Keighley and Fielding graded fecal incontinence and its response to therapy. The authors are from the General Hospital in Birmingham, England.
Conditions to exclude:
(1) urgency, which involves a sudden need to use the toilet, with leakage of feces if a toilet is not available. This may be associated with inflammation of the bowel mucosa, rectal cancer, or a low rectal capacity to store stool.
(2) soiling, which involves the seepage of a small amount of stool through the anal sphincter associated with minor damage to the sphincter or a fecal bolus in the rectum
Extent of Fecal Incontinence
Grade
episodes of fecal leakage no more than once a month, usually associated with diarrhea (liquid stool)
minor
incontinence at least once a week, with failure to control solid stool
moderate
incontinence on most days, requiring use of a perineal pad
severe
where:
• In the implementation I have added a grade "mild" to cover the 2 to 3 times a month interval.
Response to Therapy
Descriptor
no improvement
no better
some lack of control, typically with liquid stool during an episode of diarrhea
improved but not perfect
control of feces and usually flatus, even during an episode of diarrhea
continent
where:
• In the implementation I added a descriptor for when therapy made the incontinence worse.
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