Quantitative and qualitative analysis of fecal incontinence

Fecal incontinence (FI), a condition characterised by the involuntary passage of flatus or fecal matter, has significant impacts on individuals it afflicts. Despite the availability of a myriad of treatments, it remains a difficult condition to treat. Valid and reliable measures for this condition are important to evaluate its severity at baseline, assess treatment response, and compare various treatment options and innovations. Various tools have been described to assess FI, but few are widely adopted. These tools can assess the degree of incontinence, qualify and characterise it further, or assess its impact on quality of life-respectively categorized as grading scales, severity scores and impact measures. Grading scales use ordinal scales to describe various types of incontinence (for example incontinence to solid stool, liquid stool or flatus). While easy to use, they lack important details and cannot detect the subtle effects of treatments on incontinence. Summary scores address some of the limitations of grading scales by incorporating both quantifying and qualifying values to describe and grade the incontinence. While less straightforward to use than the available grading scales, they represent a more accurate reflection of the patient's incontinence. In addition, summary scores are more likely to reflect the effects of treatment interventions. As such, they have emerged as the preferred way of measuring FI and of comparing different interventions. Impact measures aim to qualify the effect of FI on various spheres of life such as the emotional, social or physical spheres. However, they can be arduous to administer, and their use has largely been limited to research settings. This article will review and summarize the various tools available to measure FI.