Fecal Incontinence Severity Index Research Articles

Translation and validation of the traditional Chinese version of the faecal incontinence quality of life scale.

Psychometric evaluation with tools such as the faecal incontinence quality of life scale is an essential component of clinical assessment. Currently, there is no translated Traditional Chinese version of the scale. A validated translated version may help to improve the quality of healthcare received in countries with Chinese minorities (0.5, 1.2 and 4.0% of the UK, USA and Australian population, respectively) as well as local population of Hong Kong. The purpose of this study is to validate the Traditional Chinese version of the faecal incontinence quality of life scale (FIQL). The FIQL questionnaire was translated into Traditional Chinese Language followed by linguistic validation. It was then tested on 55 patients with faecal incontinence and 93 controls in the colorectal outpatients clinic. Faecal incontinence severity index was also used for the assessment of disease severity. Internal consistency was good/excellent for all scales (Cronbach's alpha >0.70, between 0.71 and 0.93). The intra-class correlation indicated a high stability over time with coefficients ranging between 0.78 and 0.90. Test and retest of all four scales found no significant differences of mean scores between baseline and retest. The mean faecal incontinence quality of life scale scores of all four domains improved significantly after treatment of 10 patients whose faecal incontinence severity index scores decreased by 50 % of their pre-treatment scores, hence indicating good sensitivity. This study demonstrates the linguistic and psychometric validity of the traditional Chinese version of the faecal incontinence quality of life scale.

New-onset rectoanal intussusception may not result in symptomatic improvement after laparoscopic ventral rectopexy for external rectal prolapse.

This study was designed to assess defecatory function in patients who underwent laparoscopic ventral rectopexy (LVR) for external rectal prolapse (ERP). Thirty-one patients who underwent evacuation proctography 6months postoperatively were assessed. Preoperative proctography had been performed in 21 patients of these patients. Defecatory function was evaluated using the constipation scoring system (CSS) and fecal incontinence severity index (FISI). The findings of postoperative proctography revealed no full-thickness ERP in any patient, although in 10 patients the ERP was replaced by rectoanal intussusception (RAI). Of the 31 patients, 30 presented with fecal incontinence preoperatively. Ten of 30 had new-onset RAI. Six months postoperatively, a reduction of at least 50% in the FISI score of the patients with new-onset RAI tended to be significantly smaller than in the patients without RAI (6/10 vs. 18/20, p=0.141). Seventeen patients presented with obstructed defecation preoperatively. Seven of them had new-onset RAI. Six months postoperatively, a reduction of at least 50% in their CSS score in the patients with new-onset RAI was significantly smaller than in patients without RAI (0/7 vs. 8/10, p=0.002). Evacuation proctography showed new-onset RAI in some patients with ERP who underwent LVR, which was associated with a lack of symptomatic improvement.

Effect of Coexisting Pelvic Floor Disorders on Fecal Incontinence Quality of Life Scores: A Prospective, Survey-Based Study.

The association between an objective measure of fecal incontinence severity and patient-reported quality of life is poorly understood. The purpose of this study was to evaluate patients with various degrees of fecal incontinence to determine whether their quality of life as measured by the Fecal Incontinence Quality of Life Scale is affected by coexisting pelvic floor disorders. This was a prospective, survey-based study. The study was conducted at a tertiary pelvic floor disorders center. Included patients were all of those presenting between January 2007 and March 2014. Survey data were analyzed to determine the association between Fecal Incontinence Severity Index and Fecal Incontinence Quality of Life Scale, as well as scores from the Constipation Severity Instrument, Pelvic Floor Impact Questionnaire, Pelvic Organ Distress Inventory, and Urinary Distress Inventory. A total of 585 patients reported fecal incontinence ranging from none (n = 191) to mild/moderate (n = 159) to severe (n = 235). As expected, patients with severe fecal incontinence have worse scores on all fecal incontinence quality-of-life subscales (lifestyle, coping/behavior, depression/self-perception, and embarrassment) and worse colorectal/anal symptoms than those with mild/moderate or no fecal incontinence (p < 0.0001). Patients with severe fecal incontinence also have worse bladder/urinary symptoms (p ≤ 0.0001). Pelvic organ prolapse and constipation symptoms were similar between groups (p ≥ 0.61). After correcting for baseline differences in patient comorbidities and bladder/urinary symptoms, a significant association persisted between Fecal Incontinence Severity Index and all of the subscales of the fecal incontinence quality-of-life instrument (p < 0.0001). However, urinary distress scores also remained significantly associated with all of the fecal incontinence quality-of-life subscales except for embarrassment after risk adjustment (p < 0.01). Nongeneral population and a lack of patient data on previous medical management of fecal incontinence were limitations of this study. The Fecal Incontinence Quality of Life Scale correlates strongly with instruments measuring both fecal and urinary incontinence. This underscores the importance of quantifying the presence or absence of coexistent urinary leakage in studies where a drop in fecal incontinence quality of life is considered a primary end point.

