Fecal Incontinence Severity Index (FISI) Calculator

How does this Fecal Incontinence Severity Index (FISI) calculator work?

This is a health tool that is based on the Rockwood model which describes the severity of different types of incontinence for bowel contents.

The FISI is often applied form monitoring purposes as well, as a response to different treatment methods.

The model uses data from colon and rectal surgeon and patient input databases and consists in a type x frequency matrix which includes four types of leakage and five frequencies plus an added “never” choice.

■ Types of incontinence:

(1) gas;

(2) mucus;

(3) liquid stool;

(4) solid stool.

■ Frequency of incontinence:

(1) never;

(2) 1 to 3 times per month;

(3) once a week;

(4) 2 or more times per week but not daily;

(5) once a day;

(6) 2 or more times per day;

The overall result aims to stratify quality of life and correlate it with physical symptoms in adult incontinence.

Fecal incontinence is one of the main debilitating problems, usually affecting populations over 65 years of age with symptoms ranging in severity. Usually patients are most concerned with the risk of accidents.

Due to the embarrassing nature of the symptoms, often cases are left unreported and undertreated.

Some of the main causes include traumatic (obstetric surgery, side effect of poorly performed anorectal surgery), congenital, neurological but also iatrogenic etiologies.

The basic mechanisms however look at the disturbance of factors that usually produce continence:

■ sphincter function;

■ rectal sensation;

■ adequate rectal capacity and compliance;

■ colonic transit time;

■ stool consistency;

■ neurologic factors.

Whilst assessing the symptoms, the clinician should also evaluate whether the patient suffers from chronic diarrhea or has other medical comorbidities that affect the functioning of the bowels.

Treatment options include surgical and nonsurgical means such as anal sphincter repair, artificial bowel sphincter and sacral nerve stimulation. Therefore an efficient therapy needs to address the pelvic floor musculature, the external and internal sphincters and the local innervation.

FISI score interpretation

There are 4 items in the FISI scale with 6 answer choices each as described above, every item needs to be completed in order for the Fecal Incontinence Severity Index (FISI) calculator to produce the final result.

However, unlike in other scales, although the frequency choices are similar in the 4 types of incontinence, these weight a different number of points based on the rule of thumb that the more severe the incontinence, the higher the points. There is a maximum of 19 points awarded to liquid stool incontinence with a frequency of 2 or more times per week.

In the original Rockwood et al. study there is no specific cut off established and the main score interpretation is that the higher the FISI (which ranges from 0 to 61), the higher the severity of the fecal incontinence.

Cavanaugh et al found that FISI scores above 30 are more likely to be associated with an impaired quality of life due to fecal incontinence.

There are other scoring systems available for the same condition such as the Cleveland Clinic Incontinence Score or the Fecal Incontinence Quality of Life Questionnaire (FIQL) published by the American Society of Colon and Rectal Surgeons.

References

1) Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC. (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum; 42(12):1525-32.

2) Norton C, Whitehead WE, Bliss DZ, Harari D, Lang J; Conservative Management of Fecal Incontinence in Adults Committee of the International Consultation on Incontinence. (2010) Management of fecal incontinence in adults. Neurourol Urodyn; 29(1):199-206.

3) Hayden DM, Weiss EG. Guest Editor Isenberg GA. (2011) Anorectal Disease: Fecal Incontinence: Etiology, Evaluation, and Treatment. Clin Colon Rectal Surg; 24(1): 64–70.

4) Zutshi M, Salcedo L, Hammel J, Hull T. (2010) Anal physiology testing in fecal incontinence: is it of any value? Int J Colorectal Dis; 25(2):277-82.