RESULTS The most frequent symptom and consequence were “emptying difficulties” and “dissatisfaction with the bowels,” respectively. Aside from “emptying difficulties,” the proportions of negative symptom domains increased after reversal. In particular, both the frequency responses and the severity scores of “emptying difficulties” did not differ between groups. The percentages of “always option” for consequence domains improved at 12-months follow-up, whereas a higher rate was observed at 24-months later, except for “toilet dependence” and “dissatisfaction with the bowels.” We found significant improvements in the summary score of Fecal Incontinence Quality of Life Scale ( p = 0.04) and our exploratory instrument ( p = 0.009), but not in functional scores measured by traditional questionnaires. Furthermore, the condition-specific quality of life strongly correlated with the Delphi consensus severity score ( r s = -0.73). LIMITATIONS Single-institution data and limited sample size. CONCLUSIONS The important priorities identified by the Delphi consensus might enable a comprehensive overview and a better assessment of low anterior resection syndrome after intersphincteric resection. See Video Abstract .
Article
This article reports the effect that the ranges presented in answer categories for sun?ey questions can have on respondent answers. Response categories were manipulated in a split-ballot survey conducted in both telephone and mail modes. These categories, presented in the separate ballots, overlapped in one category; the other categories were unique to each bailor. The experiment was conducted on four questions: two frequent and mundane and two ran and salient. It was found that the response categories significantly affected the response for frequent and mundane questions. One question demonstrated a significant difference in response between the mail and telephone modes. For this question, a response scale with a limited number of socially desirable alternatives resulted in a social desirability effect in the telephone mode. Alternatively the telephone mode demonstrated an extremeness effect when the response scale comprised a greater number of socially desirable alternatives.
Article
Practical Surveys. Cornerstones of a Quality Survey. Deciding What Information You Need. Choosing a Survey Method. When and How to Select a Sample. Writing Good Questions. Questionnaire Design. Setting Your Survey in Motion and Getting It Done. From Questionnaires to Survey Results. Reporting Survey Results. Advice, Resources, and Maintaining Perspective. References. Index.
Article
Because people sometimes answer similar questions differently in telephone and mail surveys, the increasing tendency to use both modes in survey designs makes an understanding of these patterns a pressing concern.
Article
A general formula (α) of which a special case is the Kuder-Richardson coefficient of equivalence is shown to be the mean of all split-half coefficients resulting from different splittings of a test. α is therefore an estimate of the correlation between two random samples of items from a universe of items like those in the test. α is found to be an appropriate index of equivalence and, except for very short tests, of the first-factor concentration in the test. Tests divisible into distinct subtests should be so divided before using the formula. The index [`(r)]ij\bar r_{ij} , derived from α, is shown to be an index of inter-item homogeneity. Comparison is made to the Guttman and Loevinger approaches. Parallel split coefficients are shown to be unnecessary for tests of common types. In designing tests, maximum interpretability of scores is obtained by increasing the first-factor concentration in any separately-scored subtest and avoiding substantial group-factor clusters within a subtest. Scalability is not a requisite.
Article
Reliability, the ratio of the variance attributable to true differences among subjects to the total variance, is an important attribute of psychometric measures. However, it is possible for instruments to be reliable, but unresponsive to change: conversely, they may show poor reliability but excellent responsiveness. This is especially true for instruments in which items are tailored to the individual respondent.Therefore, we suggest a new index of responsiveness to assess the usefulness of instruments designed to measure change over time. This statistic, which relates the minimal clinically important difference to the variability in stable subjects, has direct sample size implications. Responsiveness should join reliability and validity as necessary requirements for instruments designed primarily to measure change over time.
Article
While functional gastrointestinal complaints are common in the elderly, valid instruments for their assessment are lacking. We have developed the elderly bowel symptom questionnaire (EBSQ) and report its feasibility, reliability, and validity in medical outpatients and a larger sample of the community (aged 65-93). Reliability was measured by a test-retest procedure, while concurrent validity was documented by comparing physician interview and self-report data. Reliability (median kappa 0.65, interquartile range 0.49-0.79), and validity (median kappa 0.68, interquartile range 0.51-0.80) were very acceptable. A random sample of 424 independently living elderly persons was obtained; 77% replied to the mail survey. Medical record review showed that no current diagnosis of irritable bowel syndrome was missed by the questionnaire. Our results confirm that the EBSQ was easy to understand and well accepted, and was a reliable and valid measure of gastrointestinal symptoms in older persons; this instrument may have important clinical and research applications.