The Differential Impact of Flatal Incontinence in Women With Anal Versus Fecal Incontinence.

The differential impact on quality of life (QOL) that leakage of both stool and flatus confers on women compared with stool only is unclear. Our aim was to characterize differences in symptom distress, impact on QOL, and anorectal testing among women with leakage of stool and flatus, stool only, and flatus only. A retrospective review was conducted of women undergoing evaluation of at least monthly bowel incontinence symptoms. Subjects were divided into the following 3 groups: liquid/solid stool and flatus (anal incontinence [AI]), liquid/solid stool only (fecal incontinence [FI]), and flatal only (FL). Baseline assessment included the Modified Manchester Health Questionnaire (MMHQ) including the Fecal Incontinence Severity Index (FISI), Short Form-12 (SF-12), as well as anorectal manometry and endoanal ultrasound evaluations. Of 436 subjects, 381 had AI, 45 FI, and 10 FL. Significant between-group differences were noted in MMHQ (P = 0.0002) and FISI total scores (P < 0.0001) where women with AI reflected greater negative impact than women with FI. The Short Form-12 (mental and physical component summary scores) scores were similar in all 3 groups (P = 0.22, 0.08). Resting/squeeze pressures were significantly lower in AI and FI groups compared with FL (P = 0.0004), whereas rectal capacity was similar in all 3 groups. Although exploratory, MMHQ scores were similar between FI and FL groups, although FISI scores were higher in the FI group (P < 0.0001). Women with AI have higher symptom specific distress and greater negative impact on QOL compared with women with FI. Treatment of all bowel incontinence symptoms is important to improve symptom-specific and general QOL.

Faecal incontinence in men referred for specialty care: a cross-sectional study.

Little is known about men with faecal incontinence. We compared clinical findings and quality of life in a large cohort of men and women with faecal incontinence to guide its evaluation and treatment in men. We analysed men and women presenting to a tertiary referral centre with faecal incontinence between 2005 and 2013. Demographics, physical examination, anorectal physiology testing, symptom severity (Fecal Incontinence Severity Index) and quality of life (Fecal Incontinence Quality of Life Scale) were recorded. We determined differences between men and women and analysed the association between gender and quality of life. Data were obtained from 144 men and 897 women. Men with faecal incontinence were slightly younger than women (55.3 vs 57.6 years, P = 0.001), more likely to report coexisting constipation (P = 0.004) and more likely to have normal internal and external sphincter function on physical examination (both P < 0.001). Anorectal physiology testing revealed fewer sphincter defects (P < 0.05) and less pudendal neuropathy (P < 0.05) in men compared with women. Although symptom severity and overall quality of life were similar, men had improved coping and less embarrassment compared with women after we adjusted for important clinical factors. Men with faecal incontinence presenting to a tertiary referral centre are more likely than women to have a mixed presentation characterized by constipation and less sphincter dysfunction. They exhibited better coping and less embarrassment than women. These findings should be taken into consideration when evaluating and treating men with faecal incontinence.

Transanal minimally invasive surgery: impact on quality of life and functional outcome.

BackgroundTransanal minimally invasive surgery (TAMIS) is emerging as an alternative to transanal endoscopic microsurgery. Quality of life (QOL) and functional outcome are important aspects when valuing a new technique. The aim of this prospective study was to assess both functional outcome and QOL after TAMIS.MethodsFrom 2011 to 2013, patients were prospectively studied prior to and at least 6 months after TAMIS for rectal adenomas and low-risk T1 carcinomas using a single-site laparoscopy port. Functional outcome was determined using the Faecal Incontinence Severity Index (FISI). Quality of life was measured using functional [Faecal Incontinence Quality of Life (FIQL)] and generic (EuroQol EQ-5D) questionnaires.ResultsThe study population consisted of 24 patients 13 men, median age 59 (range 42–83) with 24 tumours [median distance from the dentate line 8 cm (range 2–17 cm); median tumour size 6 cm2 (range 0.25–51 cm2); 20 adenomas; 4 low-risk T1 carcinomas]. Post-operative complications occurred in one patient (4 %; grade IIIb according to Clavien Dindo classification). Compared to baseline, FISI remained unaffected (9.8 vs 7.3; P = 0.26), FIQL remained unaffected, and EuroQol EQ-5D improved (EQ-VAS: 77 vs 83; P = 0.04).ConclusionThere was no detrimental effect of TAMIS on anorectal function. Overall QOL was improved after TAMIS, probably due to removal of the tumour, and at 6 months was equal to the general population.

