Oresland et al developed an index to evaluate bowel function in patients with ulcerative colitis treated with restorative proctocolectomy. This can help identify patients with significant problems following the procedure who may require more aggressive management and monitoring. The authors are from the University of Goteborg in Sweden.
Elements of a restorative proctocolectomy:
(1) colectomy
(2) mucosal proctectomy
(3) ileal pouch-to-anus anastomosis
Parameters:
(1) number of bowel movements during the day
(2) number of bowel movements at night
(3) urgency
(4) evacuation difficulties at any time during the week
(5) soiling or seepage during the day
(6) soiling or seepage at night
(7) inability to release flatus safely
(8) perianal soreness
(9) protective pad used during the day
(10) protective pad used at night
(11) dietary restrictions
(12) medication required (intermittent or continuous)
(13) social handicap
where:
• Urgency is the inability to defer evacuation for > 30 minutes.
• Evacuation difficulties involves spending > 15 minutes on the toilet.
• Social handicap is the inability to resume a full-time occupation or social life.
|
Parameter |
Finding |
Points |
|
number of bowel movements during the day |
<= 4 |
0 |
|
|
5 |
1 |
|
|
>= 6 |
2 |
|
number of bowel movements at night |
none to once per week |
0 |
|
|
more than once a week |
1 |
|
|
>= 2 per night |
2 |
|
urgency |
no |
0 |
|
|
yes |
1 |
|
evacuation difficulties |
no |
0 |
|
|
yes |
1 |
|
soiling or seepage during the day |
no |
0 |
|
|
yes |
1 |
|
soiling or seepage at night |
no |
0 |
|
|
yes |
1 |
|
inability to release flatus safely |
no |
0 |
|
|
yes |
1 |
|
perianal soreness |
no |
0 |
|
|
occasional |
1 |
|
|
permanent |
2 |
|
protective pad during the day |
no |
0 |
|
|
yes |
1 |
|
protective pad at night |
no |
0 |
|
|
yes |
1 |
|
dietary restrictions |
no |
0 |
|
|
yes |
1 |
|
medications required |
no |
0 |
|
|
yes |
1 |
|
social handicap |
no |
0 |
|
|
yes |
1 |
total score =
= SUM(points for all 13 parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
• The higher the score the worse the overall function.
Specialty: Gastroenterology
