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Abstract

Background

Fecal incontinence is a disabling condition affecting up to 20% of women.

Objective

We investigated fecal incontinence assessment in both inflammatory bowel disease and non-inflammatory bowel disease patients to propose a diagnostic approach for inflammatory bowel disease trials.

Methods

We searched on Pubmed, Embase and Cochrane Library for all studies on adult inflammatory bowel disease and non-inflammatory bowel disease patients reporting data on fecal incontinence assessment from January 2009 to December 2019.

Results

In total, 328 studies were included; 306 studies enrolled non-inflammatory bowel disease patients and 22 studies enrolled inflammatory bowel disease patients. In non-inflammatory bowel disease trials the most used tools were the Wexner score, fecal incontinence quality of life questionnaire, Vaizey score and fecal incontinence severity index (in 187, 91, 62 and 33 studies). Anal manometry was adopted in 41.2% and endoanal ultrasonography in 34.0% of the studies. In 142 studies (46.4%) fecal incontinence evaluation was performed with a single instrument, while in 64 (20.9%) and 100 (32.7%) studies two or more instruments were used. In inflammatory bowel disease studies the Wexner score, Vaizey score and inflammatory bowel disease quality of life questionnaire were the most commonly adopted tools (in five (22.7%), five (22.7%) and four (18.2%) studies). Anal manometry and endoanal ultrasonography were performed in 45.4% and 18.2% of the studies.

Conclusion

Based on prior validation and experience, we propose to use the Wexner score as the first step for fecal incontinence assessment in inflammatory bowel disease trials. Anal manometry and/or endoanal ultrasonography should be taken into account in the case of positive questionnaires.

Keywords

Fecal incontinence assessment inflammatory bowel disease Wexner score clinical trial

Introduction

Fecal incontinence (FI) is defined as the involuntary loss of liquid or solid stool.¹ It represents not only an embarrassing and humiliating symptom for patients, but also a serious social problem impacting considerably on everyday life.² FI was traditionally thought to affect about 2–10% of the general population and to increase in incidence with age.^3,4 However, more recent population-based studies^5–7 have revealed an incidence of 18.8% in adult women in the USA. Although 18.8% might seem a high prevalence, in patients with inflammatory bowel disease (IBD) FI occurs in an even higher percentage of patients.⁸ A study by the British National Crohn’s and Colitis UK Organization⁸ including over 3000 subjects showed that 74% of IBD patients reported at least one episode of FI in their life. The increased rate of FI in IBD patients is probably due to predisposing factors such as perianal disease, invasive perianal surgical approach, liquid stools and secretory diarrhoea caused by bile acid malabsorption.^9–12 The pathophysiology of FI is very complex and may depend on different structures, including pelvic floor, anal sphincter muscles and both the voluntary and autonomous nervous system.¹³ Furthermore, the diagnosis of FI is not easy as patients are reluctant to report this embarrassing symptom, treating physicians often do not investigate it, and a clear and validated approach to diagnose it is lacking.^5–7,14 A combination of different tests may be necessary to diagnose FI and to attribute the incontinence to a specific aetiology. Available options include self-reported questionnaires, anorectal manometry, electromyography (EMG), defecography, endoanal ultrasonography, magnetic resonance imaging (MRI), computed tomography (CT) and pudendal nerve terminal motor latency (PNTML) assessment.¹⁵ Tools such as the validated Wexner score,¹⁵ Vaizey score¹⁶ and fecal incontinence quality of life (FIQL) questionnaire¹⁷ assess FI measuring severity and impact on quality of life. Anorectal manometry allows us to measure resting and squeeze pressure, duration of the voluntary contraction and length of the anal canal.¹⁸ Endoanal ultrasonography is recommended to investigate sphincteric lesions as a preoperative assessment, while physiology tests and other imaging procedures provide additional anatomical and functional data.¹⁸ A correct FI evaluation is essential to obtain an early diagnosis of disease and to ensure a rapid treatment. Our aim was to investigate FI assessment in both patients with or without IBD in order to clarify the diagnostic approach for this disabling condition and to propose an algorithm for IBD trials.

Methods

This systematic review has been developed according to the guidance specified in the Cochrane Handbook and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.^19,20

Search strategy

The review consists of two parts: FI assessment in non-IBD patients and FI assessment in IBD patients. We searched for published studies on Pubmed, Embase and the Cochrane Library starting from January 2009 to December 2019 in order to investigate the literature evidence of the past 10 years. The following MESH terms alone or matched to ‘IBD’, ‘inflammatory bowel disease’, ‘UC’, ‘ulcerative colitis’, ‘CD’ and ‘Crohn’s disease’ were used: ‘fecal incontinence’, ‘anal incontinence’, ‘assessment’, ‘evaluation’, ‘diagnosis’, ‘tool’ and ‘investigation’. All studies on adult patients reporting data on FI assessment were included in our review. Reviews, meta-analyses, guidelines and editorials were excluded. Our search focused on full-text articles published in English, but relevant abstracts were evaluated. The careful analysis of the reference lists of the included studies allowed us to identify additional studies.

Selection process and data extraction

Two authors (FD and CG) independently screened all titles and removed duplicates and non-fitting papers. Subsequently the articles that met the inclusion criteria were evaluated by two authors (FD and CG) to define their eligibility. Any disagreement between investigators was discussed with the co-authors (SD and LPB) until consensus was reached. Two reviewers (FD and CG) extracted the following data from each study: name of the first author, publication year, study design, field of research (e.g. gastroenterology, surgery, gynaecology, etc.), patient cohort (number, sex, mean age, type of bowel disease) and FI assessment (diagnostic tools, used investigations). In the case of non-specified data, we indicated it as ‘NS’.

Quality of studies

The Newcastle–Ottawa Scale (NOS) score²¹ was used to measure the quality of non-randomised studies, while in randomised clinical trials the Jadad score²² was adopted. High quality studies were defined as NOS score of 6 or greater or Jadad score of 3 or greater, respectively. Two authors (FD and CG) graded the studies independently and disagreements were discussed with a third author until their resolution.

Results

Search results

The flow chart of the search process is shown in Figure 1. Patient demographics and main characteristics of non-IBD and IBD studies are reported in Tables 1 and 2, respectively. A total of 1727 articles were investigated (Pubmed: 1022; Embase: 426; Cochrane Library: 279). Three hundred and fifty-five papers were eligible for inclusion after the elimination of duplicates and screening of all titles. After careful evaluation of full-text papers 27 studies were excluded: 15 studies^23–37 did not evaluate FI assessment, six manuscripts^38–43 were just protocols, five were paediatric studies,^44–48 and one trial⁴⁹ had an inappropriate study design. Finally, 328 studies were included in our review: 306 studies^50–355 on non-IBD patients and 22 studies on IBD patients.^8,356–376 Overall, 102,460 patients were enrolled in non-IBD studies (66.7% women) and 8289 in IBD studies (63.9% women), with the number of patients per study ranging from six to 47,714. Among non-IBD trials there were 137 prospective cohort studies,^{48,50–53,58,59,61,62,64,68–72, 74–76,79–81,93,103,104,107,110–113,119,120,124–126,128,131,135,137, 142–145,149,151,153,157–163,166,168,169,171–174,176–182,187,190,192, 197,198,202,204,207,211–214,216,218,219,221,222,224,225,231,234,235, 238,240,242,244,245,247–251,253,259,261–263,267,269,273,275,277,280, 281,285,288,290–293,298–300,303,304,306,308,312,315,317,323,325,327–331,333,340,343,346} 78 retrospective cohort studies,^{51,57, 69,75,84,88,90–93,98,99,107,108,110,116,117,120,124,129,131,134,138, 140,141,148,150,152,154,158,167,169,177,185–188,190,193,198,201,205, 210,211,219,229,230,239,243,245,254,256,258,259,262,274,276,278,280,281, 285,286,288,289, 291, 299,311,315,337,339–341,344, 346,347,349,350, 355} 76 randomised clinical trials,^{58,65,67,68,79,80,85–87,96,97,100–104,111,118,119,123,125,132,135,136,142,143,156,157,166,172,191,195–197, 203,207,212,217,225,228,231,232,234,235,238, 241,248,257,260,267,268,270, 272,273,284,296–298,303,304,307,309,312,321–324,328,334,336,338,343, 351–354} nine cross-sectional^{56,59,62,89,222,266,316,318,320} and six case–control studies.^{94,149,202,208,313,326} In IBD trials, instead, there were 11 retrospective cohort studies,^8, ^{359,360,362,365–368,371,372,374} 10 prospective cohort studies^{356–358,361,363,364,370,373,375,376} and one cross-sectional study.³⁶⁹ Overall, studies on FI involved 16 different research areas: the most frequent were surgery, gynaecology and gastroenterology (179,^{51,52,54,59–64,66–73,75,80, 81,83,84,88,89,97–99,105,106,109,110,114,115,120,124–127,129–132,135–139, 141,148,154–156,160–163,165–167,170,174–181,183,184,188,193–196,198–208, 210–215,219,223–229,234–238,240–245,247–253,256,258–260,262–264,266, 267,269–273,275,276,278,279,282,284–286,292,295–297,299,302–308,310, 311,314–316,319,321,324,327–330,332–336,340,341,344,345,349,350,352–355} 45,^{53,56,79,93,112,113,116–118,121,133,140,142–144,146,147,149,} ^{151–153,169,171,173,182,186,187,222,254,255,283,287–291,293,298,312,} ^313, ^{317,318,325,331,342} and 32 studies,^{50,65,76–78,82,90–92,94–96,103,} ^{107,122,123,172,216–218,257,277,280,281,301,309,338,343,347,348,362,376} respectively). Overall, 172/252 non-randomised studies (68.2%) had a NOS score of 6 or greater and 51/76 randomised studies (67.1%) had a Jadad score of 3 or greater (see Supplementary Tables 1 and 2).

Figure 1.

Flow chart of the search process.

Table 1.

Fecal incontinence assessment in non-IBD patients.