PTU-246 Augmentation of a sphincter repair

Introduction Faecal incontinence (FI) affects between 1–10% of adults in varying degrees. Current epidemiological studies have shown that up to 1% of adults have regular episodes of faecal incontinence that adversely impacts their quality of life. A variety of synthetic and biological agents have been used for both overlapping sphincter repair (OSR) and as an anal bulking agent. The aim of this review is to provide an overview of the use of biological materials in the augmentation of the sphincter repair. Method A systematic search of PubMed was conducted using the search terms ‘anal bulking agents’, ‘anal sphincter repair’ or ‘overlapping sphincter repair’. Studies that utilised biological material for either sphincter repair or as a bulking agent were included. Overall, 5 studies were indentified for analysis after inclusion and exclusion criteria were applied. Results There were 3 studies with 127 patients of which 122 underwent anal bulking with a biological agent. 105 patients received a cross-linked porcine dermal collagen in the form of PermacolTM and a further 17 received Glutaraldehyde cross-linked (GAX) collagen, a highly purified bovine dermal collagen. Anorectal physiology was carried out in 27 patients and demonstrated deterioration in maximum resting pressure, and no significant change in maximum squeeze increment. Quality of life scores such as St Mark’s incontinence score, SF-36 and the Cleveland Clinic Florida Incontinence Score (CCFIS) demonstrated an improvement in scores at 6 weeks and 6 months, but this had deteriorated at 12 month follow up. There were no complications reported. 10 patients received a cross-linked porcine dermal collagen (PermacolTM) for OSR and 13 patients received porcine intestinal submucosa (Surgisis©) to carry out an anal encirclement procedure. Improvements in Faecal Incontinence Severity Index (FISI), CCFIS and two subscales of Faecal Incontinence Quality of Life (FIQL) (coping/behaviour and embarrassment) were observed in the group of patients undergoing OSR. Furthermore, the FISI, Wexner score and all components of FIQL score (lifestyle, coping/behaviour, depression and embarrassment) showed an improvement following anal encirclement using biological material. Incontinence episodes decreased to an average of one per week from 8 to 10 preoperatively and no complications were reported. Conclusion Sphincter augmentation with biological material has demonstrated significantimprovement in continence and quality of life scores in the short term compared to traditional repair. Long-term studies are necessary to determine if this effect is sustained. Disclosure of interest None Declared.

Is group pelvic floor retraining as effective as individual treatment?

Traditionally, pelvic floor retraining for faecal incontinence or obstructed defaecation has been delivered to patients through individual sessions with a specialist pelvic floor nurse, a resource-intensive practice. This study aimed to assess whether a similar outcome can be achieved by delivering retraining to patients in small groups, allowing considerable savings in the use of resources. Data were collected prospectively in a pelvic floor database. Patients received pelvic floor retraining either individually or in a small group setting and completed baseline and follow-up questionnaires. Two hundred and fifteen patients were treated, 119 individually and 96 in a small group setting. Scores before and after treatment for the two settings were compared for the Gastrointestinal Quality of Life Index, the Fecal Incontinence Severity Index and the Patient Assessment of Constipation Symptoms. Additionally patients receiving group treatment completed a short questionnaire on their experience. The median change in Gastrointestinal Quality of Life Index score was 5 (range -62 to 73) for individual treatment and 4 (range -41 to 47) for group treatment, both showing statistically significant improvement. However, there was no significant difference between the settings. Similar results were obtained with the Fecal Incontinence Severity Index and Patient Assessment of Constipation Symptoms scores for the faecal incontinence and obstructed defaecation subgroups respectively. The majority of patients experienced symptomatic improvement following pelvic floor retraining and there was no significant difference in the resulting improvement according to treatment setting. As treatment costs are considerably less in a group setting, group pelvic floor retraining is more cost-effective than individual treatment.

