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


episodes of fecal leakage no more than once a month, usually associated with diarrhea (liquid stool)


incontinence at least once a week, with failure to control solid stool


incontinence on most days, requiring use of a perineal pad




• In the implementation I have added a grade "mild" to cover the 2 to 3 times a month interval.


Response to Therapy


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




• In the implementation I added a descriptor for when therapy made the incontinence worse.


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