Study	Research area	Study design	no. of pts	F (n)	Mean age	FI aetiology	Tools	Anal manometry	Endoanal ultrasound	Defecography	Other
Eléouet et al., 2010 [50]	Gastroenterology	Prospective cohort study	32	30	61	Structural	Wexner score FIQL	3-lumen, water perfused catheter (R3B and PIP4-4, Mui Scientific, Mississauga, Ontario, Canada)	/	/	/
Göttgens et al., 2015 [51]	Surgery	Retrospective cohort study	537	158	45.5	Structural	Vaizey score	/	/	/	/
Köhler et al., 2012 [52]	Surgery	Prospective cohort study	80	69	NS	Structural	Wexner score	/	/	ns	Dynamic MRI
Naidoo et al., 2018 [53]	Gynaecology	Prospective cohort study	100	100	NS	Mixed	Non-validated questionnaire	(Stryker, Kalamazoo, Michigan)	InNovaSound USB® endocavity ultrasound probe. This is a 360° rotating 7.5 MHz endoprobe.	/	/
Pena Ros et al., 2015 [54]	Surgery	Prospective cohort study	55	44	58.6	Structural	Wexner score	/	/	/	/
Valles et al., 2009 [55]	Neurology	Prospective cohort study	54	22	43	Neurogenic	Wexner score	Measurements were performed using three different catheters	/	/	/
Taithongchai et al., 2019 [56]	Gynaecology	Cross-sectional study	250	250	31	Mixed	modified Vaizey score	/	/	/	/
Szucs et al., 2012 [57]	Urology	Retrospective cohort study	76	30	61	Structural	EORTC QLQ	Medtronic rectal manometer	/	/	/
Bø et al., 2010 [58]	Physiotherapy	Prospective randomised clinical trial	105	105	31	/	Non-validated questionnaire	/	/	/	/
Parés et al., 2015 [59]	Surgery	Cross sectional study	228	228	31	/	Wexner score	/	/	/	/
Davé et al., 2016 [60]	Surgery	Prospective cohort study	268	268	32	/	FISI	/	/	/	/
Lopez-Delgado et al., 2014 [61]	Surgery	Prospective cohort study	24	19	62	Mixed	Wexner score	8 channel recorder (Griffon, Albyn Medical, Cordovilla-Navarra, Spain)	/	/	/
Pares et al., 2011 [62]	Surgery	Cross sectional study	518	332	60	/	Vaizey score FIQL	/	/	/	/
Worsøe et al., 2012 [63]	Surgery	Prospective cohort study	9	9	60	Idiopathic	Vaizey score Wexner score	/	/	/	/
Waniczek et al., 2012 [64]	Surgery	Prospective cohort study	16	14	76.3	Structural	Miller’s score	/	/	/	/
Sjodahl et al., 2014 [65]	Gastroenterology	Prospective randomised clinical trial	57	57	58	/	Non-validated questionnaire	(Hallböök & Sjödahl)	3D-EAUS Falcon 2101 ELX scanner (B-K Medical, Herlev, Denmark) 13 MHz probe	/	/
Petersen et al., 2016 [66]	Surgery	Prospective cohort study	110	71	59.7	Structural	Wexner score	/	/	/	/
Horrocks et al., 2015 [67]	Surgery	Prospective randomised clinical trial	227	104	58	Mixed	Vaizey score FIQL	/	/	/	/
Brown et al., 2016 [68]	Surgery	Prospective randomised clinical trial	370	153	49	Structural	Vaizey score	/	/	/	/
Abbas et al., 2012 [69]	Surgery	Retrospective cohort study	27	22	64	Mixed	Wexner score	/	/	/	/
Abramowitz et al., 2013 [70]	Surgery	Prospective cohort study	264	140	45.2	Structural	Wexner score Vaizey score	/	/	/	/
Abramowitz et al., 2016 [71]	Surgery	Prospective cohort study	195	51	45.5	Structural	Wexner score Vaizey score	/	/	/	/
Adusumilli et al., 2013 [72]	Surgery	Prospective cohort study	120	/	60	/	FISI GIQLI	water-perfused 9-lumen vector manometry catheter (MED 2280; Mediplus, High Wycombe, UK), and 8 channel transducer	(B&K Medical, Naerum, Denmark) 10-MHz probe	oral 100 ml barium sulphate paste and 10 ml Gastrografin contrast. 100 ml of rectal barium paste	/
Aigner et al., 2009 [73]	Surgery	Prospective cohort study	11	11	66	Idiopathic	Wexner score FIQL	(ACP Manometer Reha Medi, Ganderkesee, Germany).	(Pro Focus 2202, B-K Medical, Herlev, Denmark) 6–16 MHz probe	/	/
Ait Said et al., 2017 [74]	Urology	Prospective cohort study	116	83	47.6	Structural	Wexner score FIQL	/	/	/	/
Al Asari et al., 2014 [75]	Surgery	Retrospective cohort study	57	50	61	/	Wexner score FIQL	/	/	/	PNE (Medtronic, Minneapolis, MN, USA)
Albuquerque et al., 2016 [76]	Gastroenterology	Prospective cohort study	23	16	56	Structural	Wexner score	/	Hitachi-Aloka Medical Ltd., Tokyo, Japan ultrasound scanner	/	/
Allgayer et al., 2010 [77]	Gastroenterology	Prospective cohort study	50	20	58..3	Mixed	Modified Wexner score	ns	(EUB 8500 and 900 HV; Hitachi, Wiesbaden, Germany) 5–10 MHz probe	/	Endoscopy
Allgayer et al., 2012 [78]	Gastroenterology	Prospective cohort study	90	39	59	Structural	Modified Wexner score	ns	(EUB 8500 and 900 HV; Hitachi, Wiesbaden, Germany) 5–10 MHz probe	/	Endoscopy
Altman et al., 2016 [79]	Gynaecology	Prospective randomised clinical trial	30	30	61.8	/	Wexner score FIQL	/	/	/	/
Altomare et al., 2011 [80]	Surgery	Prospective randomised clinical trial	64	/	50.5	Structural	Wexner score	ns	ns	/	/
Altomare et al., 2015 [81]	Surgery	Prospective cohort study	407	/	/	/	Wexner score Vaizey score	/	/	/	/
Andrianjafy et al., 2019 [82]	Gastroenterology	Prospective cohort study	1477	1182	54	Neurogenic	Wexner score	3DHRAM probe (Mano-Scan 3D; Sierra Scientific Instruments, Los Angeles, CA, USA)	/	/	/
Arroyo et al., 2014 [83]	Surgery	Prospective cohort study	16	15	56.5	Structural	Wexner score	Albyn medical, Palex, with 8 channels	Pro Focus, Ultrasound Scanner Class I, Type B. Ref: 2002 SN1880355, BK Medical, model. Herlev, Dinamarca.	/	/
Aytac et al., 2015 [84]	Surgery	Retrospective cohort study	217	95	55	Structural	FISI FIQL	/	/	/	/
Barak et al., 2019 [85]	Neurology	Prospective randomised clinical trial	19	3	42.6	Neurogenic	FISI FIQL	MCOMPASS (Medspira, Minneapolis, MN)	/	/	/
Bartlett et al., 2011 [86]	Physiotherapy	Prospective randomised clinical trial	72	53	62.1	/	Wexner score FIQL	ns	ns	/	/
Bartlett et al., 2015 [87]	Physiotherapy	Prospective randomised clinical trial	75	63	61.1	/	Wexner score FIQL	/	/	/	/
Barussaud et al., 2013 [88]	Surgery	Retrospective cohort study	23	23	64	/	Wexner score FIQL	/	/	/	/
Battersby et al., 2016 [89]	Surgery	Cross sectional study	462	184	70	Structural	Wexner score EORTC QLQ	/	/	/	/
Beer-Gabel et al., 2015 [90]	Gastroenterology	Retrospective cohort study	105	105	56	/	Wexner score	/	(B&K, Profocus Ultra View, Herlev, Denmark) 5–8 MHz probe	120 ml rectal barium paste	/
Benezech et al., 2014 [91]	Gastroenterology	Retrospective cohort study	19	19	53	/	Wexner score	3D High-Resolution Given Imaging probe	/	Rectal contrast (300 ml)	/
Benezech et al., 2015 [92]	Gastroenterology	Retrospective cohort study	206	187	54	/	Wexner score	3D High-Resolution Given Imaging probe ManoView (Given Imaging, Yokneam, Israel)	(model EUP-U533, Hitachi, Tokyo, Japan) 7-MHz probe	/	/
Berretta et al., 2016 [93]	Gynaecology	Retrospective cohort study	22	22	65	Structural	FISI	/	/	/	/
Bharucha et al., 2010 [94]	Gastroenterology	Case control study	176	176	58	/	FICA	/	/	/	/
Bharucha et al., 2011 [95]	Gastroenterology	Prospective cohort study	32	/	/	/	FICA	ns	/	/	/
Bharucha et al., 2014 [96]	Gastroenterology	Prospective randomised clinical trial	43	43	58	/	FICA	(Sierra Scientific Instruments, Los Angeles, CA)	/	/	Endoanal MRI
Biondo et al., 2013 [97]	Surgery	Prospective randomised clinical trial	106	27	64	Structural	Wexner score	/	/	/	/
Boenicke et al., 2012 [98]	Surgery	Retrospective cohort study	181	/	64	Structural	Wexner score	ns	/	ns	Endoscopy CT scan
Bokhari et al., 2009 [99]	Surgery	Retrospective cohort study	128	37	45	Structural	Wexner score	/	/	/	/
Bols et al., 2012 [100]	Physiotherapy	Prospective randomised clinical trial	80	72	59.3	/	Vaizey score FIQL	/	/	/	/
Bols et al., 2013 [101]	Physiotherapy	Prospective randomised clinical trial	80	72	59.3	/	Vaizey score Wexner score FIQL	/	/	/	/
Booth et al., 2013 [102]	Physiology	Prospective randomised clinical trial	30	24	84.2	/	ICIQ Bowel questions	/	/	/	/
Bouguen et al., 2014 [103]	Gastroenterology	Prospective randomised clinical trial	19	18	64.7	/	Wexner score	4-lumen, water-perfused catheter (R3B and PIP4-4; Mui Scientific, Mississauga, ON, Canada)	/	/	/
Boyer et al., 2018 [104]	Immunology	Prospective randomised clinical trial	24	24	52	Structural	Wexner score FIQL	ns	ns	/	PNTML Defeco-MRI
Boyle et al., 2009 [105]	Surgery	Prospective cohort study	15	15	53	Structural	Wexner score	ns	(Type 1846 probe with 10-MHz transducer, B-K Medical, Berkshire, UK)	ns	PNTML
Bridoux et al., 2010 [106]	Surgery	Prospective cohort study	6	3	56.6	Neurogenic	Wexner score FIQL	ns	/	/	/
Butt et al., 2015 [107]	Gastroenterology	Retrospective cohort study	10	10	54	Neurogenic	Wexner score	ns	/	/	/
Caremel et al., 2012 [108]	Urology	Retrospective cohort study	51	36	56.8	/	Non-validated questionnaire	/	/	/	/
Cauley et al., 2019 [109]	Surgery	Prospective cohort study	946	844	60	/	FISI FICA FIQL	(Duet software, Mediwatch USA, West Palm Beach, FL)	ns	ns	/
Cerro et al., 2016 [110]	Surgery	Retrospective cohort study	95	95	33.8	Structural	Wexner score	/	3D diagnostic ultrasound system (type 2052, Ultraview-800; BK-Medical) 13 MHz probe	/	/
Chakraborty et al., 2016 [111]	Neurology	Prospective randomised clinical trial	36	36	56	/	Non-validated questionnaire	HD-ARM probe (Given Imaging, Yoqneam, Israel) HR-ARM catheter (Given Imaging, Los Angeles, CA, USA)	/	/	endoanal MRI
Chan et al., 2013 [112]	Gynaecology	Prospective cohort study	328	328	30.6	Structural	PFDI	/	/	/	/
Chan et al., 2014 [113]	Gynaecology	Prospective cohort study	328	328	30.6	Structural	PFDI PFIQ	/	GE Voluson 730 3D Ultrasound system (GE Medical Systems, Zipf, Austria) 4–8 MHz probe	/	/
Chen et al., 2015 [114]	Surgery	Prospective cohort study	46	42	48	/	Wexner score GIQLI	/	/	/	CT scan
Chew et al., 2011 [115]	Surgery	Prospective cohort study	17	13	67.2	Idiopathic	FISI FIQL	ns	ns	/	PNTML
Cichowski et al., 2013 [116]	Gynaecology	Retrospective cohort study	1115	1115	56	/	Wexner score	/	/	/	/
Cichowski et al., 2014 [117]	Gynaecology	Retrospective cohort study	1004	1004	58.5	/	Wexner score	/	/	/	/
Cichowski et al., 2015 [118]	Gynaecology	Prospective randomised clinical trial	90	90	58	/	FISI	/	/	/	/
Cohen-Zubary et al., 2015 [119]	Physiotherapy	Prospective randomised clinical trial	36	36	67.45	/	Vaizey score	/	/	/	/
Contin et al., 2013 [120]	Surgery	Retrospective cohort study	263	80	67	Structural	Wexner score	/	/	/	/
Cornelisse et al., 2016 [121]	Gynaecology	Prospective cohort study	335	335	/	Structural	Wexner score FIQL	/	/	/	/
Coura et al., 2016 [122]	Gastroenterology	Prospective cohort study	76	76	56.3	/	Wexner score	8-channel manometer (Dynamed, Procto Master Software, São Paulo, Brazil)	Pro-Focus 2052, 9-16 MHz, (B&K Medical, Herlev, Denmark).	/	/
Damon et al., 2014 [123]	Gastroenterology	Prospective randomised clinical trial	157	121	61	/	Wexner score FIQL	ns	/	/	/
Dehli et al., 2011 [124]	Surgery	Retrospective cohort study	76	73	54.5	/	Vaizey score FIQL	/	/	/	/
Dehli et al., 2013 [125]	Surgery	Prospective randomised clinical trial	126	117	57.5	/	Vaizey score FIQL	8 channel water-perfused catheter coupled to a computer (Medtronic, Skovlunde, Denmark)	3D anal ultrasound (B-K Medical, Gentofte, Denmark)	/	/
de la Portilla et al., 2009 [126]	Surgery	Prospective cohort study	16	11	59	/	Wexner score	/	/	/	/
de la Portilla et al., 2017 [127]	Surgery	Prospective cohort study	7	6	55.6	Structural	Wexner score FIQL	(Laborie Medical, Belgium)	3D-EAU using Pro Focus 2202s ultrasound with a B-K 2050 probe (B-K Medical, Herlev, Denmark)	/	/
de Mello Portella et al., 2012 [128]	Urology	Prospective cohort study	190	190	54.3	Structural	Wexner score FIQL	/	/	/	/
Denoya et al., 2014 [129]	Surgery	Retrospective cohort study	40	/	53	Structural	FIQL	/	/	/	/
Didailler et al., 2018 [130]	Surgery	Prospective cohort study	25	6	62	Structural	Wexner score GIQLI	/	/	/	/
Digennaro et al., 2012 [131]	Surgery	Retrospective cohort study	60	/	65	Structural	Wexner score FIQL EORTC QLQ	/	/	/	/
Doeksen et al., 2011 [132]	Surgery	Prospective randomised clinical trial	107	34	66	/	COREFO EORTC QLQ	/	/	/	/
Drusany Starič et al., 2016 [133]	Gynaecology	Prospective cohort study	60	60	32	Structural	Wexner score	/	B&K Medical 2050 endoscopic probe (B&K Medical, Sandhoften, Denmark)	/	/
Dudding et al., 2011 [134]	Physiology	Retrospective cohort study	9	7	44	Structural	FIQL	ns	/	/	/
Duelund-Jakobsen et al., 2012 [135]	Surgery	Prospective randomised clinical trial	15	/	54.2	Mixed	FIQL Vaizey score Wexner score	/	/	/	/
Duelund-Jakobsen et al., 2013 [136]	Surgery	Prospective randomised clinical trial	19	18	59.5	Mixed	Wexner score FIQL Vaizey score	/	/	/	/
Duelund-Jakobsen et al., 2016 [137]	Surgery	Prospective cohort study	164	153	/	Mixed	Wexner score Vaizey score	/	/	/	/
Dumont et al., 2013 [138]	Surgery	Retrospective cohort study	36	11	60.5	Structural	EORTC QLQ Wexner score	/	/	/	/
El-Gazzaz et al., 2009 [139]	Surgery	Prospective cohort study	24	24	56.5	Mixed	Wexner score FIQL	/	/	/	/
Ellington et al., 2013 [140]	Gynaecology	Retrospective cohort study	407	407	56	Structural	FISI	/	/	/	/
Emile et al., 2016 [141]	Surgery	Retrospective cohort study	70	16	36	Structural	Wexner score	8-channel catheters (Sandhill Bioview Program, Milwaukee, WI)	(BK Medical, Herlev, Denmark) 16-MHz Probe	/	/
Farrell et al., 2010 [142]	Gynaecology	Prospective randomised clinical trial	149	149	29	/	Non-validated questionnaire	8-channel catheters (Laborie Medical Technologies, Inc., Montreal, Canada)	(B&K Medical, Sandhoften, Sweden) 10 MHz probe	/	/
Farrell et al., 2012 [143]	Gynaecology	Prospective randomised clinical trial	104	104	29	/	Non-validated questionnaire	/	/	/	/
Fashokun et al., 2012 [144]	Gynaecology	Prospective cohort study	505	505	53	/	Wexner score	/	/	/	/
Fellin et al., 2009 [145]	Radiotherapy	Prospective cohort study	1132	/	/	/	Non-validated questionnaire	/	/	/	/
Fitzpatrick et al., 2016 [146]	Gynaecology	Prospective cohort study	557	557		Structural	Modified Wexner score	water perfusion system with 8-channel (Synectics, Stockholm, Sweden)	Bruel & Kjaer, Naerum, Denmark) 10 mHz probe	/	/
Fonseca et al., 2016 [147]	Gynaecology	Prospective cohort study	70	70	57.5	/	Wexner scoreFIQL	/	/	/	/
Formijne-Jonkers et al., 2012 [148]	Surgery	Retrospective cohort study	245	234	62	Structural	Wexner score	/	/	ns	dynamic MRI
Forsgren et al., 2010 [149]	Gynaecology	Case control study	117	117	72	Structural	Wexner score	/	/	/	/
Frees et al., 2016 [150]	Urology	Retrospective cohort study	90	/	62	/	Wexner score	/	/	/	/
Frudinger et al., 2010 [151]	Gynaecology	Prospective cohort study	10	10	/	Mixed	Wexner scoreFIQL	water-perfused six-channel catheter (Samsung, Sync Master 700 TFT)	B-K Medical Scanner, Type 2101 Falcon (B-K Medical, Herlev, Denmark)	/	PNTML (Dantec, Scovlunde, Denmark)