Factors associated with fecal incontinence in a nationally representative sample of diabetic women.

Fecal incontinence (FI) is a debilitating condition that significantly affects quality of life, and has been associated with multiple risk factors. Our goal was to assess the prevalence of FI among diabetic women and evaluate factors associated with FI in this population. The National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010 was used to evaluate women with diabetes mellitus and FI. FI was defined as involuntary loss of mucus, liquid, or solid stool at least monthly. Severity was evaluated using the Fecal Incontinence Severity Index. Potential risk factors associated with FI were explored with weighted chi-squared statistics. Variables associated with FI in multivariable logistic regression analysis are reported with odds ratios (OR) and 95 % confidence intervals (95 % CI). Among 7,039 women, 13.6 % were diabetic, and 18.1 % of diabetic women reported FI compared to 8.4 % in the overall NHANES population (p < .001). In diabetic women, FI was associated with advancing age (OR 1.3, 95 % CI 1.1 - 1.5), depression (OR 2.0 95 % CI 0.9 - 4.5), poorer health status (OR 1.9, 95 % CI 1.2 - 3.1), urinary incontinence (OR 3.5, 95 % CI 2.1 - 5.9) and bowel movement frequency of ≥21/week (OR 4.9, 95 % CI 2.3 - 10.6) in a multivariable logistic regression model adjusted for race, education level, BMI, comorbidities, prior hysterectomy, and stool consistency. FI affects one in five diabetic women and is strongly associated with high bowel movement frequency, a possible important modifiable factor that should be investigated further in prospective studies.

The Severity of Bowel Dysfunction in Patients with Neurogenic Bladder

Patients with neurological conditions often experience severe debilitating lower urinary and bowel dysfunction in addition to the physical disabilities. However, only the bladder has received the attention of medical providers with neurogenic bowel being poorly understood and characterized. This is a cross-sectional analysis of a prospective institutional neurogenic bladder database from 2010 to 2013. Of the 175 patients 60.6% had traumatic spinal cord injury and 18.3% had multiple sclerosis. Median ± SD FISI (Fecal Incontinence Severity Index) scores were 18.0 ± 1.39 (moderate). The median neurogenic bowel dysfunction score was 11.0 ± 0.63 (moderate). Those scores were worse in those patients with spinal cord injury and spina bifida compared to those with other diseases and in younger patients (each p = 0.020), and those in the spinal cord injury group with higher levels of injury (p = 0.0046). Based on the Bristol stool scale 65% of patients had abnormal stool consistency, mostly constipation. None of the FISI, Bristol or neurogenic bowel dysfunction scores correlated significantly with SF-12® quality of life measures. However, bladder symptom scores on M-ISI (Michigan Incontinence Symptom Index) (p = 0.05) and AUA-SI (American Urological Association symptom index) (p = 0.03) correlated with FISI severity while the neurogenic bowel dysfunction score correlated with M-ISI (ρ = 0.29, p= 0.02). Patients with abnormal stool consistency on the Bristol scale reported more urgency and stress incontinence on M-ISI. Bowel dysfunction is common among patients with neurogenic bladder. Those with worse bladder symptoms also experience worse bowel dysfunction. This highlights the importance of addressing both bowel and bladder dysfunction in this often poorly understood population.

Standard compared with mnemonic counseling for fecal incontinence: a randomized controlled trial.

To estimate whether women who underwent mnemonic counseling had better recall of fecal incontinence therapies at 2 months and if mnemonic counseling resulted in greater satisfaction with physician counseling and improvement in quality of life when compared with a group who underwent standard counseling. Counseling-naive women with fecal incontinence were recruited from an academic urogynecology clinic. Women underwent physical examinations, completed the Quality of the Physician-Patient Interaction, recorded fecal incontinence treatment options they recalled, and completed the Fecal Incontinence Severity Index and Manchester Health Questionnaire immediately after counseling and again at 2 months. Ninety women consented to participate, were randomized, and completed baseline questionnaires. At baseline, women did not differ in age, ethnicity, education, Fecal Incontinence Severity Index, or Manchester Health Questionnaire scores. After counseling, the mnemonic group reported higher satisfaction on Quality of the Physician-Patient Interaction (66.4±6.5 compared with 62.2±10.7, P=.03). Ninety percent (81/90) of women followed up at 2 months. Our primary endpoint, 2-month recall of fecal incontinence treatments, was not different between groups (2.3±1.6 mnemonic counseling compared with 1.8±1.0 standard counseling; P=.08). Secondary endpoints for the mnemonic group reported greater improvement on total Manchester Health Questionnaire (P=.02), emotional (P=.03), sleep (0.045), role limitations (P<.01), and physical limitations (P=.04) when compared with the standard group. Fecal incontinence counseling with a mnemonic aid did not improve recall at 2 months but improved patient satisfaction and quality of life at 2 months.