Article
The results of 172 patients with imperforate anus are reported. In these patients 215 operations where performed. The complications, lethality and the results concerning anorectal continence are analysed. The lethality was 58% in the risk group A (high risk), 27% in group B and 3% in C group (low risk). The overall lethality was 16.6%. Specific complications were anal stenosis (15.5%), relapse of anorectal or anovaginal fistulas (7%) and mucosa prolapse (5%). Anorectal continence was evaluated according to the Kelly score of continence and to our own electromanometric and clinical score. Five years after the operation 50% of the patients with high type, and 14% of those with low type imperforate anus remained incontinent. Only 15% of the high anal atresias and 43% of the low forms became continent. Thirty-five percent of the children with a high anorectal malformation and 43% with a low type acquired a partial continence with small amounts of soiling. The current surgical techniques to improve anorectal continence are discussed: Pickrell's gracilis transplantation and its modifications, the free muscle transplantation according to Hakelius and Grotte, the free smooth muscle transplantation according to Schmidt and the reverse smooth muscle transplantation according to Holschneider and Hecker. Clinical and electromanometrical as well as electromyographical results are presented.
Article
The psychosocial adjustment of 160 children with anorectal malformations was assessed at 6 to 17 years of age in relation to levels of continence (Kelly score). Five measures of emotional and behavioural adjustment were used to assess a number of domains of child/adolescent functioning and to include measures from multiple perspectives. The psychiatric assessment of the child identified a disorder in 29% of the group overall. Based on parental assessments, behavioural maladjustment was shown in 27% of the children, and on the basis of a self-report questionnaire 24% of the children were depressed. Behavioural adjustment as rated by teachers was similar to the norms. The level of continence achieved (total Kelly score) did not appear to influence psychological adjustment, with the exception of the incontinent young girls (6 to 11 years) who were shown to be less well adjusted than the continent young girls. Differences between children showing positive versus negative adjustment were dependent on the perspective of the respondent and were also related to the child's age and gender, age of achieving continence, frequency of accidents, and parental factors.
Article
Anorectal physiology and continence were assessed prospectively before and after surgery in 50 patients with chronic perianal sepsis. Functional and physiological parameters were unchanged after surgery in 13 control patients who had sepsis but who did not undergo division of the anal sphincter. Group 1 comprised 22 patients with internal sphincter division alone (15 intersphincteric, seven trans-sphincteric treated by a loose seton technique) and group 2 consisted of 15 patients with a trans-sphincteric fistula laid completely open. In group 1 the median (interquartile range (i.q.r.)) resting pressure in the distal 1 cm of the anal canal was reduced from 68 (60-90) cmH2O before surgery to 44 (35-60) cmH2O after operation (P < 0.001); squeeze pressure was less affected, but function deteriorated in 11 of the 22 patients. The median (i.q.r.) resting pressure in group 2 patients also fell, from 68 (34-84) cmH2O before operation to 28 (20-54) cmH2O afterwards (P = 0.003); median (i.q.r.) maximum squeeze pressure decreased more, from 124 (76-170) cmH2O to 72 (48-112) cmH2O (P = 0.002). Functional deficit occurred in eight of the 15 patients. Incontinence was related to low resting pressure, reflecting internal sphincter integrity, and to local epithelial electrosensitivity (reflecting scarring), but not to squeeze pressure, fistula type or surgical treatment.
Article
A significant proportion of children with anorectal malformations have long term problems with faecal continence. The psychological consequences of this chronic disability was assessed in 160 children and adolescents. The prevalence of clinically significant emotional problems among the sample overall, as assessed by a diagnostic psychiatric interview (19%), parental assessment (27%), and child self report depressive scale (24%) was higher than expected relative to normative populations. With the exception of the young girls (6-11 years), the incontinent children and adolescents were not judged to be less well adjusted than those with good bowel control. Treatment for anorectal malformations appears to be associated with an increased risk for behavioural and social problems, but this was not related to the level of continence. Parental factors and gender were significantly associated with outcome. These children and families would benefit from psychological evaluation and support especially during early childhood.
Article
As part of a study concerning the psychosocial adjustment of 160 children treated for anorectal anomalies, the authors investigated the ways in which the children coped with faecal incontinence (FIC). At the time of assessment, the children were 6 to 18 years of age. Portions of the in-depth interviews with the children and their parents covered questions about methods of managing and coping with FIC at home, socially, and at school. In addition, information was obtained about child and family characteristics that have been shown to contribute to the ability to adapt to chronic health problems. The ways in which the children dealt with their problems could be grouped into three distinct phases and were different for boys and girls. In phase 1, around 6 to 7 years of age, boys were largely unaware of the unsocial nature of their condition; the girls were sensitive and withdrawn. In phase 2, between 8 and 11 years of age, boys used overt denial, girls used secretiveness. Phase 3, from around 12 years into adolescence, for both sexes was marked by continued covert denial and eventual acceptance of their disability. The coping strategies reflected a complex interrelationship between characteristics of the child, the family, the social environment, and the unsocial and embarrassing nature of FIC. The findings showed that coping with FIC has potentially severely disruptive implications for the overall development of the child.
Defining anal incontinence: establishing a uniform continence scale
  • A Shelton
  • Madof
Conceptual and methodological issues in selecting and developing quality of life measures
  • N E Avis
  • K W Smith
  • NE Avis
Health measurement scales: a practical guide to their development and use
  • D L Streiner
  • G R Norman
  • DL Streiner
Methodology and epistemology for social science: selected papers
  • D T Campbell
  • E S Overman
  • DT Campbell