Frudinger et al., 2015 [152]	Gynaecology	Retrospective cohort study	10	10	/	Structural	Wexner scoreFIQL	water-perfused six-channel catheter (Samsung, Sync Master 700 TFT)	B-K Medical Scanner, Type 2101 Falcon (B-K Medical, Herlev, Denmark)	/	/
Frudinger et al., 2018 [153]	Gynaecology	Prospective cohort study	39	34	60.6	Structural	Wexner score	ManoScan™360 High-Resolution Manometry (Sierra Scientific Instruments, Los Angeles, CA, USA)	B-K Flexfocus Type 400 Medical Scanner fitted with a 2052 endoprobe (B-KMedical, Herlev, Denmark)	/	PNTML (Dantec, Scovlunde, Denmark)
Fu et al., 2012 [154]	Surgery	Retrospective cohort study	278	123	51	Structural	Wexner score	/	/	/	/
Gallas et al., 2010 [155]	Surgery	Prospective cohort study	200	194	60	Mixed	Wexner scoreFIQL	water-perfused system	ns	/	/
Gandomkar et al., 2015 [156]	Surgery	Prospective randomised clinical trial	99	66	38	/	Wexner score	/	/	/	/
George et al., 2013 [157]	Physiology	Prospective randomised clinical trial	30	28	57	/	Vaizey scoreFIQL	/	ns	/	/
George et al., 2014 [158]	Physiology	Retrospective cohort study	13	11	47	Neurogenic	Vaizey scoreFIQL	/	/	/	/
Gill et al., 2012 [159]	Physiology	Prospective cohort study	36	36	61.2	/	Non-validatedquestionnaire	/	/	/	/
Giordano et al., 2016 [160]	Surgery	Prospective cohort study	30	3	48	Structural	Wexner score	/	/	/	/
Gorissen et al., 2015 [161]	Surgery	Prospective cohort study	82	57	54	/	FISIFIQLGIQLI	/	/	/	/
Gosselink et al., 2013 [162]	Surgery	Prospective cohort study	72	67	59	Structural	FISI	water-perfused 9-lumen vector manometry catheter (MED 2280; Mediplus, High-Wycombe, UK)	(B&K Medical, Naerum, Denmark) 10-MHz probe	310-mL mixture of 100 mL of barium sulfate paste	/
Gosselink et al., 2015 [163]	Surgery	Prospective cohort study	91	86	61	Structural	FISIGIQLI	water-perfused 9-lumen vector manometry catheter (MED 2280; Mediplus, High-Wycombe, UK)	(B&K Medical, Naerum, Denmark) 10-MHz probe	310-mL mixture of 100 mL of barium sulfate paste	Endoscopy or CT colonography
Gourcerol et al., 2015 [164]	Physiology	Prospective cohort study	74	74	/	/	Wexner score	3D-HRM (Given Imaging, Yoqneam, Israel)	/	/	/
Govaert et al., 2009 [165]	Surgery	Prospective cohort study	22	16	60.4	Mixed	Wexner scoreFIQL	ns	ns	/	PNTML
Graf et al., 2011 [166]	Surgery	Prospective randomised clinical trial	206	183	61	Mixed	Wexner scoreFIQL	/	/	/	/
Grande et al., 2010 [167]	Surgery	Retrospective cohort study	387	280	61	Mixed	Wexner score	flexible catheter with six channels (MUI Scientific, Mississauga, Ontario, Canada)	ns	ns	Endoscopy
Guinet et al., 2011 [168]	Neurology	Prospective cohort study	21	13	47.3	Neurogenic	/	(Latitude© equipment)	/	/	/
Gyhagen et al., 2014 [169]	Gynaecology	Retrospective cohort study	6148	6148	/	Structural	Wexner score	/	/	/	/
Habr-Gama et al., 2016 [170]	Surgery	Prospective cohort study	82	33	61.9	/	Wexner scoreFIQL	ALA CER (Multiplex II) manometer. 8-channelwater-perfused catheter	/	/	/
Heilbrun et al., 2010 [171]	Gynaecology	Prospective cohort study	89	89	27.8	Structural	FISI	/	/	/	MRI
Heymen et al., 2009 [172]	Gastroenterology	Prospective randomised clinical trial	108	83	59.6	/	FISIFIQL	/	(10 MHz probe (Falcon® 2101EXL,B-K Medical, Herlev, Denmark)	/	/
Chan et al., 2017 [173]	Gynaecology	Prospective cohort study	442	442	30.6	/	PFDIPFIQ	/	ns	/	/
Horisberger et al., 2013 [174]	Surgery	Prospective cohort study	54	16	62	Structural	Wexner score	ns	ns	/	Endoscopy
Hornung et al 2012 [175]	Surgery	Prospective cohort study	100	100	57	/	Vaizey score	pull-through technique	(BK Medical, Herlev, Denmark) 10 MHz probe	/	/
Hornung et al 2014 [176]	Surgery	Prospective cohort study	52	52	57	/	Vaizey score	pull-through technique	(BK Medical, Herlev, Denmark) 3D 10-MHz probe	/	/
Horrocks et al., 2017 [177]	Surgery	Retrospective cohort study	205	185	/	/	Wexner score	/	/	/	/
Hotouras et al., 2012 [178]	Surgery	Prospective cohort study	88	88	58	Mixed	Wexner score	ns	ns	/	/
Hotouras et al., 2013 [179]	Surgery	Prospective cohort study	20	17	55	Mixed	Wexner scoreFIQL	water-perfused anal canal pull-through manometry	ns	/	/
How et al., 2012 [180]	Surgery	Prospective cohort study	62	21	63	Structural	EORTC QLQVaizey score	/	/	/	Endoscopy
Hull et al., 2013 [181]	Surgery	Prospective cohort study	120	110	60.5	Mixed	FISIFIQL	/	/	/	/
Huser et al., 2017 [182]	Gynaecology	Prospective cohort study	953	953	/	/	Wexner score	/	/	/	/
Hussain et al., 2012 [183]	Surgery	Prospective cohort study	38	24	66	Idiopathic	Vaizey scoreFIQL	8-channel catheter (Flexilog 3000, Oakfield Instruments Ltd, Evensham, Oxon, UK) pull through technique	(B&K, Denmark) 2D 10 mHz probe	/	PNTML
Hyman et al., 2009 [184]	Surgery	Prospective cohort study	245	83	46	Structural	FISI	/	/	/	/
Jamieson et al., 2017 [185]	Internal Medicine	Retrospective cohort study	47714	26751	82.5	/	InterRAI HC	/	/	/	/
Jelovsek et al., 2013 [186]	Gynaecology	Retrospective cohort study	921	921	/	Structural	FISI	/	/	/	/
Jelovsek et al., 2014 [187]	Gynaecology	Retrospective cohort study	133	133	57	Structural	FISI	/	/	/	/
Joh et al., 2010 [188]	Surgery	Retrospective cohort study	981	612	73.6	Mixed	Modified Rothenberger scale	/	/	/	/
Johannessen et al., 2014 [189]	Physiotherapy	Prospective cohort study	1571	1571	28.2	Structural	Vaizey score	/	/	/	/
Johannessen et al., 2014 [190]	Physiotherapy	Retrospective cohort study	1571	1571	28.2	Structural	Vaizey scoreFIQL	/	/	/	/
Johannessen et al., 2017 [191]	Physiotherapy	Prospective randomised clinical trial	109	109	30.1	Structural	Vaizey score	Polygraf ID manometry machine with a catheter puller and POLYGRAM NET software (Alpine Biomed, USA)	2D and 3D EAUSB-K Medical type 2050 (B-K Medical Aps, Denmark) 2D EAUS (Hitachi EUB-6500, Providian Medical Equipment, USA)	/	EMG
Johannessen et al., 2018 [192]	Physiotherapy	Prospective cohort study	976	976	29	Structural	Vaizey score	/	/	/	/
Johannsson et al., 2013 [193]	Surgery	Retrospective cohort study	19	9	62	Structural	Miller’s score	pull-through manometry	(Bruel & Kjaer Medical, Gentofte, Denmark) 10-MHz probe	/	/
Kahlke et al., 2011 [194]	Surgery	Prospective cohort study	214	97	55.3	Structural	Wexner score	/	/	/	/
Kahlke et al., 2015 [195]	Surgery	Prospective randomised clinical trial	31	31	55	Mixed	Wexner score	/	/	/	/
Kauff et al., 2016 [196]	Surgery	Prospective randomised clinical trial	188	/	/	/	Wexner scoreVaizey score	/	/	/	/
Khan et al., 2015 [197]	Rehabilitation Medicine	Prospective randomised clinical trial	54	31	33.3	/	Wexner score	/	/	/	/
Khoury et al., 2013 [198]	Surgery	Retrospective cohort study	14	3	75	Structural	Wexner score	/	/	/	/
Kim et al., 2012 [199]	Surgery	Prospective cohort study	56	16	53	Structural	Wexner score	8-channel flexible catheter (Polygraf ID; Medtronics, Copenhagen, Denmark)	/	/	/
Kim et al., 2014 [200]	Surgery	Prospective cohort study	222	80	59	Structural	Wexner score	8-channel flexible catheter (Medtronics, Copenhagen, Denmark)	ns	/	/
Kirss et al., 2018 [201]	Surgery	Retrospective cohort study	236	215	64.5	Structural	Wexner score	ns	BK Medical®.	/	/
Kneist et al., 2013 [202]	Surgery	Case control study	15	2	65	Structural	Wexner score	/	/	/	/
Knowles et al., 2015 [203]	Surgery	Prospective randomised clinical trial	227	205	58	Mixed	Wexner score	/	/	/	/
Koch et al., 2009 [204]	Surgery	Prospective cohort study	35	31	59.7	/	Vaizey score	four-point solid state catheter (Konigsberg instrument Inc., Pasadena, California, USA)	(7.5 MHz, SDD 2000, Multiview, Aloka, Japan)	/	PNTML
Koyama et al., 2014 [205]	Surgery	Retrospective cohort study	178	54	65	Structural	Wexner score	/	/	/	/
Kuo et al., 2015 [206]	Surgery	Prospective cohort study	32	15	56.5	Structural	Wexner score	(Enraf nonius international Myomed 932, 2600 AV Delft, Netherlands)	/	/	EMG
Kye et al., 2016 [207]	Surgery	Prospective randomised clinical trial	47	22	63	Structural	Wexner score	/	/	/	/
Laforest et al., 2012 [208]	Surgery	Case control study	46	20	57.5	Structural	Wexner scoreKirwan’s scoreFIQL	/	/	/	/
Lam et al., 2014 [209]	Gastroenterology	Prospective cohort study	31	31	61	/	Vaizey scoreFIQL	4-microtip transducer, water-perfused catheter (MuiScientific Type SR4B-5-0-0-0, Mississauga, Ontario, Canada)	3D diagnostic ultrasound system (Hawk type 2050, B-K Medical, Naerum, Denmark)	/	/
Lamb et al., 2011 [210]	Surgery	Retrospective cohort study	143	0	74	Structural	Wexner scoreCARIQCARDI	/	/	/	/
Lambrescak et al., 2017 [211]	Surgery	Retrospective cohort study	144	130	61.3	/	Wexner score	/	/	/	/
La Torre et al., 2013 [212]	Surgery	Prospective randomised clinical trial	83	72	62.4	/	Wexner scoreFIQL	/	/	/	/
Martínez-Vilalta et al., 2011 [213]	Surgery	Prospective cohort study	14	14	52	/	/	4 channels water-perfused catheter (PC Polygraph HR Synectics Medical®)	Brüel & Kjaer® (Nacrum, Denmark) 7 MHz probe	/	/
Lehur et al., 2010 [214]	Surgery	Prospective cohort study	14	14	62.8	Mixed	Wexner scoreFIQL	/	/	/	/
Lenisa et al., 2010 [215]	Surgery	Prospective cohort study	60	29	47	Structural	Wexner score	/	/	/	/
Leroi et al., 2011 [216]	Gastroenterology	Prospective cohort study	162	146	59	Mixed	Vaizey score	/	/	/	/
Leroi et al., 2012 [217]	Gastroenterology	Prospective randomised clinical trial	144	131	60	Mixed	Wexner scoreFIQL	standard technique with a perfused catheter	/	/	/
Leroi et al., 2018 [218]	Gastroenterology	Prospective cohort study	91	83	59	Mixed	Wexner scoreFIQL	3D-HRAM probe (Given Imaging, Manoscan 3D, Medtronic, MN, USA) EndoFLIP® system (Crospon, Inc., Galway, Ireland)	/	/	/
Liang et al., 2015 [219]	Surgery	Retrospective cohort study	57	24	47.8	Structural	Wexner score	/	/	/	/
Lin et al., 2016 [220]	Nursing	Prospective cohort study	53	11	64.1	/	Wexner score	/	/	/	/
Lin et al., 2018 [221]	Physiotherapy	Prospective cohort study	30	14	56	Structural	EORTC QLQHRQoL	/	/	/	/
Lipschuetz et al., 2015 [222]	Gynaecology	Cross sectional study	198	198	28	Structural	PFBQ	/	/	/	/
Luglio et al., 2016 [223]	Surgery	Prospective cohort study	40	40	68	Structural	Wexner score	ns	/	ns	Endoscopy
Lukacz et al., 2015 [224]	Surgery	Prospective cohort study	91	82	68.6	Mixed	Wexner score	/	/	/	/
Madbouly et al., 2014 [225]	Surgery	Prospective randomised clinical trial	70	28	36.1	Structural	Wexner scoreCGQL	/	ns	/	/
Madbouly et al., 2015 [226]	Surgery	Prospective cohort study	71	28	/	Structural	Wexner score	/	/	/	Endoscopy
Maeda et al., 2009 [227]	Surgery	Prospective cohort study	109	75	57	/	Vaizey score	8-channel water-perfused system (Medical Measurement Systems MMS, Enschede, Holland)	(B&K Medical, Herlev, Denmark) 10 MHz probe	/	/
Magdy et al., 2012 [228]	Surgery	Prospective randomised clinical trial	150	49	32.3	/	Pescatori scoreGIQLI	Eight channel catheters	/	/	/
Manceau et al., 2013 [229]	Surgery	Retrospective cohort study	106	44	63	Structural	Wexner scoreEORTC QLQ	/	/	/	/
Markland et al., 2010 [230]	Gerontology	Retrospective cohort study	155	155	58.7	/	FISIModified MHQ	water-perfused catheter system (MedtronicInc, Minneapolis, MN)	(B&KMedical Systems Inc, Wilmington, MA) 10-MHz probe	/	/
Markland et al., 2011 [231]	Gerontology	Prospective randomised clinical trial	291	291	53	/	Modified FISI	/	/	/	/
Markland et al., 2017 [232]	Gerontology	Prospective randomised clinical trial	67	35	58	/	ICIQ-BVaizey score	/	/	/	/
Markland et al., 2017 [233]	Gerontology	Prospective cohort study	133	133	57	/	FISIModified MHQ	/	/	/	/
Masoni et al., 2012 [234]	Surgery	Prospective randomised clinical trial	107	48	63	Structural	Wexner score	4 channel system (Polygraf ID, Sierra Scientific Instruments, Los Angeles, CA, USA)	/	/	/
Matsuda et al., 2015 [235]	Surgery	Prospective randomised clinical trial	100	33	68	Structural	Wexner scoreFIQL	/	/	/	/
Matsuoka et al., 2010 [236]	Surgery	Prospective cohort study	45	22	66.5	Structural	Wexner score	pull-through technique with a water perfusioncatheter (Andorfer, Star Medical Inc., Tokyo, Japan)	/	/	/
McManus et al., 2015 [237]	Surgery	Prospective cohort study	85	85	62	Structural	Wexner score	ns	/	ns	PNTML
Mehmood et al., 2014 [238]	Surgery	Prospective randomised clinical trial	51	48	59	Structural	Wexner scoreFISI	/	ns	/	MRIEndoscopy
Melchior et al., 2014 [239]	Physiology	Retrospective cohort study	74	74	60.5	Mixed	Wexner score	ns	ns	/	MRI defecographyEndoscopyPNTML
Mellgren et al., 2011 [240]	Surgery	Prospective cohort study	133	110	60.5	/	FISIFIQL	ns	ns	/	PNTML
Mellgren et al., 2014 [241]	Surgery	Prospective randomised clinical trial	136	122	61.8	Mixed	Wexner scoreFIQL	/	/	/	/
Mellgren et al., 2016 [242]	Surgery	Prospective cohort study	152	152	59.6	Mixed	Wexner scoreFIQL	/	/	/	/
Meurette et al., 2009 [243]	Surgery	Retrospective cohort study	27	/	62	/	Wexner score	/	ns	/	/
Michelsen et al., 2009 [244]	Surgery	Prospective cohort study	19	16	57.5	/	Wexner score	two-channel water-perfused system (Menuet, Dantec, Denmark) by a pull through technique	ns	/	/
Michot et al., 2010 [245]	Surgery	Retrospective cohort study	32	32	63	/	Wexner score	ns	ns	ns	MRI
Mion et al., 2017 [246]	Physiology	Prospective cohort study	126	113	52	/	Vaizey scoreKess scoreGIQLI	(Medtronic, Shoreview, MN, USA)	(Brüel & Kjaer, Naerum, Denmark) or (Hitachi, Tokyo, Japan)	/	/
Mistrangelo et al., 2016 [247]	Surgery	Prospective cohort study	27	26	78	Structural	Wexner score	ns	/	ns	Endoscopy
Morris et al., 2013 [248]	Surgery	Prospective randomised clinical trial	35	/	/	/	Wexner score	closed balloon technique with a pressuremonitor (Stryker).	(B&K Medical) 10 megahertz probe	/	PNTML
Moya et al., 2014 [249]	Surgery	Prospective cohort study	52	42	63.5	/	Wexner scoreFIQL	(SmartGI AnorectalManometry System)	(Pro Focus Ultrasound Scanner model 2202 with a 360 rotatingtransducer model 2050)	/	/
Moya et al., 2016 [250]	Surgery	Prospective cohort study	19	0	60	/	Wexner score	ns	ns	/	/
Murad-Regadas et al., 2013 [251]	Surgery	Prospective cohort study	31	31	39	/	Wexner score	8-channel manometer with ProctoMaster software (DynaMed, São Paolo, Brazil)	3D endoprobe (Pro-Focus 2052; 9–16 MHz; BK Medical, Herlev, Denmark)	/	/
Murad-Regadas et al., 2014 [252]	Surgery	Prospective cohort study	52	52	61	/	Wexner score	/	3D endoprobe (Pro-Focus 2052; 9–16 MHz; BK Medical, Herlev, Denmark)	/	/
Murad-Regadas et al., 2019 [253]	Surgery	Prospective cohort study	124	124	64	/	Wexner score	8-channel manometer with ProctoMaster software (Dynamed, São Paulo, Brazil)	3D endoprobe (Pro-Focus 2052; 9–16 MHz; BK Medical, Herlev, Denmark)	/	/
Ng et al., 2017 [254]	Gynaecology	Retrospective cohort study	506	506	30.6	/	PFDIPFIQ	/	/	/	/