Short- and Long-Term Quality of Life and Bowel Function in Patients With MRI-Defined, High-Risk, Locally Advanced Rectal Cancer Treated With an Intensified Neoadjuvant Strategy in the Randomized Phase 2 EXPERT-C Trial

Intensified preoperative treatments have been increasingly investigated in locally advanced rectal cancer (LARC), but limited data are available for the impact of these regimens on quality of life (QoL) and bowel function (BF). We assessed these outcome measures in EXPERT-C, a randomized phase 2 trial of neoadjuvant capecitabine combined with oxaliplatin (CAPOX), followed by chemoradiation therapy (CRT), total mesorectal excision, and adjuvant CAPOX with or without cetuximab in magnetic resonance imaging-defined, high-risk LARC. QoL was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR29 questionnaires. Bowel incontinence was assessed using the modified Fecal Incontinence Severity Index questionnaire. Compared to baseline, QoL scores during preoperative treatment were better for symptoms associated with the primary tumor in the rectum (blood and mucus in stool, constipation, diarrhea, stool frequency, buttock pain) but worse for global health status, role functioning, and symptoms related to the specific safety profile of each treatment modality. During follow-up, improved emotional functioning and lessened anxiety and insomnia were observed, but deterioration of body image, increased urinary incontinence, less sexual interest (men), and increased impotence and dyspareunia were observed. Cetuximab was associated with a deterioration of global health status during neoadjuvant chemotherapy but did not have any long-term detrimental effect. An improvement in bowel continence was observed after preoperative treatment and 3 years after sphincter-sparing surgery. Intensifying neoadjuvant treatment by administering induction systemic chemotherapy before chemoradiation therapy improves tumor-related symptoms and does not appear to have a significantly detrimental effect on QoL and BF, in both the short and the long term.

Sa1345 Fecal Incontinence Severity Index Helps to Identify Patients Who View Their Symptoms As Severe Enough to Consult a Physician

G A A b st ra ct s for fecal incontinence, and underwent recto-anal manometry. Extraperitoneal rectal tumors staged <T2 N0 and/or with size <4 cm at diagnosis time or after irradiation were submitted to TEM. Ano-rectal manometry was performed using a water-perfused system: pressure at rest and during squeezing, rectal sensitivity and compliance, were evaluated. Mann-Whitney and chi-square tests were used for statistical analysis. Twenty-seven patients (14 F, 72±5 yrs, m±sd) underwent TEM without n-RCT (group A); 10 patients (2 F, 68.8±5 yrs) underwent TEM after n-RCT (group B); 9 M, (67±9 yrs) underwent RT for prostate cancer (group C). In group A mean anal resting pressure decreased from 68±23 to 54±26 mmHg at month 4 (p=0.04) after surgery and returned to normal values 12 months postoperatively (60±30 mmHg). In group B and C, respectively, mean anal resting pressure decreased from 65±23 to 50±18 mmHg and from 94±11 to 72±15 mmHg at month 4, and remained stable 12 month postoperatively (44±11 mmHg, p=0.04 and 72.6±12.4 mmHg, p=0.001 vs preoperative values and ns vs 4 month postoperatively). The anal resting pressure differences between basal and 12 months after irradiation of group B and C was similar and was significantly lower than group A (p=0.001). Gas incontinence, soiling and urgency were reported by 50%, 45% and 25% and by 38%, 12% and 12% of the patient group A, B and C , respectively at 4 and 12 months after treatment. The results of this study indicate that TEM per se does not significantly affect anal function. N-RCT to obtain downstaging and downsizing of distal rectal cancers, in order to perform TEM, affects resting anal pressure but it does not cause major anal incontinence. 1. Loos M, Quentmeier P, Schuster T. Ann Surg Oncol. 2013 Jun;20(6):1816-28.

Laparoscopic ventral rectopexy for rectoanal intussusception: postoperative evaluation with proctography.

