Domain A: Symptoms because of fistula
(1) sharp, intense pain around the anus
(2) dull/background discomfort around the anus
(3) any type of discharge
(4) sore skin around the fistula (because of discharge)
(5) restriction on sitting, standing or walking because of fistula
|
Response
|
Points
|
|
never
|
0
|
|
occasionally
|
1
|
|
one to few times per week
|
2
|
|
daily
|
3
|
|
several times a day
|
4
|
Domain B: Effects of Current Fistula Treatment
(6) bothersome medication side effects
(7) bothersome complications from surgery
(8) seton (stitch, string, loop) causes discomfort/pain/irritation
|
Response
|
Points
|
|
strongly disagree
|
0
|
|
disagree
|
1
|
|
unsure
|
2
|
|
agree
|
3
|
|
strongly agree
|
4
|
|
not applicable
|
NA
|
(9) anything else to be said about symptoms or treatment effects
total score for domain A =
= SUM(points for all 5 items)
total score for domain B =
= SUM(points for all 3 items)
Interpretation:
• minimum domain A score: 0
• maximum domain A score: 20
• minimum domain B score: 0
• maximum domain B score: 12
• The higher the scores the greater the impact of the perianal fistula.