Richter et al., 2019 [255]	Gynaecology	Prospective cohort study	73	73	61.3	/	Vaizey scoreFIQL	/	/	/	/
Nishigori et al., 2018 [256]	Surgery	Retrospective cohort study	30	7	67	Structural	Wexner scoreFISIFIQL	(Starlet ano ST4000/12P14-6; Star Medical, Tokyo, Japan)	/	/	/
Noelting et al., 2016 [257]	Gastroenterology	Prospective randomised clinical trial	44	44	58	/	FICAFISSFIQL	/	/	/	/
Nordenstam et al., 2010 [258]	Surgery	Retrospective cohort study	108	108	31	/	Pescatori score	8-channel water-perfused manometry with Synectics Polygram v 2.2 software (Medtronic Diagnostics, Minneapolis, MN)	(type 1850; B & K, Herlev,Denmark) 10-MHz probe	/	/
Norderval et al., 2013 [259]	Surgery	Retrospective cohort study	63	/	/	Mixed	Wexner score	/	/	/	PNTML
Oakley et al., 2016 [260]	Surgery	Prospective randomised clinical trial	54	54	29.8	Structural	FISIFIQL	4-channel catheter (T-doc-ARM4; T-DOC Company LLC, Wilmington, Del; Clinical Innovations LLC, Murray, Utah)	/	/	EMG
Oliveira et al., 2009 [261]	Physiology	Prospective cohort study	35	28	60.3	Mixed	Wexner scoreFIQL	8-channel water perfused system (Dynapack MPX 816; Dynamed, São Paulo, Brazil)	7.5-MHz probe	/	/
Oom et al., 2010 [262]	Surgery	Retrospective cohort study	117	117	58.5	Structural	FIQL	/	Kretz Voluson 730 expert system (GE Healthcare, Hoevelaken, The Netherlands) 4–8 MHz or 5–9 MHz probe	/	endoanal MRI
Oom et al., 2012 [263]	Surgery	Prospective cohort study	55	55	56	Structural	FIQL	/	(EUB 7000 HV, Hitachi Medical Systems) 10 MHz probe or GE Kretz Voluson 730 expert system (GE Healthcare, clinical systems, Hoevelaken, the Netherlands), 5- 9 MHz probe	/	/
Otto et al., 2013 [264]	Surgery	Prospective cohort study	40	21	43	Mixed	Wexner score	8 perfusion channels (Medtronic Software, Minneapolis, MN)	/	/	/
Richard et al., 2017 [265]	Rheumatology	Prospective cohort study	298	262	59.4	/	Wexner scoreFIQL	/	/	/	/
Paka et al., 2016 [266]	Surgery	Cross sectional study	486	486	57	/	Vaizey score	/	4D GE Kretz Voluson 730 Expert or Voluson S 6 systems (GE Medical Systems, Zipf, Austria) 8–4-MHz probe	/	/
Parc et al., 2009 [267]	Surgery	Prospective randomised clinical trial	364	/	/	Structural	FISI	/	/	/	/
Patton et al., 2013 [268]	Physiology	Prospective randomised clinical trial	11	10	/	/	Vaizey score	ns	B&K 2052 rotating anal probe (Bruel & Kjær, Nærum, Denmark)	/	PNTML
Patton et al., 2017 [269]	Surgery	Prospective cohort study	166	/	/	/	Vaizey scoreFIQL	ns	(2052 Bruel and Kjaer, Nærum, Denmark, rotating transducer)	/	PNTML
Peirce et al., 2013 [270]	Surgery	Prospective randomised clinical trial	120	120	/	/	Wexner scoreFIQL	ns	/	/	/
Perrenot et al., 2013 [271]	Surgery	Prospective cohort study	77	/	/	Structural	Wexner score	/	/	/	/
Pinedo et al., 2009 [272]	Surgery	Prospective randomised clinical trial	36	36	67	/	Wexner score	/	ns	/	/
Pinedo et al., 2012 [273]	Surgery	Prospective randomised clinical trial	50	/	61	/	Wexner scoreFIQL	/	ns	/	/
Prichard et al., 2017 [274]	Physiology	Retrospective cohort study	118	118	53	/	/	HRM catheter (Sierra Scientific Instruments; Los Angeles, CA)	/	/	MRI (MRInnervu, Medrad, Inc, Indianola, PA)
Pucciarelli et al., 2011 [275]	Surgery	Prospective cohort study	149	/	/	Structural	AMS scoreEORTC QLQ	/	/	/	/
Ramage et al., 2017 [276]	Surgery	Retrospective cohort study	161	161	32.9	Structural	Wexner score	T-DOC® Air-Charged™ ARM catheters	ns	/	/
Rao et al., 2014 [277]	Gastroenterology	Prospective cohort study	50	42	61	Structural	Vaizey score	6-sensor solid-state probe (Konigsberg Laboratories, Pasadena, CA)	/	/	PNTML
Ratto et al., 2010 [278]	Surgery	Retrospective cohort study	14	14	4706	Structural	Wexner score	water-perfused 4-channel catheter	(BK Medical, Herlev, Denmark)	/	/
Ratto et al., 2016 [279]	Surgery	Prospective cohort study	54	37	66	Mixed	Vaizey scoreWexner scoreAMS scoreFIQL	/	ns	/	/
Reddymasu et al., 2009 [280]	Gastroenterology	Retrospective cohort study	27	20	56	Mixed	/	water-perfused catheter (Medtronic, Minneapolis, MN)	(PENTAX of America, Montvale, NJ) 5.0, 7.5 and 10 MHz probes.	/	/
Rezaie et al., 2015 [281]	Gastroenterology	Retrospective cohort study	39	31	64.7	Structural	Wexner score	3D HRAM (Given Imaging®)	BK Medical Flex Focus 400 system with a 2052 type 3D16-6 MHz probe	/	/
Ribaric et al., 2014 [282]	Surgery	Prospective cohort study	100	98	60	Structural	Vaizey scoreKESS score	/	/	/	/
Richter et al., 2015 [283]	Gynaecology	Prospective cohort study	61	61	61	/	FIQLModified MHQ	/	/	/	/
Rimmer et al., 2015 [284]	Surgery	Prospective randomised clinical trial	43	38	60.5	Mixed	Wexner score	/	ns	/	/
Robert-Yap et al., 2010 [285]	Surgery	Retrospective cohort study	11	11	59	Structural	Wexner scoreASCRS quality of life questionnaire	8-channel water perfusion catheter (ZineticsMedical, Salt Lake City, Utah) or multichannel manometry system (SEDIA SE-6; SEDIA AG, 1752 Givisiez, Switzerland)	ns	/	MRI
Rodrigues et al., 2017 [286]	Surgery	Retrospective cohort study	26	26	60	/	Wexner score	/	ns	/	PNTML
Rogers et al., 2014 [287]	Gynaecology	Prospective cohort study	782	782	25	Structural	Wexner score	/	/	/	/
Roman et al., 2013 [288]	Gynaecology	Retrospective cohort study	24	24	34.7	Structural	FIQL	/	/	/	/
Roman et al., 2016 [289]	Gynaecology	Retrospective cohort study	77	77	41	Structural	Wexner scoreGIQLIKESS score	/	/	/	/
Roos et al., 2012 [290]	Gynaecology	Prospective cohort study	159	159	31.5	Structural	Vaizey score	ns	B and K Viking 2400system (Gentofte, Denmark) 13-MHz probe	/	/
Ros et al., 2017 [291]	Gynaecology	Retrospective cohort study	55	55	32.6	/	Wexner score	/	(type RIC5-9, Voluson-V730 Expert, GE) -4 MHz probe or (type 2052, Ultraview-800 BK-Medical) 13 MHz probe	/	/
Rosato et al., 2015 [292]	Surgery	Prospective cohort study	53	41	60	/	Wexner scoreFIQL	/	/	/	/
Rosenblatt et al., 2014 [293]	Gynaecology	Prospective cohort study	29	29	60.6	/	Wexner scoreFIQL	ns	/	ns	MRIPNTML
Roy et al., 2014 [294]	Physiology	Prospective cohort study	60	59	59	Mixed	Wexner scoreFIQL	ns	ns	/	EMGPNTML
Ruiz et al., 2010 [295]	Surgery	Prospective cohort study	24	23	72.8	Mixed	Wexner scoreFIQL	/	/	/	/
Rybakov et al., 2016 [296]	Surgery	Prospective randomised clinical trial	80	48	62	Structural	Wexner scoreFIQL	8-channel catheter (Lower GI Polygram, Synectics, Stockholm, Sweden). pull through technique	/	/	/
Rydningen et al., 2017 [297]	Surgery	Prospective randomised clinical trial	58	58	61	Structural	Vaizey scoreFIQL	/	/	/	PNE
Rygh et al., 2010 [298]	Gynaecology	Prospective randomised clinical trial	119	119	29	/	Wexner score	stationary pullthrough method using Polygraf ID 8 channel manometry system with Polygram NET software.	3D EAUS (Bruel & Kjær, Denmark; Hawk2102 EXL, 2050 endoanal ultrasound probe)	/	/
Ryu et al., 2015 [299]	Surgery	Retrospective cohort study	53	18	60	/	Wexner score	single-channelpressure sensor, the GMMS 100/ACP 101 (StarMedical Co, Tokyo, Japan)	/	/	fecoflowmetry (FFM) (Takei Medical & Optical Co, Tokyo, Japan)
Sansoni et al., 2013 [300]	Psychiatry	Prospective cohort study	61	51	/	/	Wexner scoreVaizey scoreRFIS	/	/	/	/
Sauter et al., 2014 [301]	Gastroenterology	Prospective cohort study	26	15	/	/	Wexner score	HR-ARM device (Manoscan AR 360; Given Imaging, Yoquem, Israel)	(Siemens Sono Line Prima, 5–7.5 MHz; Siemens AG, Zurich, Switzerland)	/	Endoscopy
Schiano di Visconte et al., 2018 [302]	Surgery	Prospective cohort study	11	7	67.3	Structural	Wexner scoreFIQL	8 channels, stationary pull-through procedure (Polygraf™ ID multiparametricrecorder with POLYGRAM NET® analysis software, Medtronic, USA)	(type 2052, BK Medical, Analogic, Herlev, Denmark)	/	PNTML
Schwandner et al., 2010 [303]	Surgery	Prospective randomised clinical trial	158	/	79	Structural	Vaizey scoreWexner scoreParks’s scoreFIQL	/	/	/	/
Schwandner et al., 2011 [304]	Surgery	Prospective randomised clinical trial	80	/	63	/	Wexner score	ns	/	/	/
Schwandner et al., 2013 [305]	Surgery	Prospective cohort study	9	3	61	Structural	Wexner score	(SPM-2100; M&B Biomedizintechnik, Traunstein, Germany)	/	/	/
Schwandner et al., 2014 [306]	Surgery	Prospective cohort study	38	0	51	Structural	Wexner score	(SPM-2100; M&B Biomedizintechnik, Traunstein, Germany)	ns	ns	MRIEndoscopy
Senapati et al., 2013 [307]	Surgery	Prospective randomised clinical trial	293	/	/	Structural	Vaizey score	/	/	/	/
Sileri et al., 2012 [308]	Surgery	Prospective cohort study	34	34	59	Structural	FISIWexner score	/	/	ns	MRIEndoscopy or CT colography
Siproudhis et al., 2016 [309]	Gastroenterology	Prospective randomised clinical trial	466	390	62.1	/	Vaizey scoreWexner scoreFIQL	/	/	/	/
Soerensen et al., 2009 [310]	Surgery	Prospective cohort study	33	24	53	/	Wexner score	Pull through technique	(type Falcon 2101 EXL; B-K Medical, Herlev, Denmark) 10 MHz probe	/	/
Soerensen et al., 2013 [311]	Surgery	Retrospective cohort study	363	363	50.4	Structural	Vaizey scoreWexner scoreFIQL	/	/	/	/
Stafne et al., 2012 [312]	Gynaecology	Prospective randomised clinical trial	855	855	30.5	/	Vaizey score	/	/	/	/
Stedenfeldt et al., 2014 [313]	Gynaecology	Case control study	74	74	29.5	/	Vaizey score	/	/	/	/
Stephens et al., 2010 [314]	Surgery	Prospective cohort study	21	15	58.2	/	Wexner scoreFIQLFISI	ns	ns		EndoscopyPNTMLMRI
Sturkenboom et al., 2018 [315]	Surgery	Retrospective cohort study	18	15	43	Mixed	Vaizey scoreWexner score	/	/	/	/
Sunesen et al., 2015 [316]	Surgery	Cross sectional study	84	76	58	/	Non-validatedquestionnaire	/	/	/	/
Sze et al., 2009 [317]	Gynaecology	Prospective cohort study	69	69	57	/	Pescatori score	/	/	/	/
Sze et al., 2013 [318]	Gynaecology	Cross sectional study	2319	52.5	50.1	/	Vaizey score	/	/	/	/
Dedemadi et al., 2018 [319]	Surgery	Prospective cohort study	22	13	64.1	Mixed	FIQLWexner score	12-channelmicroballoon sensor (Star Medical Inc, Tokyo, Japan)	/	/	/
Tate et al., 2016 [320]	Urology	Cross sectional study	291	76	/	Neurogenic	FISI	/	/	/	/
Thin et al., 2014 [321]	Surgery	Prospective randomised clinical trial	40	39	59	Mixed	Wexner scoreFIQL	/	/	/	/
Thomas et al., 2013 [322]	Physiology	Prospective randomised clinical trial	30	26	52.5	/	Vaizey scoreFIQL	/	/	/	/
Thomas et al., 2015 [323]	Physiology	Prospective randomised clinical trial	11	10	/	/	Wexner score	/	/	/	/
Tjandra et al., 2009 [324]	Surgery	Prospective randomised clinical trial	40	36	59	/	Wexner scoreFIQL	pull-through technique	/	/	PNTML
Torrisi et al., 2011 [325]	Gynaecology	Prospective cohort study	960	960	29.8	/	Wexner score	/	/	/	/
Townsend et al., 2016 [326]	Physiology	Case control study	200	100	56.5	/	Wexner score	pull-through technique, (Medical Measurement Systems [MMS], Enschede, The Netherlands	(B-K Medical 2101, Berkshire, UK) 13 MHz probe	ns	/
Trenti et al., 2017 [327]	Surgery	Prospective cohort study	49	38	63.3	Mixed	Vaizey score	/	ns	/	/
Tsunoda et al., 2009 [328]	Surgery	Prospective randomised clinical trial	44	12	65.5	/	Wexner score	/	/	150 ml of a barium suspension	/
Tsunoda et al., 2013 [329]	Surgery	Prospective cohort study	20	4	42	/	Parks’s scoreFISI	/	ns	/	MRI
Tuech et al., 2015 [330]	Surgery	Prospective cohort study	56	15	65	Structural	Wexner score	/	/	/	/
van Delft et al., 2014 [331]	Gynaecology	Prospective cohort study	269	269	30.7	/	Vaizey score	/	3D/4D TPUS using the GE Voluson 730 system with a 4–8 MHz probe	/	/
van der Hagen et al., 2011 [332]	Surgery	Prospective cohort study	50	9	38	/	Vaizey score	ns	ns	/	MRI
van der Hagen et al., 2012 [333]	Surgery	Prospective cohort study	70	70	54	Mixed	Wexner scoreVaizey scoreFIQL	ns	ns	/	MRI
van der Wilt et al., 2017 [334]	Surgery	Prospective randomised clinical trial	59	51	64	/	Wexner scoreFIQL	ns	ns	ns	/
van Iersel et al., 2016 [335]	Surgery	Prospective cohort study	51	51	56.2	Structural	Pescatori scoreWexner scoreVaizey score	/	/	ns	MRI defecographyEndoscopy
van Koperen et al., 2011 [336]	Surgery	Prospective randomised clinical trial	60	18	43.5	/	Vaizey scoreWexner scoreCOREFO	/	/	/	/
van Meegdenburg et al., 2015 [337]	Physiology	Retrospective cohort study	70	47	50	/	Non-validated questionnaire	high-Resolution manometry equipment, version 8.23 (medical measurement systems, enschede, netherlands)	/	/	/
Visscher et al., 2017 [338]	Gastroenterology	Prospective randomised clinical trial	40	40	62	/	Vaizey scoreFIQL	4-microtip transducer, water-perfused catheter (Mui Scientific Type SR4B-5-0-0-0, Mississauga, ONT, Canada)	3-dimensional diagnostic ultrasound system (Hawk type 2050, B-K Medical, Naerum, Denmark)	/	/
Vitton et al., 2013 [339]	Gastroenterology	Retrospective cohort study	201	177	53.6	/	KESS scoreWexner score	(MT 95000; Astromed, Inc., Elancourt, France)	/	/	/
Wahed et al., 2011 [340]	Surgery	Retrospective cohort study	65	/	62	Structural	Wexner score	/	ns	ns	EndoscopyColonic transit
Wei et al., 2015 [341]	Surgery	Retrospective cohort study	81	63	50	Structural	Wexner scoreGIQLI	/	/	/	/
Whitcomb et al., 2012 [342]	Gynaecology	Prospective cohort study	98	98	43.3	/	FISI	/	/	/	/
Whitebird et al., 2010 [343]	Gastroenterology	Prospective randomised clinical trial	188	144	58	/	Non-validated questionnaire	/	/	/	/
Wijffels et al., 2012 [344]	Surgery	Retrospective cohort study	88	83	57.2	Mixed	FISI	/	/	ns	/
Wilson et al., 2018 [345]	Surgery	Prospective cohort study	64	39	51	/	COREFO	/	/	/	/
Savoye-Collet et al., 2010 [346]	Radiology	Retrospective cohort study	66	0	55.4	/	Park’s score	/	/	ns	/
Muñoz-Yagüe et al., 2014 [347]	Gastroenterology	Retrospective cohort study	764	645	57.3	Mixed	Wexner score	Synetics Medical (Stockholm, Sweden)	/	/	/
Awad et al., 2015 [348]	Gastroenterology	Prospective cohort study	11	5	45	Mixed	Vaizey score	/	/	/	/
Wong et al., 2011 [349]	Surgery	Retrospective cohort study	10	10	64.5	Mixed	Wexner scoreFIQL	ns	ns	/	/
Wong et al., 2012 [350]	Surgery	Retrospective cohort study	28	28	63.5	Mixed	Wexner scoreFIQL	ns	/	/	/
Yeoh et al., 2009 [351]	Radiotherapy	Prospective randomised clinical trial	67	0	69	/	Non-validated questionnaire	ns	(Bruel and Kjaer, Naerum, Denmark) 7.5-MHz probe	/	/
Young et al., 2018 [352]	Surgery	Prospective randomised clinical trial	352	332	61	/	Vaizey score	/	/	/	/
Youssef et al., 2015 [353]	Surgery	Prospective randomised clinical trial	73	33	44.2	Structural	Wexner scorePescatori score	water perfusion system and 8 channel catheters, stationed pull-through technique	/	/	/
Youssef et al., 2017 [354]	Surgery	Prospective randomised clinical trial	62	62	41.4	Structural	Wexner score	ns	ns	ns	EMGPNTML
Zutshi et al., 2010 [355]	Surgery	Retrospective cohort study	53	53	48	/	FISIFIQL	ns	ns	/	/