Laparoscopic ventral rectopexy can relieve symptoms of obstructed defecation and fecal incontinence in patients with rectoanal intussusception. However, pelvic floor imaging after surgery has not been reported. This study was designed to assess the outcome of patients who underwent laparoscopic ventral rectopexy for rectoanal intussusception, with special reference to the postoperative findings on evacuation proctography. This study was a retrospective analysis of prospectively collected data. The study was conducted from 2012 to 2013 at the Department of Surgery, Kameda Medical Center, Japan. We included 26 patients with symptomatic rectoanal intussusception. Laparoscopic ventral rectopexy was performed. Evacuation proctography was performed before and 6 months after the procedure. Defecatory function was evaluated using the Constipation Scoring System and Fecal Incontinence Severity Index. Of 26 patients with rectoanal intussusception preoperatively, 22 had symptoms of obstructed defecation and 21 complained of fecal incontinence. Postoperatively, rectoanal intussusception was eliminated in all patients, though 8 developed recto rectal intussusception. There was an overall reduction in both grade 2 rectocele size (median preop 26 mm vs. postop 11 mm; p < 0.0001) and pelvic floor descent (median preop 26 mm vs. postop 20 mm; p < 0.0001). 6 months after surgery, a reduction of at least 50% was observed in the Constipation Scoring System score for 9 patients (41%) with obstructive defecation and in the Fecal Incontinence Severity Index score for 14 incontinent patients (67%). This was a preliminary study with a small sample size, no control group, and short follow-up time. Evacuation proctography showed anatomical correction in patients with rectoanal intussusception who underwent laparoscopic ventral rectopexy. However, the data also indicate that such correction does not necessarily result in meaningful symptomatic relief.

PD10-08 THE NATURAL HISTORY OF NEUROGENIC BLADDER IN ADULTS WITH SEVERE CEREBRAL PALSY

INTRODUCTION AND OBJECTIVES: Patients with neurological conditions often suffer from severe debilitating lower urinary and bowel dysfunction in addition to their physical disabilities. However, only the bladder has received the attention of medical providers with neurogenic bowel being poorly understood and characterized. The primary aim in this study was to determine the level of severity and impact on quality of life of bowel dysfunction in a population with neurogenic bladder using validated surveys and to determine those patient variables that correlate with worse bowel symptoms. Our second aim was to determine if the severity of bowel dysfunction correlates with the severity of bladder dysfunction. METHODS: This is a cross-sectional analysis of a prospective institutional Neurogenic Bladder Database from 2010e2013. RESULTS: Among the 175 patients 60.6% had traumatic SCI and 18.3% MS. Fecal Incontinence Severity Index (FISI) scores were a median of 18.0 1.39 (moderate). Neurogenic Bowel Dysfunction (NBD) score, which is specific to patients with neurological disease, were a median of 11.0 0.63 (moderate). NBD Scores were worse in those patients with SCI and myelomeningocele compared to other diseases (P1⁄40.020), in younger patients (p1⁄40.020) and in the SCI group those with higher levels of injury (p1⁄40.0046). Based on the Bristol stool scale 65% of patient had abnormal stool consistency, mostly constipation. None of the FISI, Bristol or NBD scores correlated significantly with SF12 quality of life measures. None of the urodynamic findings correlated with any of the bowel symptom scores. However, both of the bladder symptom scores Michigan Incontinence Symptom Index (MISI)(p1⁄40.05) and the AUA-SI (p1⁄40.03) correlated with FISI severity and the NBD score correlated with the M-ISI (~ n1⁄40.29, p1⁄40.02). Those patients with abnormal stool consistency on the Bristol reported more urgency and stress incontinence on M-ISI. CONCLUSIONS: Bowel dysfunction is very common among patients with neurogenic bladder. Those patients with worse bladder symptoms also suffered from worse bowel dysfunction although the severity of bowel dysfunction did not correlate with overall quality of life or urodynamic measures.

