eP605 - A New Objective Scoring System to Clinically Assess Fecal Incontinence

Purpose/Background: Several scoring systems are used to assess fecal incontinence (FI), among which the most commonly used are Wexner and Vaizey’s scoring systems. However, there are significant lacunae in these scoring systems like assigning equal weightage to all types of FI (solid, liquid, flatus, urge etc.), not including all six types of FI (solid, liquid, flatus, mucous, stress, and urge), not validated in patient data, etc. Due to this, they were neither accurate nor comprehensive. The aim was to develop a new scoring system for FI that is accurate, comprehensive, and easy to use.Methods/Interventions: A pro forma was made in which six types of FI were included: solid, liquid, flatus, mucous, stress, and urge. The weight for each FI was determined by asking a group of patients and laypersons to give a disability score to each type of FI from 0 to 100 (0m least, 100, maximum disability). The disability was assessed on a modified EQ-5D+ (EuroQol) description system, 4D3L (4 dimensions and 3 levels) for each FI. The average score of each FI was calculated, divided by 10, and rounded off to determine the weight of each FI type. The scores for the three levels of frequency of each FI were assigned as never = 0 (No episode of FI ever), occasional = 1 (≤1 episode of FI/ week),, and common = 2 (>1 episode of FI/ week), and was termed as frequency score. The score for each FI would be derived by multiplying the frequency score and the weight for that FI type. In the second phase of the study, a group of colorectal surgeons was asked to rank the six FI types in order of severity, and their ranking was compared with the patient and laypersons’ rankings.Results/Outcomes: Fifty patients and 50 laypersons participated in the study. After a detailed statistical analysis, the final weights assigned to solid, liquid, flatus, mucous, stress, and urge FI were 8, 8, 6, 6, 5, and 7, respectively and a new scoring system was formulated. The maximum possible score was 80 (total incontinence), and the least 0 (no incontinence) (Figure-1, upper panel). The surgeons’ ranking of FI severity did not correlate well with patients’ and laypersons’ rankings of FI, highlighting that surgeons and patients may perceive the severity of FI differently.Conclusion/

Discussion: A new scoring system for FI was formulated, which was simple, logical, comprehensive, and easy to use. It eliminated all shortcomings in the existing scoring systems (Wexner’s and Vaizey’s), especially assigning equal weightage to all types of FI by previous scoring systems (Figure-1, lower panel). Patients’ and surgeons’ perceptions of FI severity of FI did not correlate well.Figure-1Upper panel: New incontinence scoring system
Lower panel: Comparison of existing scoring systems with the new scoring system