n: number; pts: patients; F: female; FI: fecal incontinence; PNTML: pudendal nerve terminal motor latency; MRI: magnetic resonance imaging; ns: not specified; /: not reported; FISI: fecal incontinence severity index; FIQL: fecal incontinence quality of life; GIQLI: gastrointestinal quality of life index; EORTC QLQ: European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire; AMS: American medical system; COREFO: colorectal functional outcome; PFDI: pelvic floor distress inventory; PFIQ: pelvic floor impact questionnaire; EMG: electromyography; CT: computed tomography; FICA: fecal incontinence and constipation assessment; ICIQ-B: international consultation on incontinence questionnaire-bowel; MHQ: Manchester health questionnaire; FISS: fecal incontinence scoring system; InterRAI HC: international standardised geriatric home care assessment; ASCRS: American Society of Colon and Rectal Surgery; CARIQ: colon and ano-rectal impact questionnaire; CARDI: colon and ano-rectal distress inventory; HRQoL: health-related quality of life; PFBQ: pelvic floor symptom bother questionnaire; PNE: peripheral nerve evaluation; RFIS: revised fecal incontinence scale.

Table 2.

Fecal incontinence assessment in IBD patients.

Study	Research area	Study design	No. of pts	F (n)	Mean age	Aetiology	IBD	Tools	Anal manometry	Endoanal ultrasound	Defecography	Other
Litta et al., 2019 [356]	Surgery	Prospective cohort study	37	16	40.6	/	30 CD7 UC	Wexner scoreIBDQ	(EB Neuro, Florence, Italy)	3D-EAUS (model 2052; BK Medical, Herlev, Denmark)	/	/
Brochard et al., 2015 [357]	Gastroenterology	Prospective cohort study	19	10	39.5	/	10 UC	/	3-lumen water-perfused catheter (R3B & PIP4-4; Mui Scientiﬁc, Mississauga, ON, Canada)	/	/	/
Dibley et al., 2016 [358]	Nursing	Prospective cohort study	190	/	/	/	/	ICIQ-IBD	/	/	/	/
Dibley et al., 2013 [359]	Nursing	Retrospective cohort study	3264	2187	50.3	/	1599 UC1534 CD131 IC	Non-validated questionnaire	/	/	/	/
Khanna et al., 2013 [360]	Gastroenterology	Retrospective cohort study	45	21	40.5	/	41UC2 CD2 IC	/	(Trition manometry equipment; Laborie, Toronto, Canada)	/	/	/
Kozeluhova et al., 2017 [361]	Internal medicine	Prospective cohort study	57	57	29	Structural	17 UC23 CD17 HC	Vaizey score	/	/	/	/
Lam et al., 2014 [362]	Gastroenterology	Retrospective cohort study	46	34	51.5	/	12 UC34 CD	IBDQVaizey scoreICIQ-SF	4-microtip transducer, water-perfused catheter (Mui Scientific Type SR4B-5-0-0-0, Mississauga, Ontario, Canada) pull-through technique	3D diagnostic ultrasound system (Hawk type 2050, B-K Medical, Naerum, Denmark) 2–16 MHz probe	/	/
Norton et al., 2013 [8]	Nursing	Retrospective cohort study	3264	2178	50.26	/	1599 UC1543 CD122 IC	ICIQ-BIBDQ	/	/	/	/
Papathanasopoulos et al., 2010 [363]	Gastroenterology	Prospective cohort study	72	25	40	/	20 UC38 CD14 HC	Non-validatedquestionnaire	8 manometric channels (Medtronic, Innova, Athens, Greece)	(type 1850, BK Medical, Herlev, Denmark) 10-MHz probe	/	/
Papathanasopoulos et al., 2013 [364]	Gastroenterology	Prospective cohort study	58	18	42	/	20 UC38 CD	FISS	stationary pull through (Medtronic, Minneapolis, MN).	(type 1850; BK Medical, Herlev, Denmark) 10-MHz probe	/	/
Perera et al., 2013 [365]	Gastroenterology	Retrospective cohort study	30	24	42.1	/	6 UC24 CD	SIBDQ	(Medical Measurement Systems, Netherlands)	/	/	/
Quinn et al., 2017 [366]	Internal Medicine	Retrospective cohort study	115	66	44	Structural	94 UC	/	ns	/	ns	/
Raffals et al., 2014 [367]	Gastroenterology	Retrospective cohort study	42	27	42	Structural	/	/	ns	/	ns	/
Tremaine et al., 2013 [368]	Gastroenterology	Retrospective cohort study	177	125	48	/	62 UC66 CD	/	ns	/	/	/
Vollebregt et al., 2017 [369]	Gastroenterology	Cross-sectional study	325	215	42	/	325 CD	Vaizey scoreWexner scoreFIQL	/	/	/	/
Subasinghe et al., 2016 [370]	Surgery	Prospective cohort study	184	101	44.5	/	153 UC31 CD	Vaizey scoreIBDQ	/	/	/	/
Andersson et al., 2011 [371]	Surgery	Retrospective cohort study	110	50	47	/	105 UC1 IC	Wexner scoreHRQOL	/	/	/	/
Chung et al., 2010 [372]	Surgery	Retrospective cohort study	51	11	39	Structural	11 UC40 CD	Vaizey score	/	/	/	/
Cornish et al., 2012 [373]	Surgery	Prospective cohort study	109	109	43	Structural	54 IBD	Wexner score	/	/	/	/
Kariv et al., 2009 [374]	Surgery	Retrospective cohort study	23	/	34.7	Structural	19 CD4 IC	CGQL	/	/	/	/
Kuruvilla et al., 2012 [375]	Surgery	Prospective cohort study	59	20	53	Structural	59 UC	HRQOLSIBDQCGQLFIQL	/	/	/	/
Vitton et al., 2009 [376]	Gastroenterology	Prospective cohort study	12	9	51	/	3 UC7 CD2 IC	Wexner score	/	/	/	/

n: number; pts: patients; F: female; UC: ulcerative colitis; CD: Crohn’s disease; IC: indeterminate colitis; IBD: inflammatory bowel disease; ICIQ-IBD: incontinence questionnaire – inﬂammatory bowel disease; HC: healthy controls; IBDQ: inflammatory bowel disease quality of life questionnaire; ICIQ-SF: international consultation on incontinence questionnaire-short form; ICIQ-B: international consultation on incontinence questionnaire-bowel; FISS: fecal incontinence scoring system; SIBDQ: short inﬂammatory bowel disease questionnaire; HRQoL: health-related quality of life; FIQL: fecal incontinence quality of life; CGQL: Cleveland Clinic global QOL; /: not reported.

Fecal incontinence assessment in non-IBD patients

FI was assessed using specific questionnaires in all studies, except for four trials.^{168,213,274,280} Twenty-nine different questionnaires were applied: the most widely adopted were the Wexner score (187 studies),^{50,52,54,55,59,61,63,66,69–71,73–83,86–92,97–99,101,103–107,110,114,116,117,120–123,126–128,130,131,133,135–139,141,144,146–156,160,164–167,169,170,174,177–179,182,194–203,205–208,210–212,214, 215,217–220,223–226,229,234–239,241–245,247–253,256,259,261,264, 265,270–273,276,278,279,281,284–287,289,291–296,298–306,308–311,314, 315,319,321,323–326,328,330,333–336,339–341,347,349,350,353,354} FIQL questionnaire (91 studies),^{50,62,67,73–75,79,84–88, 100,101,104,106,109,115,121,123–125,127–129,131,134–136,139,147,151,} ^{152,155,157,158,161,165,166,170,172,179,181,183,190,208,209,212,214,} ^{217,218,235,240–242,249,255–257,260–263,265,269,270,273,279,283,288,} ^{292–297,302,303,309,311,314,319,321,322,324,333,334,338,349,350,355} the Vaizey score (62 studies)^{51,56,63,65,67,68,70,71,81,100, 101,119,124,125,135–137,157,158,175,176,180,183,189–192,196,204,209, 216,227,232,246,255,266,268,269,277,279,282,290,297,300,303,307,309, 311–313,315,318,322,327,331–333,335,336,338,348,352} and fecal incontinence severity index (FISI; 33 studies).^{42,60,72, 84,85,93,109,115,118,140,161–163,171,172,181,184,186,187,230–232,238, 240,256,260,308,314,320,329,342,344,355} In 13 studies (4.2%)^{53, 58,65,108,111,142,143,145,159,316,337,343,351} non-validated questionnaires were used. Anal manometry was used in 126 studies (41.2%)^{50,53,55,57,61,65,72,73,77,78,80,82,83,} ^{85,86,91,92,95,96,98,103–107,109,111,115,122,123,125,127,134,141,142,} ^{146,151–153,155,162–165,167,168,170,174–176,178,179,183,191,193,199–201,204,206,213,217,218,223,227,228,230,234,236,237,239,240,244–251, 253,256,258,260,261,264,268–270,274,276–278,280,281,285,290,293,294, 296,298,299,301,302,304–306,310,314,319,324,326,332–334,337,338,347, 349–351,353–355,362,376} for the evaluation of FI: eight-channel water-perfused manometries were the most common systems (in 22 studies).^{61,83,122,125,141,142, 146,170,183,199,200,227,251,253,258,261,264,285,296,298,302,353} Endoanal ultrasonography was performed in 104 studies (34.0%).^{53,65,72,73,76–78,80,83,86,90,92,104,105,109,110,113, 115,122,125,127,133,141,142,146,151–153,155,157,162,163,165,167,172–176,178,179,183,191,193,200,201,204,213,225,227,230,238–240,243–246, 248–253,258,261–263,266,268,269,272,273,276,278–281,284–286,290,291, 294,298,301,302,306,310,314,326,327,329,331–334,338,340,349,351,354, 355,362} In 26 studies (8.5%)^{52,72,90,91,98,105,109,148,162,} ^{163,167,223,237, 245,247,293,306,308,326,328,334,335,340,344,346,354} the FI diagnostic approach included defecography. Other methods for FI evaluation implied PNTML investigation (23 studies),^{104,105,115,151,153,165,183,204,237, 239,240,248,258,268,269,277,286,293,294,302,314,324,354} MRI (20 studies),^{52,96,104,111,148, 171,238,239,245,262,274,285,293,306,308, 314,329,332,333,335} endoscopic procedures (18 studies),^{77, 78,98,163,167,174,180,223,226,238,239,247,301,306,308,314,335,340} EMG (five studies),^{191,206,260,294,354} CT scan (two studies),^98,114 peripheral nerve evaluation (PNE; two studies),^75,297 CT colonography (two studies),^163,308 gastrointestinal transit time study (one study)³⁴⁰ and fecoflowmetry (one study).²⁹⁹ FI was diagnosed with one technique in 142 (46.4%) studies (questionnaires in 141 studies^{51,54,56,58–60,62–64,66–71,74,79,81,84,87–89,93,94,97,99–102,108,112,116–121,124,} ^{126,128–132,135–140,143–145,147,149,150,154,156,158–161,166,169,177, 181,182,184–190,192,194–198,202,203,205,207,208,210–212,214–216,219–222,224,229,231–233,235,241,242,254,255,257,265,267,271,275,282,283,} ^{287–289,292,295,300,303,307,309,311–313,315–318,320–323,325,330,336,} ^{341–343,345,348,352} or anal manometry in one study),¹⁶⁸ with two techniques in 64 trials (20.9%),^50,55,57, ^{61,75,76,82,85,95,103,106,107,110,113,114,123,133,134,157,164,170–173,} ^{180,199,213,217,218,225,226,228,234,236,243,252,256,259,263,264,266,} ^270, ^{272–274,279,} ^{280,284,291,296,297,304,} ^{305,319,327, 328,331,337,344,} ^346, ^{347,350,353,376} and with three or more combined methods in 100 studies (32.7%).^{52,53,65,72,73,77,78,80,83,86,90–92,96,98,} ^{104,105,109,111,115,122,125,127,141,142,146,148,151–153,155,162,163,165,} ^{167,174–176,178,179,183,191,193,200,201,204,206,223,227,230,237–240,} ^{244–251,253,258,260–262,268,269,276–278,281,285,286,290,293,294,298,299,} ^{301,302,306,308,310,314,324,326,329,332–335,338,340,349,351,354,355,362}