A novel data collection and monitoring system for health status measures in patients undergoing lateral internal sphincterotomy: The Knowledge Program (TKP)

The Knowledge Program (TKP) allows prospective data collection during routine clinical practice. The aim of this study was to evaluate the efficacy and feasibility of TKP for capturing and monitoring health status measures in patients undergoing lateral internal sphincterotomy (LIS). TKP data of patients undergoing LIS from December 2008 to May 2013 were retrieved. Health status measures including the Cleveland Global Quality of Life (CGQL), European Quality of Life Index (EQ-5D), Fecal Incontinence Severity Index (FISI), anorectal pain scores, and satisfaction questions were evaluated in the study. A total of 500 patients underwent LIS within the study period. Overall patient numbers responding to the health status measures in the pre- and postoperative period were as follows: CGQL: 112 preoperatively, 53 postoperatively; EQ-5D: 112 preoperatively, 55 postoperatively; FISI: 102 preoperatively, 30 postoperatively; and anorectal pain score: 107 preoperatively, 45 postoperatively. Among the responders, the number of patients who completed the health status measures both pre- and postoperatively was as follows: EQ-5D: 31, CGQL: 28, anorectal pain: 24, and FISI: 15. A total of 30 patients completed postoperative satisfaction and recommendation questions. Postoperative earliest (p=0.02) and most recent (p=0.01) anorectal pain visual analog scores were significantly lower than the preoperative measurements. The earliest postoperative EQ-5D scores were significantly higher than their preoperative values (p=0.02). The majority of patients who completed the surveys said they were satisfied (70% and 67%) and would recommended (73% and 70%) LIS to others undergoing postoperative earliest and most recent follow up. LIS reduces anorectal pain without worsening quality of life. TKP captures information directly from patients and records it to a database which may reduce the risk of information loss or alteration.

Restorative proctocolectomy with a handsewn IPAA: S-pouch or J-pouch?

The efferent limb on the S-pouch fits well into the anal canal while the body of the pouch lies on the levators. In contrast, the blunt end of a J-pouch may be distorted as it is forced into the muscular tube of the stripped anus. The aim of this study is to compare the clinical outcomes and quality of life between patients with S- and J-pouches with a handsewn IPAA. This study was retrospective. This study was conducted at a high-volume tertiary referral center. Patients undergoing a primary handsewn IPAA from 1983 to 2012 were identified. Demographics, operative details, functional outcomes, and quality of life were abstracted. A total of 502 patients, including 169 patients with an S-pouch (33.7%) and 333 patients with J-pouch (66.3%), met our inclusion criteria; 55.8% (n = 280) were men. Mean age at pouch construction was 37.8 ± 12.5 years. Patients with an S-pouch were younger (p = 0.004) and had a higher BMI (p = 0.035) at pouch surgery. There was no significant difference between patients with S- or J-pouches in other demographics. The frequencies of short-term complications in the 2 groups were similar (p > 0.05), but pouch fistula or sinus (p = 0.047), pelvic sepsis (p = 0.044), postoperative partial small-bowel obstruction (p = 0.003), or postoperative pouch-related hospitalization (p = 0.021) occurred in fewer patients with an S-pouch. At a median follow-up of 12.2 (range, 4.3-20.1) years, patients with an S-pouch were found to have fewer bowel movements (p < 0.001), less frequent pad use (p = 0.001), and a lower fecal incontinence severity index score (p = 0.015). The pouch failed in 62 patients (12.4%), but neither univariate nor multivariate analysis showed a significant association with pouch configuration. The use of data from a single tertiary referral center was a limitation of this study. We recommend using an S-pouch when constructing an IPAA with a handsewn technique.

Laparoscopic ventral rectopexy using biologic mesh for the treatment of obstructed defaecation syndrome and/or faecal incontinence in patients with internal rectal prolapse: a critical appraisal of the first 100 cases

