|437||What is the Impact of Fecal Incontinence on Quality of Life? [2001년 1월 DCR]||2011-11-12||1561|
Joost Rothbarth, M.D., Willem A. Bemelman, M.D., Ph.D.,Wilhelmus J. H. J. Meijerink, M.D., Ph.D., Anne M. Stiggelbout, Ph.D.,Aeilko H. Zwinderman, Ph.D., Marianne E. Buyze-Westerweel, M.D.,Johannes B. V. M. Delemarre, M.D., Ph.D.
From the Department of Gastrointestinal Surgery, Leiden University Medical Center, Leiden, the Netherlands
PURPOSE: 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 vaildated quality of life tests (Gastrointestinal Quality of LifeIndex 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.
A large number of incontinence scoring scales have been developed in the past. Many scoring scales are very limited in describing fecal incontinence, resulting in different interpretations of fecal incontinence. Scoring scales, such as the scores according to Rudd, 2 Hiltunen et al., 3 and Broden et al., 4 use loose descriptions such as "occasional accidents," which could be interpreted differently. Neither the consistency nor the frequency of fecal incontinence is described using these scoring systems. Other fecal incontinence scoring scales according to Parks, :° Corman,:: Womack et
al, :2 and Rainey et al. :3 do describe the consistency of stool but do not mention the frequency of fecal
incontinence. The Miller score, the score used by The American Society of Colon and Rectal Surgeons, 14 and the Wexner score:, ~5 combine the consistency with frequency of stool. In addition, the Wexner score and the score used by The American Society of Colon and Rectal Surgeons assess the impact of fecal incontinence on daily life.
We have selected the Wexner score to correlate with the quality of life because we consider it a reliable
score for fecal incontinence, which is widely used in general practice in Europe. The Wexner score
contains a value for alteration of lifestyle, which is a reflection of quality of life. Analysis of both the Wexner score and the adapted Wexner score (excluding the lifestyle item) showed similar results. For this reason, the Wexner score can be considered a reliable objective measurement not only to assess fecal incontinence but also to estimate the expected loss of quality of life if the score is 9 or higher.
It is of great importance to know at what point fecal incontinence really affects quality of life. It might help
the clinician in deciding whether a sphincter repair is indicated, particularly since the latter operation is
characterized by a disappointing long-term success rate of only 60 percent.:< :7 It is unlikely that patients with fecal incontinence who have a good quality" of life wilt benefit from sphincter repair. Various quali Wof-life scales, such as the GIQLI and the MOS SF-20, could be used to determine quality of life, but they are quite elaborate in clinical practice. Assessment of the Wexner score can be easily done, and, unlike the quality-of-life scales, the result is not influenced by comorbid diseases.
This study demonstrates that a Wexner score higher than 9 is associated with a significant decrease in
quality of life. In patients with a Wexner score equal to or less than 9, incontinence was mainly determined by loss of flatus and loss of stool less than once a month. Almost all patients with a Wexner score higher than 9 were losing stool more than once a week, needed a diaper, and felt restricted in their daily functioning.