Fecal incontinence assessment in IBD patients

In 17 trials (77.3%)^{8,356,358,359,361–365,369–376} FI was evaluated using specific questionnaires. Ten different tools were adopted. The Wexner score, the Vaizey score and the inflammatory bowel disease quality of life (IBDQ) questionnaire were the most frequently used tools (in five (22.7%),^{356,369,371,373,376} five (22.7%)^{361,362,369,370,372} and four (18.2%)^{8,356,362,370} studies, respectively). In two studies (9.1%)^359,363 non-validated questionnaires were applied. Anal manometry was used in 10 studies (45.4%) for FI assessment. Data concerning anal manometry were not specified in three studies (13.6%),^366–368 while in seven studies (31.8%)^{356,357,360,362–365} singularly different systems were used. Anal ultrasound was performed in four studies (18.2%)^{356,362–364} using Bruel and Kjaer medical probes in all cases. Defecography was used in two studies (9.1%).^366,367 However, no additional data were specified regarding diagnostic evaluation. In 15 studies (68.2%) the diagnosis of FI was obtained only with one technique (questionnaires in 12 studies^{8,358,359,361,369–376} and anal manometry in three studies).^357,360,368 In three trials (13.6%)^365–367 two techniques were used, while in four papers (18.2%)^{356,362–364} more than three methods were combined.

Discussion

We summarised all tools and investigations for FI diagnosis of the past 10 years in both IBD and non-IBD patients, including over 300 papers. Questionnaires represented the main technique for FI evaluation. They were used in almost all non-IBD studies and in over 75% of IBD trials. The most frequent tools in descending order of use were the Wexner score, FIQL, the Vaizey score and FISI for non-IBD patients and the Wexner score, the Vaizey score and the IBDQ for IBD patients. Patients’ evaluation included anal manometry in about 40% of cases in both groups, while endoanal ultrasound was adopted more in non-IBD patients than in IBD patients (34.0% vs. 18.2%, respectively). Defecography was performed in a similar percentage of studies in both examined groups (8.5% vs. 9.1%), while investigations on anal physiopathology (such as PNTML and EMG) and morphological studies (such as MRI, CT scan and endoscopy) were used only in a small number of non-IBD patients. The difference in FI assessment between IBD and non-IBD patients could be due to several reasons. The management by many specialists, from the surgeon to the gastroenterologist to the gynaecologist, etc. could justify the different approaches. Moreover, in IBD patients the involuntary loss of feces could be attributed to the underlying disease rather than a concomitant FI related to other causes, determining not only an underestimation of the problem but also a less comprehensive approach. A recent systematic review and meta-analysis by Gu et al.³⁷⁷ analysed the prevalence, pathophysiology and treatment of FI in IBD patients, reporting questionnaires and anal manometry as the main instruments for FI diagnosis. No additional tool was used to reach the diagnosis of FI. However, questionnaires are based on subjective responses of the patients and they could determine evaluation bias. Some psychometric properties,¹⁰¹ such as sensitivity, validity, reliability and responsiveness are measured to overcome this limitation. The sensitivity and validity of four scores (Pescatori score, Wexner score, Vaizey score and American medical systems score) were assessed in a small prospective study¹⁶ including 23 patients showing a high and significant correlation of all scores with the clinical impression of physicians. A prospective randomised clinical trial¹⁰¹ compared the Vaizey score, Wexner score and FIQL scale in order to evaluate their responsiveness and interpretability. All instruments showed adequate external responsiveness (Pearson correlation (r)=0.60, r=0.44 and r=0.48, respectively) and interpretability (minimally important change (MIC)=20%, MIC=17.5% and MIC=33.8%, respectively) although none reached high psychometric levels. The main strength of our review is the large number of included studies, providing a summary of the evidence on FI diagnostic approaches in the past 10 years. Furthermore, to our knowledge it is the first paper that is specifically designed to investigate FI assessment, comparing the approach between IBD and non-IBD patients. However, there are some limitations. First of all, the marked heterogeneity of the studies, which included different scientific areas and took into account several patient populations and evaluation methods. Second, the study design of our work did not allow us to obtain sufficient data to compare the accuracy of the diagnostic tools and only direct comparative studies between the different methods will allow us to overcome this gap. Third, no distinction between ulcerative colitis and Crohn’s disease in IBD trials was provided. Fourth, only studies published in the past 10 years were included in our systematic review representing a possible bias for result interpretation. There is no globally accepted consensus on the FI diagnostic approach. The neuro-urological guidelines³⁷⁸ state that the initial FI assessment should be based on a careful patient history using standard instruments such as Wexner and Vaizey scores. Digital rectal examination is considered an essential component for FI diagnosis, while the role of physiological and radiological tests is not established and their execution depends on the presence of alarm symptoms (e.g. weight or blood loss) or comorbidities.³⁷⁸ The National Institute for Health and Care Excellence (NICE) guidelines,³⁷⁹ instead, suggest clinical examination as a first step and a combination of anorectal physiology tests and endoanal ultrasonography (or MRI if ultrasonography is not available) in patients with FI who are candidates for surgical treatment. These data, as also indicated by our review, emphasize the lack of standardization in FI assessment. In some hospitals, colorectal units have been developed in order to manage complex FI cases. A retrospective study by Saunders et al.³⁸⁰ analysed the impact of the colorectal unit on the rate of adverse events and functional outcomes. A multidisciplinary management resulted in reduced rates of post-treatment complications and in higher rates of functional outcomes compared to the pre-colorectal unit management.³⁸⁰ However, the team consisted only of a surgeon, gastroenterologist, psychologist and a specialised nurse; some specialists who have a fundamental role in the management of patients with FI were not consulted. Currently, several tools have been developed to assess FI but there is no solid evidence on FI evaluation in the field of IBD. The Wexner and Vaizey scores are generic tools that can be applied to different research areas, including IBD. They are widely used in clinical practice as they are simple, quick and reliable.³⁸¹ The Wexner score is mainly focused on symptoms related to anal sphincter impairment and assesses the presence of solid, liquid, or gas incontinence.³⁸¹ The Vaizey score is based on the Wexner score and includes two additional parameters: defecation urgency and the use of constipating medication.³⁸¹ However, they do not evaluate patients’ quality of life and were developed without any input from patients, ignoring patients’ views. The International consultation on incontinence questionnaire-inflammatory bowel disease (ICIQ-IBD) is a new initially validated questionnaire, specifically structured for IBD patients.³⁵⁸ It is based on both expert and patient inputs including a quality of life measure. Nevertheless, the ICIQ-IBD is hardly utilised, due to its complexity and lack of full validation.³⁸¹ To date, no score is perfectly fit for FI evaluation in IBD patients and data on the accuracy of FI diagnostic tools in the field of IBD are lacking, preventing definitive conclusions from being drawn. The Wexner score could be used, as the most appropriate for historical comparison, until a better tool is developed. The ongoing International Organization for the Study of Inflammatory Bowel Disease (IOIBD) consensus on endpoints for disease modification will determine which tools should be recommended for FI assessment in IBD patients. Therefore, based on the data of our work we propose to use the Wexner score as a first step for assessment of IBD patients with suspected FI. Other investigations should be performed only in the case of doubt and after multidisciplinary evaluation, including a team of experts consisting of a gastroenterologist, surgeon, gynaecologist, urologist, physiologist, neurologist, radiologist and psychologist. They should define the best diagnostic approach and guide therapeutic decisions, allowing better patient management and avoiding FI under/overestimation and misdiagnosis.

Conclusion

Fecal incontinence is a common and disabling condition in patients regardless of whether or not they have IBD. A validated and globally accepted algorithm to diagnose FI has not yet been defined. A detailed history, including the characteristics of the feces and the type and frequency of incontinence, is necessary promptly to identify red flag symptoms. In the past 10 years questionnaires have been the most frequently used tools for FI evaluation. Based upon validation and global researcher preference, we propose to start FI assessment of IBD patients with the Wexner score. Any future instrument development might best be achieved by interdisciplinary international collaboration. Anal manometry and/or endoanal ultrasonography should be considered when questionnaires are suggestive of fecal incontinence.

Supplemental Material

sj-pdf-1-ueg-10.1177_2050640620943699 - Supplemental material for Tools for fecal incontinence assessment: lessons for inflammatory bowel disease trials based on a systematic review

Supplemental material, sj-pdf-1-ueg-10.1177_2050640620943699 for Tools for fecal incontinence assessment: lessons for inflammatory bowel disease trials based on a systematic review by Ferdinando D’Amico, Steven D Wexner, Carolynne J Vaizey, Célia Gouynou, Silvio Danese and Laurent Peyrin-Biroulet in United European Gastroenterology Journal

Footnotes

Author contribution

FD wrote the manuscript with support from CG. SD critically reviewed the content of the paper and supervised the project. CV and SW performed critical appraisal of the data and critical revision of the paper. LPB conceived the study, contributed to the critical interpretation of the results and supervised the project. All authors discussed the results and contributed to the final paper.

Declaration of conflicting interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: FD declares no conflicts of interest. CG declares no conflicts of interest. SDW reports consulting fees from Medtronic, TiGenix, Regentys, Karl Storz Endoscopy America, Intuitive Surgical Innovations, LifeBond, and Stryker. He has received royalties for intellectual property licence from Medtronic, Intuitive Surgical Innovations and Karl Storz Endoscopy America. He has received stock options for consulting from LifeBond, NeatStitch and novoGI. He holds stock options from Pragma, Regentys, CRH Medical and Renew Medical. He is the managing member of Unique Surgical Innovations LLC, the company which has licensed the intellectual property responsible for his personal royalty payments from Karl Storz Endoscopy America, Intuitive Surgical Innovations and Medtronic. CJV is a consultant, speaker and educator for Medtronic Inc. and an educator for THD. She holds stock options from Renew Medical. SD has served as a speaker, consultant and advisory board member for Schering-Plough, AbbVie, MSD, UCB Pharma, Ferring, Cellerix, Millenium Takeda, Nycomed, Pharmacosmos, Actelion, Alphawasserman, Genentech, Grunenthal, Pfizer, Astra Zeneca, Novo Nordisk, Cosmo Pharmaceuticals, Vifor and Johnson&Johnson, Nikkiso Europe GMBH, Theravance. LPB has served as a speaker, consultant and advisory board member for Merck, Abbvie, Janssen, Genentech, Mitsubishi, Ferring, Norgine, Tillots, Vifor, Hospira/Pfizer, Celltrion, Takeda, Biogaran, Boerhinger-Ingelheim, Lilly, HAC-Pharma, Index Pharmaceuticals, Amgen, Sandoz, Forward Pharma GmbH, Celgene, Biogen, Lycera, Samsung Bioepis and Theravance.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

Bharucha

Dunivan

Goode

, et al. Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. Am J Gastroenterol 2015; 110: 127–136.

Saldana Ruiz

Kaiser

AM.

Fecal incontinence – challenges and solutions. World J Gastroenterol 2017; 23: 11–24.

Macmillan

Merrie

AEH

Marshall

, et al. The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature. Dis Colon Rectum 2004; 47: 1341–1349.

Whitehead

Borrud

Goode

, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology 2009; 137: 512–517; 517.e1–2.

Brown

Wexner

Segall

, et al. Accidental bowel leakage in the mature women’s health study: prevalence and predictors. Int J Clin Pract 2012; 66: 1101–1108.

Brown

Wexner

Segall

, et al. Quality of life impact in women with accidental bowel leakage. Int J Clin Pract 2012; 66: 1109–1116.

Brown

Wexner

Lukacz

ES.

Factors associated with care seeking among women with accidental bowel leakage. Female Pelvic Med Reconstr Surg 2013; 19: 66–71.

Norton

Dibley

Bassett

Faecal incontinence in inflammatory bowel disease: associations and effect on quality of life. J Crohns Colitis 2013; 7: e302–e311.

Sandborn

Fazio

Feagan

, et al. AGA technical review on perianal Crohn’s disease. Gastroenterology 2003; 125: 1508–1530.

10.

Baker

Milton-Thompson

GJ.

The anal lesion as the sole presenting symptom of intestinal Crohn’s disease.

Gut 1971; 12: 865.

11.

Rao

Read

Stobart

, et al. Anorectal contractility under basal conditions and during rectal infusion of saline in ulcerative colitis. Gut 1988; 29: 769–777.

12.

Lenicek

Duricova

Komarek

, et al. Bile acid malabsorption in inflammatory bowel disease: assessment by serum markers. Inflamm Bowel Dis 2011; 17: 1322–1327.

13.

Guillaume

Salem

Garcia

, et al. Pathophysiology and therapeutic options for fecal incontinence. J Clin Gastroenterol 2017; 51: 324–330.

14.

Bartlett

Nowak

YH.

Reasons for non-disclosure of faecal incontinence: a comparison between two survey methods. Tech Coloproctol 2007; 11: 251–257.

15.

Jorge

Wexner

SD.

Etiology and management of fecal incontinence.

Dis Colon Rectum 1993; 36: 77–97.

16.

Vaizey

Carapeti

Cahill

, et al. Prospective comparison of faecal incontinence grading systems. Gut 1999; 44: 77–80.

17.

Rockwood

Church

Fleshman

, et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 2000; 43: 9–16; discussion 16–17.

18.

Alavi

Chan

Wise

, et al. Fecal incontinence: etiology, diagnosis, and management. J Gastrointest Surg 2015; 19: 1910–1921.

19.

Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions. 2nd Edition. Chichester: John Wiley & Sons, 2019.

20.

Moher

Liberati

Tetzlaff

, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264–269, W64.

21.

Wells

Shea

O’Connell

, et al. The Newcastle–Ottawa Scale for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (2009, accessed 25 May 2020).

22.

Jadad

Moore

Carroll

, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996; 17: 1–12.

23.