Laparoscopic ventral mesh rectopexy (LVR) is gaining wider acceptance as the preferred procedure to correct internal as well as external rectal prolapse associated with obstructed defaecation syndrome and/or faecal incontinence. Very few reports exist on the use of biologic mesh for LVR. The aim of our study was to report the complication and recurrence rate of our first 100 cases of LVR for symptomatic internal rectal prolapse and/or rectocele using a porcine dermal collagen mesh. Prospectively collected data on LVR for internal rectal prolapse were analysed. Surgical complications and functional results in terms of faecal incontinence (measured with the Faecal Incontinence Severity Index=FISI) and constipation (measured with the Wexner Constipation Score=WCS) at 3, 6 and 12months were analysed. It was considered an improvement if FISI or WCS scores were reduced by at least 25% and a cure if the FISI score decreased to <10 and the WCS decreased to <5. Between April 2009 and April 2013, 100 consecutive female patients (mean age 63years, range 24-88years) underwent LVR. All patients had internal rectal prolapse (grade III [n=25] and grade IV [n=75] according to the Oxford classification) and rectocele. Mean operative time was 85±40min. Conversion rate to open technique was 1%. There was no post-operative mortality. Overall 16 patients (16%) experienced 18 complications, including rectal perforation (n=1), small bowel obstruction (n=2), urinary tract infection (n=8), subcutaneous emphysema (n=3), wound haematoma (n=2), long lasting sacral pain (n=1) and incisional hernia (1). Median post-operative length of stay was 2days. Ninety-eight out of 100 patients completed follow-up. At the end of follow-up, the mean FISI score improved from 8.4 (±4.0 standard deviation (SD) p=0.003) to 3.3±2.3 SD (p=0.04). Incontinence improved in 37 out of 43 patients (86%), and 31 patients (72%) were cured. Similarly, the mean WCS score improved from 18.4±11.6 SD to 5.4±4.1 SD (p=0.04). Constipation improved in 82 out of 89 patients (92%), and 70 patients (79%) were cured. No worsening of continence status, constipation or sexual function was observed. Fourteen patients (14%) experienced persistence or recurrence of prolapse. LVR using biologic mesh is a safe and effective procedure for improving symptoms of obstructed defaecation and faecal incontinence in patients with internal rectal prolapse associated with rectocele.

Symptom improvement in women after fecal incontinence treatments: a multicenter cohort study of the pelvic floor disorders network.

The study aims were to characterize women with fecal incontinence (FI) and measure changes in FI severity and quality of life 3 and 12 months after treatment. This study is a secondary analysis of a multicenter study measuring adaptive behaviors among women with FI. Women included had a primary complaint of at least monthly FI over 3 consecutive months and planned FI treatment. Demographic and medical history data were obtained at baseline. Data were collected at baseline, 3 months, and 12 months after clinically selected, nonstandardized treatment. Validated questionnaires were as follows: Fecal Incontinence Severity Index, Modified Manchester Health Questionnaire, Pelvic Floor Disorders Inventory's Colorectal and Anal Distress Inventory, Pelvic Floor Impact Questionnaire's Colorectal and Anal Impact Questionnaire, and Medical Outcomes Study Short Form. Questionnaire score changes from baseline were compared using paired t tests at 3 and 12 months after treatment. Of the 133 women enrolled, 90 women had treatment data at 3 months and 77 at 12 months. Nonsurgical therapies were the most common (78%) with anal sphincter repair in 22%. Fecal Incontinence Severity Index scores and Modified Manchester Health Questionnaire scores significantly improved 3 months after nonsurgical and surgical treatments (-8.8 ± 12.0 and -12.6 ± 19.2, respectively, P < 0.001), as did Colorectal-Anal Distress Inventory and Colorectal-Anal Impact Questionnaire scores (-52.7 ± 70.0 and -60.6 ± 70.0, respectively, P < 0.001) and Medical Outcomes Study Short Form mental health scores (4.2 ± 9.4, P = 0.001). Improvement persisted 12 months posttreatment. In women seeking care for FI, symptom severity and condition-specific quality of life significantly improve within the first 3 months after FI treatment and are maintained up to 12 months.

Dynamic versus Adynamic Graciloplasty in Treatment of End-Stage Fecal Incontinence: Is the Implantation of the Pacemaker Really Necessary? 12-Month Follow-Up in a Clinical, Physiological, and Functional Study.

Purpose. The aim of the study is to compare functional results of end-stage fecal incontinence treatment with dynamic graciloplasty and adynamic graciloplasty augmented with transanal conditioning of the transposed muscle. Methods. A total of 20 patients were qualified for graciloplasty procedure due to end-stage fecal incontinence. 7 patients underwent dynamic graciloplasty (DGP), whereas 13 patients were treated with adynamic graciloplasty, with transanal stimulation in the postoperative period (AGP). Clinical, functional, and quality of life assessments were performed 3, 6, and 12 months after the procedures. Results. There were no intraoperative or early postoperative complications. The detachment of gracilis muscle tendon was observed in one patient in DGP group and two in AGP group. There was a significant improvement of Fecal Incontinence Quality of Life (FIQL) and Fecal Incontinence Severity Index (FISI) scores in both groups 12 months after procedure. Anorectal manometry showed improvement regarding basal and squeeze pressures in both groups, with significantly better squeeze pressures in AGP group. Conclusions. The functional effects in the DGP and AGP groups were similar. Significantly lower price of the procedure and avoidance of implant-related complication risk suggest the attractiveness of the AGP method augmented by transanal stimulation.