Fecal incontinence - Challenges and solutions

Table 3 Structured workup of patients with fecal incontinence

Assessment tool	Details
History	Onset
	Quantitation: staining < soilage < seepage < accidents
	Qualitative assessment: passive incontinence vs urge incontinence
	Obstetrical history: pregnancies, vaginal deliveries
	Previous surgeries: anorectal surgeries, hysterectomy, bladder surgeries, (colo)rectal surgeries, spinal surgeries
	Underlying diseases (diabetes, stroke, etc.)
	Bowel function and stool quality
	Incomplete evacuation
	Stool/gas passage through vagina
	Medications
Scoring instruments	CCF incontinence score (“Wexner score”)
	Fecal Incontinence Quality of Life score
	Fecal Incontinence Severity Index
	St. Marks Incontinence Score
	EORTEC SF-36
	Revised Fecal Incontinence Scale
	Other scoring instruments
Physical exam	Inspection: patulous anus, folds, perineal body, keyhole, skin irritation, perineal descent, prolapse, cloaca, rectovaginal fistula (stool in vagina)?
	Digital exam: sphincter integrity, tone (rest/squeeze), compensatory contraction/discoordination, rectocele, mass?
	Sensation/anal reflex
	Instrumentation/visualization: rule out other pathologies (e.g., rectal tumor, proctitis)
Anophysiology testing	Anal ultrasound
	Anophysiology testing:
	Manometry
	Anorectal sensation and volume tolerance
	Compliance measurement
	Nerve studies: PNTML, occasionally EMG
	Placement of SNS trial electrode (phase I)
Additional evaluations in select cases	Imaging: dynamic pelvic MRI
	Defecating proctogram
	Evaluation by other specialties (Urogynecology, Urology, Gastroenterology, etc.)