Defining anal incontinence: Establishing a uniform continence scale

Many fecal incontinence scoring systems are used throughout the colorectal literature. The sheer number of systems attests to the lack of general agreement about the best way to grade the severity of fecal incontinence. For a scoring system to be useful, it needs to be accurate, reproducible, and able to measure clinically significant changes in a patient's condition. Although valuable in the investigation of anorectal disorders, objective tests of anorectal physiology are unreliable in the determination of severity of fecal incontinence. Despite the inherent limitations, scoring systems for fecal incontinence are forced to rely on information obtained from a patient's history. Several currently used scoring systems are presented including an assessment of their strengths and weaknesses.