Int J Colorectal Dis. 2021 Jan 12. doi: 10.1007/s00384-021-03836-7. Online ahead of print.

Felicity Creamer ¹, Alessandra Orlando ², Maximillian Brunner ³, Steen Buntzen ⁴, Alexander Dennis ², Laura Gómez-Fernández ⁵, Claudia Handtrack ³, Ann Hanly ⁶, Klaus E Matzel ³, Arantxa Muñoz Duyos ⁷, Guillaume Meurette ⁸, P Ronan O'Connell ⁶, Cristina Pérez Alonso ⁷, Yolanda Ribas ⁵, Mona Rydningen ⁴, Vincent Wyart ⁸, Carolynne J Vaizey ², Yasuko Maeda ⁹

Author information

• ¹Department of Colorectal Surgery, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
• ²Sir Alan Parks Physiology Unit, St. Mark's Hospital, Harrow, UK.
• ³Department of Surgery, University of Erlangen, Erlangen, Germany.
• ⁴Department of Gastroenterological Surgery, University Hospital of North Norway, Tromsø, Norway.
• ⁵Department of Surgery, Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain.
• ⁶Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.
• ⁷Department of Surgery, Hospital Mútua de Terrassa, Barcelona, Spain.
• ⁸Department of Colorectal Surgery, Nantes University Hospital, Nantes, France.
• ⁹Department of Colorectal Surgery, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK. yazmaeda@gmail.com.

Abstract

Purpose: 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 well-being.

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 well-being (HADS, Hospital Anxiety and Depression Scale), and social interaction (a three-item loneliness scale).

Results: Three hundred eighteen patients completed questionnaires (62 men, mean age 58.7). Sixty percent 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 ages > = 65, p = 0.03) with lower quality of life (ICIQ-B QoL, median score 19 (14-23)) vs age > = 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.