Tools for fecal incontinence assessment: lessons for inflammatory bowel disease trials based on a systematic review

United European Gastroenterol J. 2020 Jul 17;2050640620943699.doi: 10.1177/2050640620943699. Online ahead of print.

Ferdinando D'Amico 1 2, Steven D Wexner 3, Carolynne J Vaizey 4, Célia Gouynou 2, Silvio Danese 1 5, Laurent Peyrin-Biroulet 2


Author information

  • 1Department of Biomedical Sciences, Humanitas University, Milan, Italy.
  • 2Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.
  • 3Department of Colorectal Surgery, Cleveland Clinic Florida, Weston USA.
  • 4St Mark's, The National Bowel Hospital, London, UK.
  • 5IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy.


Background: Fecal incontinence is a disabling condition affecting up to 20% of women.

Objective: We investigated fecal incontinence assessment in both inflammatory bowel disease and non-inflammatory bowel disease patients to propose a diagnostic approach for inflammatory bowel disease trials.

Methods: We searched on Pubmed, Embase and Cochrane Library for all studies on adult inflammatory bowel disease and non-inflammatory bowel disease patients reporting data on fecal incontinence assessment from January 2009 to December 2019.

Results: In total, 328 studies were included; 306 studies enrolled non-inflammatory bowel disease patients and 22 studies enrolled inflammatory bowel disease patients. In non-inflammatory bowel disease trials the most used tools were the Wexner score, fecal incontinence quality of life questionnaire, Vaizey score and fecal incontinence severity index (in 187, 91, 62 and 33 studies). Anal manometry was adopted in 41.2% and endoanal ultrasonography in 34.0% of the studies. In 142 studies (46.4%) fecal incontinence evaluation was performed with a single instrument, while in 64 (20.9%) and 100 (32.7%) studies two or more instruments were used. In inflammatory bowel disease studies the Wexner score, Vaizey score and inflammatory bowel disease quality of life questionnaire were the most commonly adopted tools (in five (22.7%), five (22.7%) and four (18.2%) studies). Anal manometry and endoanal ultrasonography were performed in 45.4% and 18.2% of the studies.

Conclusion: Based on prior validation and experience, we propose to use the Wexner score as the first step for fecal incontinence assessment in inflammatory bowel disease trials. Anal manometry and/or endoanal ultrasonography should be taken into account in the case of positive questionnaires.

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