title: Effect of Coexisting Pelvic Floor Disorders on Fecal Incontinence Quality of Life Scores: A Prospective, Survey-Based Study.
abstract: BACKGROUND
  The association between an objective measure of fecal incontinence severity and patient-reported quality of life is poorly understood.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  This was a prospective, survey-based study.
  
  
  METHODS
  The study was conducted at a tertiary pelvic floor disorders center.
  
  
  METHODS
  Included patients were all of those presenting between January 2007 and March 2014.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Nongeneral population and a lack of patient data on previous medical management of fecal incontinence were limitations of this study.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Massachusetts General Hospital Pelvic Floor Disorders Center, Boston, Massachusetts 2 Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland 3 University of Minnesota School of Public Health, Minneapolis, Minnesota 4 Brandeis University, Waltham, Massachusetts.
authors.forename: Liliana
authors.initials: L
authors.lastname: Bordeianou
authors.forename: Caitlin W
authors.initials: CW
authors.lastname: Hicks
authors.forename: Adriana
authors.initials: A
authors.lastname: Olariu
authors.forename: Lieba
authors.initials: L
authors.lastname: Savitt
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Pulliam
authors.forename: Milena
authors.initials: M
authors.lastname: Weinstein
authors.forename: Todd
authors.initials: T
authors.lastname: Rockwood
authors.forename: Patricia
authors.initials: P
authors.lastname: Sylla
authors.forename: James
authors.initials: J
authors.lastname: Kuo
authors.forename: May
authors.initials: M
authors.lastname: Wakamatsu
mesh_terms: D015331:Cohort Studies; D015897:Comorbidity; D005242:Fecal Incontinence / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059952:Pelvic Floor Disorders / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012044:Regression Analysis; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology