What is the impact of fecal incontinence on quality of life?
OBJECTIVE
The objective of this study was to determine at what point fecal incontinence affects quality of life.


METHODS
In 35 patients who had anterior sphincter repair for fecal incontinence as a result of obstetric injury, continence evaluated by the Wexner score was compared with validated quality of life tests (Gastrointestinal Quality of Life Index and Medical Outcomes Study Short-Form General Health Survey). The questionnaires were sent by mail. Thirty-two patients responded. The Wexner score (0-20) was correlated with the Gastrointestinal Quality of Life Index and the Medical Outcomes Study Short-Form General Health Survey and matched with those of reference groups.


RESULTS
The mean Wexner score was 8.8, corresponding with losing stools between once a week and once a month. The mean Gastrointestinal Quality of Life Index score was 105 (range, 48-136), which is significantly lower than the score found in a reference group of normal individuals. Medical Outcomes Study Short-Form General Health Survey scores were significantly lower in all six dimensions compared with the reference group. A Wexner score of 9 or higher was associated with a Gastrointestinal Quality of Life Index score of less than 105, which implies that patients were less mobile in the community and were confined to their homes. A similar correlation was found between a Wexner score higher than 9 and the Medical Outcomes Study Short-Form General Health Survey.


CONCLUSIONS
A Wexner score of 9 or higher indicates a significant impairment of quality of life and can therefore be used in decision making.
Rothbarth
J
J
Department of Gastrointestinal Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Bemelman
W A
WA
Meijerink
W J
WJ
Stiggelbout
A M
AM
Zwinderman
A H
AH
Buyze-Westerweel
M E
ME
Delemarre
J B
JB
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery; D005242:Fecal Incontinence / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012044:Regression Analysis; D012720:Severity of Illness Index