Cescon

Riva

Začesta

, et al. Effect of vaginal delivery on the external anal sphincter muscle innervation pattern evaluated by multichannel surface EMG: results of the multicentre study TASI-2. Int Urogynecol J 2014; 25: 1491–1499.

24.

Vyslouzil

Zboril

Skalický

, et al. Effect of hemorrhoidectomy on anorectal physiology. Int J Colorectal Dis 2010; 25: 259–265.

25.

Falkert

Willmann

Endress

, et al. Three-dimensional ultrasound of pelvic floor: is there a correlation with delivery mode and persisting pelvic floor disorders 18–24 months after first delivery? Ultrasound Obstet Gynecol 2013; 41: 204–209.

26.

Felt-Bersma

RJF

Vlietstra

Vollebregt

, et al. 3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound. BMC Gastroenterol 2018; 18: 44.

27.

Fiaschetti

Pastorelli

Squillaci

, et al. Static and dynamic evaluation of pelvic floor disorders with an open low-field tilting magnet. Clin Radiol 2013; 68: e293–e300.

28.

Handa

Lockhart

Kenton

, et al. Magnetic resonance assessment of pelvic anatomy and pelvic floor disorders after childbirth. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20: 133–139.

29.

Heinrich

Fruehauf

Sauter

, et al. The effect of standard compared to enhanced instruction and verbal feedback on anorectal manometry measurements. Neurogastroenterol Motil 2013; 25: 230–237; e163.

30.

Khafagy

Omar

El Nakeeb

, et al. Treatment of anal fistulas by partial rectal wall advancement flap or mucosal advancement flap: a prospective randomized study. Int J Surg 2010; 8: 321–325.

31.

McClurg

Hilton

Dolan

, et al. Pelvic floor muscle training as an adjunct to prolapse surgery: a randomised feasibility study. Int Urogynecol J 2014; 25: 883–891.

32.

Ozyurt

Aksoy

Gedikbasi

, et al. Screening occult anal sphincter injuries in primigravid women after vaginal delivery with transperineal use of vaginal probe: a prospective, randomized controlled trial. Arch Gynecol Obstet 2015; 292: 853–859.

33.

Patel

Oxenham

Praveen

BV.

Medium-term results of anal advancement flap compared with lateral sphincterotomy for the treatment of anal fissure. Int J Colorectal Dis 2011; 26: 1211–1214.

34.

Robinson

Bell

Christakis

, et al. Aromatase inhibitors are associated with low sexual desire causing distress and fecal incontinence in women: an observational study. J Sex Med 2017; 14: 1566–1574.

35.

Onkelen

RS van

, Gosselink

Schouten

WR.

Treatment of anal fistulas with high intersphincteric extension. Dis Colon Rectum 2013; 56: 987–991.

36.

Viebig

Franco

JTY

Araujo

, et al. Water-perfused high-resolution anorectal manometry (HRAM-WP): the first Brazilian study. Arq Gastroenterol 2018; 55 (Suppl. 1): 41–46.

37.

Worsøe

Fassov

Schlageter

, et al. Turning off sacral nerve stimulation does not affect gastric and small intestinal motility in patients treated for faecal incontinence. Colorectal Dis 2012; 14: e713–e720.

38.

Biondo

Trenti

Galvez

, et al. Two-stage Turnbull–Cutait pull-through coloanal anastomosis versus coloanal anastomosis with protective loop ileostomy for low rectal cancer. Protocol for a randomized controlled trial (Turnbull-BCN). Int J Colorectal Dis 2017; 32: 1357–1362.

39.

McAlees

Vollebregt

Stevens

, et al. Efficacy and mechanism of sub-sensory sacral (optimised) neuromodulation in adults with faecal incontinence: study protocol for a randomised controlled trial. Trials 2018; 19: 336.

40.

Siproudhis

Jones

Shing

RNK

, et al. Libertas: rationale and study design of a multicentre, phase II, double-blind, randomised, placebo-controlled investigation to evaluate the efficacy, safety and tolerability of locally applied NRL001 in patients with faecal incontinence. Colorectal Dis 2014; 16 (Suppl. 1): 59–66.

41.

Williams

Croft

Napp

, et al. SaFaRI: sacral nerve stimulation versus the FENIX magnetic sphincter augmentation for adult faecal incontinence: a randomised investigation. Int J Colorectal Dis 2016; 31: 465–472.

42.

Park

Kang

Baik

SH.

Treatment of faecal incontinence using allogeneic-adipose-derived mesenchymal stem cells: a study protocol for a pilot randomised controlled trial. BMJ Open 2016; 6: e010450.

43.

Norton

Dibley

Hart

, et al. Faecal incontinence intervention study (FINS): self-management booklet information with or without nurse support to improve continence in people with inflammatory bowel disease: study protocol for a randomized controlled trial. Trials 2015; 16: 444.

44.

Fuchs

Dantonello

Blumenstock

, et al. Treatment and outcome of patients suffering from perineal/perianal rhabdomyosarcoma: results from the CWS trials – retrospective clinical study. Ann Surg 2014; 259: 1166–1172.

45.

Koga

Miyano

Takahashi

, et al. Comparison of anorectal angle and continence after Georgeson and Peña procedures for high/intermediate imperforate anus. J Pediatr Surg 2010; 45: 2394–2397.

46.

Shi

G-G

Wang

, et al. Two different gracilis loops in graciloplasty of congenital fecal incontinence: comparison of the therapeutic effects. Int J Colorectal Dis 2015; 30: 1391–1397.

47.

Sun

Zhang

, et al. The effects of biofeedback training of pelvic floor muscles on fecal incontinence. J Pediatr Surg 2009; 44: 2384–2387.

48.

Zakaria

OM.

Bowel function and fecal continence after Soave’s trans-anal endorectal pull-through for Hirschsprung’s disease: a local experience. Updates Surg 2012; 64: 113–118.

49.

Blekken

Nakrem

Gjeilo

, et al. Feasibility, acceptability, and adherence of two educational programs for care staff concerning nursing home patients’ fecal incontinence: a pilot study preceding a cluster-randomized controlled trial. Implement Sci 2015; 10: 72.

50.

Eléouet

Siproudhis

Guillou

, et al. Chronic posterior tibial nerve transcutaneous electrical nerve stimulation (TENS) to treat fecal incontinence (FI). Int J Colorectal Dis 2010; 25: 1127–1132.

51.

Göttgens

KWA

Janssen

PTJ

Heemskerk

, et al. Long-term outcome of low perianal fistulas treated by fistulotomy: a multicenter study. Int J Colorectal Dis 2015; 30: 213–219.

52.

Köhler

Stelzner

Hellmich

, et al. Results in the long-term course after stapled transanal rectal resection (STARR). Langenbecks Arch Surg 2012; 397: 771–778.

53.

Naidoo

Moodley

The effect of pregnancy and delivery on anal function in black Africans and Indians. S Afr J Surg 2018; 56: 22–28.

54.

Peña Ros

Parra Baños

Benavides Buleje

, et al. Short-term outcome of percutaneous posterior tibial nerve stimulation (PTNS) for the treatment of faecal incontinence. Tech Coloproctol 2016; 20: 19–24.

55.

Vallès

Mearin

Pathophysiology of bowel dysfunction in patients with motor incomplete spinal cord injury: comparison with patients with motor complete spinal cord injury. Dis Colon Rectum 2009; 52: 1589–1597.

56.

Taithongchai

Gruting

IMA van

Volløyhaug

, et al. Comparing the diagnostic accuracy of 3 ultrasound modalities for diagnosing obstetric anal sphincter injuries. Am J Obstet Gynecol 2019; 221: 134.e1–134.e9.

57.

Szűcs

Keszthelyi

Szendrői

, et al. Investigation of anal sphincter function following Mainz pouch type II urinary diversion after radical cystectomy. Int Urol Nephrol 2012; 44: 1013–1020.

58.

Bø

Haakstad

LAH.

Is pelvic floor muscle training effective when taught in a general fitness class in pregnancy? A randomised controlled trial. Physiotherapy 2011; 97: 190–195.

59.

Parés

Martinez-Franco

Lorente

, et al. Prevalence of fecal incontinence in women during pregnancy: a large cross-sectional study. Dis Colon Rectum 2015; 58: 1098–1103.

60.

Davé

Leader-Cramer

Mueller

, et al. Anal sphincter injuries after operative vaginal versus spontaneous delivery – is there a difference in postpartum symptoms? Female Pelvic Med Reconstr Surg 2016; 22: 194–198.

61.

López-Delgado

Arroyo

Ruiz-Tovar

, et al. Effect on anal pressure of percutaneous posterior tibial nerve stimulation for faecal incontinence. Colorectal Dis 2014; 16: 533–537.

62.

Parés

Vial

Bohle

, et al. Prevalence of faecal incontinence and analysis of its impact on quality of life and mental health. Colorectal Dis 2011; 13: 899–905.

63.

Worsøe

Fynne

Laurberg

, et al. Electrical stimulation of the dorsal clitoral nerve reduces incontinence episodes in idiopathic faecal incontinent patients: a pilot study. Colorectal Dis 2012; 14: 349–355.

64.

Waniczek

Copija

Janiszewska

, et al. Mikulicz’s procedure with levator muscle and external anal sphincter plasty in the treatment of rectal prolapse. Pol Przegl Chir 2012; 84: 626–631.

65.

Sjödahl

Walter

Johansson

, et al. Combination therapy with biofeedback, loperamide, and stool-bulking agents is effective for the treatment of fecal incontinence in women – a randomized controlled trial. Scand J Gastroenterol 2015; 50: 965–974.

66.

Petersen

Sterzing

Ommer

, et al. TST36 stapling for rectocele and hemorrhoidal prolapse – early results of the prospective German multicenter study. German Med Sci 2016; 14: Doc14.

67.

Horrocks

Bremner

Stevens

, et al. Double-blind randomised controlled trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in the treatment of faecal incontinence: CONtrol of Faecal Incontinence using Distal NeuromodulaTion (the CONFIDeNT trial). Health Technol Assess 2015; 19: 1–164.

68.

Brown

Tiernan

Biggs

, et al. The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation. Health Technol Assess 2016; 20: 1–150.

69.

Abbas

Tam

Chun

LJ.

Radiofrequency treatment for fecal incontinence: is it effective long-term?

Dis Colon Rectum 2012; 55: 605–610.

70.

Abramowitz

Bouchard

Souffran

, et al. Sphincter-sparing anal-fissure surgery: a 1-year prospective, observational, multicentre study of fissurectomy with anoplasty. Colorectal Dis 2013; 15: 359–367.

71.

Abramowitz

Soudan

Souffran

, et al. The outcome of fistulotomy for anal fistula at 1 year: a prospective multicentre French study. Colorectal Dis 2016; 18: 279–285.

72.

Adusumilli

Gosselink

Fourie

, et al. Does the presence of a high grade internal rectal prolapse affect the outcome of pelvic floor retraining in patients with faecal incontinence or obstructed defaecation? Colorectal Dis 2013; 15: e680–e685.

73.

Aigner

Conrad

Margreiter

, et al. Anal submucosal carbon bead injection for treatment of idiopathic fecal incontinence: a preliminary report. Dis Colon Rectum 2009; 52: 293–298.

74.

Ait Said

Leroux

Menahem

, et al. Effect of bariatric surgery on urinary and fecal incontinence: prospective analysis with 1-year follow-up. Surg Obes Relat Dis 2017; 13: 305–312.

75.

Al Asari

Meurette

Mantoo

, et al. Percutaneous tibial nerve stimulation vs sacral nerve stimulation for faecal incontinence: a comparative case-matched study. Colorectal Dis 2014; 16: O393–O399.

76.

Albuquerque

Macedo

Clinical severity of fecal incontinence after anorectal surgery and its relationship with endoanal ultrasound features. Int J Colorectal Dis 2016; 31: 1395–1396.

77.

Allgayer

Ignee

Dietrich

CF.

Endosonographic elastography of the anal sphincter in patients with fecal incontinence. Scand J Gastroenterol 2010; 45: 30–38.

78.

Allgayer

Ignee

Zipse

, et al. Endorectal ultrasound and real-time elastography in patients with fecal incontinence following anorectal surgery: a prospective comparison evaluating short- and long-term outcomes in irradiated and non-irradiated patients. Z Gastroenterol 2012; 50: 1281–1286.

79.

Altman

Hjern

Zetterström

Transanal submucosal polyacrylamide gel injection treatment of anal incontinence: a randomized controlled trial. Acta Obstet Gynecol Scand 2016; 95: 528–533.

80.

Altomare

Greco

Tricomi

, et al. Seton or glue for trans-sphincteric anal fistulae: a prospective randomized crossover clinical trial. Colorectal Dis 2011; 13: 82–86.

81.

Altomare

Giuratrabocchetta

Knowles

, et al. Long-term outcomes of sacral nerve stimulation for faecal incontinence. Br J Surg 2015; 102: 407–415.

82.

Andrianjafy

Luciano

Bazin

, et al. Three-dimensional high-resolution anorectal manometry in functional anorectal disorders: results from a large observational cohort study. Int J Colorectal Dis 2019; 34: 719–729.

83.

Arroyo

Parra

Lopez

, et al. Percutaneous posterior tibial nerve stimulation (PPTNS) in faecal incontinence associated with an anal sphincter lesion: results of a prospective study. Int J Surg 2014; 12: 146–149.

84.

Aytac

Gorgun

Erem

, et al. Long-term outcomes after circular stapled hemorrhoidopexy versus Ferguson hemorrhoidectomy. Tech Coloproctol 2015; 19: 653–658.

85.

Barak

Gecse

Takács

Topical oxymetazoline for fecal incontinence in patients with spinal cord injury: a double-blind randomized controlled crossover study. Dis Colon Rectum 2019; 62: 234–240.

86.

Bartlett

Sloots

Nowak

, et al. Biofeedback for fecal incontinence: a randomized study comparing exercise regimens. Dis Colon Rectum 2011; 54: 846–856.

87.

Bartlett

Sloots

Nowak

, et al. Supplementary home biofeedback improves quality of life in younger patients with fecal incontinence. J Clin Gastroenterol 2015; 49: 419–428.

88.

Barussaud

M-L

Mantoo

Wyart

, et al. The magnetic anal sphincter in faecal incontinence: is initial success sustained over time? Colorectal Dis 2013; 15: 1499–1503.

89.

Battersby

Juul

Christensen

, et al. Predicting the risk of bowel-related quality-of-life impairment after restorative resection for rectal cancer: a multicenter cross-sectional study. Dis Colon Rectum 2016; 59: 270–280.

90.

Beer-Gabel

Carter

Comparison of dynamic transperineal ultrasound and defecography for the evaluation of pelvic floor disorders. Int J Colorectal Dis 2015; 30: 835–841.

91.

Benezech

Bouvier

Grimaud

J-C

, et al. Three-dimensional high-resolution anorectal manometry and diagnosis of excessive perineal descent: a comparative pilot study with defaecography. Colorectal Dis 2014; 16: O170–O175.

92.

Benezech

Behr

Bouvier

, et al. Three-dimensional high-resolution anorectal manometry: does it allow automated analysis of sphincter defects? Colorectal Dis 2015; 17: O202–O207.

93.

Berretta

Marchesi

Volpi

, et al. Posterior pelvic exenteration and retrograde total hysterectomy in patients with locally advanced ovarian cancer: clinical and functional outcome. Taiwan J Obstet Gynecol 2016; 55: 346–350.

94.

Bharucha

Zinsmeister

Schleck

, et al. Bowel disturbances are the most important risk factors for late onset fecal incontinence: a population-based case–control study in women. Gastroenterology 2010; 139: 1559–1566.

95.

Bharucha

Edge

Zinsmeister

AR.

Effect of nifedipine on anorectal sensorimotor functions in health and fecal incontinence. Am J Physiol Gastrointest Liver Physiol 2011; 301: G175–G180.

96.

Bharucha

Fletcher

Camilleri

, et al. Effects of clonidine in women with fecal incontinence. Clin Gastroenterol Hepatol 2014; 12: 843–851.e2; quiz e44.

97.

Biondo

Frago

Codina Cazador

, et al. Long-term functional results from a randomized clinical study of transverse coloplasty compared with colon J-pouch after low anterior resection for rectal cancer. Surgery 2013; 153: 383–392.

98.

Boenicke

Reibetanz

Kim

, et al. Predictive factors for postoperative constipation and continence after stapled transanal rectal resection. Br J Surg 2012; 99: 416–422.

99.

Bokhari

Lindsey

Incontinence following sphincter division for treatment of anal fistula. Colorectal Dis 2010; 12: e135–e139.

100.

Bols

Berghmans

de Bie

, et al. Rectal balloon training as add-on therapy to pelvic floor muscle training in adults with fecal incontinence: a randomized controlled trial. Neurourol Urodyn 2012; 31: 132–138.

101.

Bols

EMJ

Hendriks

HJM

Berghmans

LCM

, et al. Responsiveness and interpretability of incontinence severity scores and FIQL in patients with fecal incontinence: a secondary analysis from a randomized controlled trial. Int Urogynecol J 2013; 24: 469–478.

102.

Booth

Hagen

McClurg

, et al. A feasibility study of transcutaneous posterior tibial nerve stimulation for bladder and bowel dysfunction in elderly adults in residential care. J Am Med Dir Assoc 2013; 14: 270–274.

103.

Bouguen

Ropert

Lainé

, et al. Effects of transcutaneous tibial nerve stimulation on anorectal physiology in fecal incontinence: a double-blind placebo-controlled cross-over evaluation. Neurogastroenterol Motil 2014; 26: 247–254.

104.

Boyer

Bridoux

Giverne

, et al. Autologous myoblasts for the treatment of fecal incontinence: results of a phase 2 randomized placebo-controlled study (MIAS). Ann Surg 2018; 267: 443–450.

105.

Boyle

Knowles

Lunniss

, et al. Efficacy of sacral nerve stimulation for fecal incontinence in patients with anal sphincter defects. Dis Colon Rectum 2009; 52: 1234–1239.

106.

Bridoux

Gourcerol

Kianifard

, et al. Botulinum A toxin as a treatment for overactive rectum with associated faecal incontinence. Colorectal Dis 2012; 14: 342–348.

107.

Butt

Alam

Cohen

, et al. Lack of effect of sacral nerve stimulation for incontinence in patients with systemic sclerosis. Colorectal Dis 2015; 17: 903–907.

108.

Caremel

Damon

Ruffion

, et al. Can sacral neuromodulation improve minor incontinence symptoms in doubly incontinent patients successfully treated for major incontinence symptoms? Urology 2012; 79: 80–85.

109.

Cauley

Savitt

Weinstein

, et al. A quality-of-life comparison of two fecal incontinence phenotypes: isolated fecal incontinence versus concurrent fecal incontinence with constipation. Dis Colon Rectum 2019; 62: 63–70.

110.

Cerro

Franco

Santoro

, et al. Residual defects after repair of obstetric anal sphincter injuries and pelvic floor muscle strength are related to anal incontinence symptoms. Int Urogynecol J 2017; 28: 455–460.

111.

Chakraborty S, Feuerhak KJ, Zinsmeister AR, et al. Reproducibility of high-definition (3D) manometry and its agreement with high-resolution (2D) manometry in women with fecal incontinence. Neurogastroenterol Motil 2017; 29: 10.1111/nmo.12950.

112.

Chan

SSC

Cheung

RYK

Yiu

, et al. Prevalence of urinary and fecal incontinence in Chinese women during and after their first pregnancy. Int Urogynecol J 2013; 24: 1473–1479.

113.

Chan

SSC

Cheung

RYK

Yiu

, et al. Effect of levator ani muscle injury on primiparous women during the first year after childbirth. Int Urogynecol J 2014; 25: 1381–1388.

114.

Chen

Jiang

Qian

, et al. Antiperistaltic side-to-side ileorectal anastomosis is associated with a better short-term fecal continence and quality of life in slow transit constipation patients. Dig Surg 2015; 32: 367–374.

115.

Chew

SSB

Sundaraj

Adams

Sacral transcutaneous electrical nerve stimulation in the treatment of idiopathic faecal incontinence. Colorectal Dis 2011; 13: 567–571.

116.

Cichowski

Komesu

Dunivan

, et al. The association between fecal incontinence and sexual activity and function in women attending a tertiary referral center. Int Urogynecol J 2013; 24: 1489–1494.

117.

Cichowski

Komesu

Dunivan

, et al. Written versus oral disclosure of fecal and urinary incontinence in women with dual incontinence. Int Urogynecol J 2014; 25: 1257–1262.

118.

Cichowski

Dunivan

Rogers

, et al. Standard compared with mnemonic counseling for fecal incontinence: a randomized controlled trial. Obstet Gynecol 2015; 125: 1063–1070.

119.

Cohen-Zubary

Gingold-Belfer

Lambort

, et al. Home electrical stimulation for women with fecal incontinence: a preliminary randomized controlled trial. Int J Colorectal Dis 2015; 30: 521–528.

120.

Contin

Kulu

Bruckner

, et al. Comparative analysis of late functional outcome following preoperative radiation therapy or chemoradiotherapy and surgery or surgery alone in rectal cancer. Int J Colorectal Dis 2014; 29: 165–175.

121.

Cornelisse

Arendsen

van Kuijk

SMJ

, et al. Obstetric anal sphincter injury: a follow-up questionnaire study on longer-term outcomes. Int Urogynecol J 2016; 27: 1591–1596.

122.

Coura

Silva

de Almeida

, et al. Is digital rectal exam reliable in grading anal sphincter defects? Arq Gastroenterol 2016; 53: 240–245.

123.

Damon

Siproudhis

Faucheron

J-L

, et al. Perineal retraining improves conservative treatment for faecal incontinence: a multicentre randomized study. Dig Liver Dis 2014; 46: 237–242.

124.

Dehli

Martinussen

Mevik

, et al. Translation and validation of the Norwegian version of the fecal incontinence quality-of-life scale. Scand J Surg 2011; 100: 190–195.

125.

Dehli

Stordahl

Vatten

, et al. Sphincter training or anal injections of dextranomer for treatment of anal incontinence: a randomized trial. Scand J Gastroenterol 2013; 48: 302–310.

126.

de la Portilla

Rada

Vega

, et al. Evaluation of the use of posterior tibial nerve stimulation for the treatment of fecal incontinence: preliminary results of a prospective study. Dis Colon Rectum 2009; 52: 1427–1433.

127.

de la Portilla

Reyes-Díaz

Maestre

, et al. Ultrasonographic evidence of Gatekeeper™ prosthesis migration in patients treated for faecal incontinence: a case series. Int J Colorectal Dis 2017; 32: 437–440.

128.

de Melloa Portilla

Feldner

da Conceição

, et al. Prevalence of and quality of life related to anal incontinence in women with urinary incontinence and pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 2012; 160: 228–231.

129.

Denoya

Tam

Bergamaschi

Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial. Tech Coloproctol 2014; 18: 1081–1085.

130.

Didailler

Denost

Loughlin

, et al. Antegrade enema after total mesorectal excision for rectal cancer: the last chance to avoid definitive colostomy for refractory low anterior resection syndrome and fecal incontinence. Dis Colon Rectum 2018; 61: 667–672.

131.

Digennaro

Tondo

Cuccia

, et al. Coloanal anastomosis or abdominoperineal resection for very low rectal cancer: what will benefit, the surgeon’s pride or the patient’s quality of life? Int J Colorectal Dis 2013; 28: 949–957.

132.

Doeksen

Bakx

Vincent

, et al. J-pouch vs side-to-end coloanal anastomosis after preoperative radiotherapy and total mesorectal excision for rectal cancer: a multicentre randomized trial. Colorectal Dis 2012; 14: 705–713.

133.

Drusany Staric

Lukanovic

Petrocnik

, et al. Impact of mediolateral episiotomy on incidence of obstetrical anal sphincter injury diagnosed by endoanal ultrasound. Midwifery 2017; 51: 40–43.

134.

Dudding

Parés

Vaizey

, et al. Sacral nerve stimulation for the treatment of faecal incontinence related to dysfunction of the internal anal sphincter. Int J Colorectal Dis 2010; 25: 625–630.

135.

Duelund-Jakobsen

Dudding

Bradshaw

, et al. Randomized double-blind crossover study of alternative stimulator settings in sacral nerve stimulation for faecal incontinence. Br J Surg 2012; 99: 1445–1452.

136.

Duelund-Jakobsen

Buntzen

Lundby

, et al. Sacral nerve stimulation at subsensory threshold does not compromise treatment efficacy: results from a randomized, blinded crossover study. Ann Surg 2013; 257: 219–223.

137.

Duelund-Jakobsen

Lehur

P-A

Lundby

, et al. Sacral nerve stimulation for faecal incontinence – efficacy confirmed from a two-centre prospectively maintained database. Int J Colorectal Dis 2016; 31: 421–428.

138.

Dumont

Ayadi

Goéré

, et al. Comparison of fecal continence and quality of life between intersphincteric resection and abdominoperineal resection plus perineal colostomy for ultra-low rectal cancer. J Surg Oncol 2013; 108: 225–229.

139.

El-Gazzaz

Zutshi

Salcedo

, et al. Sacral neuromodulation for the treatment of fecal incontinence and urinary incontinence in female patients: long-term follow-up. Int J Colorectal Dis 2009; 24: 1377–1381.

140.

Ellington

Polin

Szychowski

, et al. The effect of obesity on fecal incontinence symptom distress, quality of life, and diagnostic testing measures in women. Int Urogynecol J 2013; 24: 1733–1738.

141.

Emile

Youssef

Elfeki

, et al. Effect of age, patient’s sex, and type of trauma on the correlation between size of sphincter defect and anal pressures in posttraumatic fecal incontinence. Surgery 2016; 160: 1318–1325.

142.

Farrell

Gilmour

Turnbull

, et al. Overlapping compared with end-to-end repair of third- and fourth-degree obstetric anal sphincter tears: a randomized controlled trial. Obstet Gynecol 2010; 116: 16–24.

143.

Farrell

Flowerdew

Gilmour

, et al. Overlapping compared with end-to-end repair of complete third-degree or fourth-degree obstetric tears: three-year follow-up of a randomized controlled trial. Obstet Gynecol 2012; 120: 803–808.

144.

Fashokun

TBO

Harvie

Schimpf

, et al. Sexual activity and function in women with and without pelvic floor disorders. Int Urogynecol J 2013; 24: 91–97.

145.

Fellin

Fiorino

Rancati

, et al. Clinical and dosimetric predictors of late rectal toxicity after conformal radiation for localized prostate cancer: results of a large multicenter observational study. Radiother Oncol 2009; 93: 197–202.

146.

Fitzpatrick

Cassidy

Barassaud

, et al. Does anal sphincter injury preclude subsequent vaginal delivery? Eur J Obstet Gynecol Reprod Biol 2016; 198: 30–34.

147.

Fonseca

Meinberg

Lucas

, et al. Cultural adaptation and validation of the Wexner scale in patients with anal incontinence in a Brazilian population. Int Urogynecol J 2016; 27: 959–963.

148.

Formijne Jonkers

Poierrié

Draaisma

, et al. Laparoscopic ventral rectopexy for rectal prolapse and symptomatic rectocele: an analysis of 245 consecutive patients. Colorectal Dis 2013; 15: 695–699.

149.

Forsgren

Zetterström

Zhang

, et al. Anal incontinence and bowel dysfunction after sacrocolpopexy for vaginal vault prolapse. Int Urogynecol J 2010; 21: 1079–1084.

150.

Frees

Schenk

Rubenwolf

, et al. Bowel function in patients with urinary diversion: a gender-matched comparison of continent urinary diversion with the ileocecal pouch and ileal conduit. World J Urol 2017; 35: 913–919.

151.

Frudinger

Kölle

Schwaiger

, et al. Muscle-derived cell injection to treat anal incontinence due to obstetric trauma: pilot study with 1 year follow-up. Gut 2010; 59: 55–61.

152.

Frudinger

Pfeifer

Paede

, et al. Autologous skeletal-muscle-derived cell injection for anal incontinence due to obstetric trauma: a 5-year follow-up of an initial study of 10 patients. Colorectal Dis 2015; 17: 794–801.

153.

Frudinger

Marksteiner

Pfeifer

, et al. Skeletal muscle-derived cell implantation for the treatment of sphincter-related faecal incontinence. Stem Cell Res Ther 2018; 9: 233.

154.

Gao

Wang

, et al. Treatment for early ultralow rectal cancer: pull-through intersphincteric stapled transection and anastomosis (PISTA) versus low anterior resection. Tech Coloproctol 2013; 17: 283–291.

155.

Gallas

Michot

Faucheron

, et al. Predictive factors for successful sacral nerve stimulation in the treatment of faecal incontinence: results of trial stimulation in 200 patients. Colorectal Dis 2011; 13: 689–696.

156.

Gandomkar

Zeinoddini

Heidari

, et al. Partial lateral internal sphincterotomy versus combined botulinum toxin A injection and topical diltiazem in the treatment of chronic anal fissure: a randomized clinical trial. Dis Colon Rectum 2015; 58: 228–234.

157.

George

Kalmar

Sala

, et al. Randomized controlled trial of percutaneous versus transcutaneous posterior tibial nerve stimulation in faecal incontinence. Br J Surg 2013; 100: 330–338.

158.

George

Dudding

Gurmany

, et al. Pudendal nerve stimulation for bowel dysfunction in complete cauda equina syndrome. Ann Surg 2014; 259: 502–507.

159.

Gill

Swartz

Rackley

, et al. Improvement of bowel dysfunction with sacral neuromodulation for refractory urge urinary incontinence. Int Urogynecol J 2012; 23: 735–741.

160.

Giordano

Sileri

Buntzen

, et al. A prospective multicentre observational study of Permacol collagen paste for anorectal fistula: preliminary results. Colorectal Dis 2016; 18: 286–294.

161.

Gorissen

Bloemendaal

ALA

Prapasrivorakul

, et al. Dynamic article: Permanent sacral nerve stimulation under local anesthesia: feasibility, best practice, and patient satisfaction. Dis Colon Rectum 2015; 58: 1182–1185.

162.

Gosselink

Adusumilli

Gorissen

, et al. Laparoscopic ventral rectopexy for fecal incontinence associated with high-grade internal rectal prolapse. Dis Colon Rectum 2013; 56: 1409–1414.

163.

Gosselink

Joshi

Adusumilli

, et al. Laparoscopic ventral rectopexy for faecal incontinence: equivalent benefit is seen in internal and external rectal prolapse. J Gastrointest Surg 2015; 19: 558–563.

164.

Gourcerol

Granier

Bridoux

, et al. Do endoflip assessments of anal sphincter distensibility provide more information on patients with fecal incontinence than high-resolution anal manometry? Neurogastroenterol Motil 2016; 28: 399–409.

165.

Govaert

Pares

Delgado-Aros

, et al. A prospective multicentre study to investigate percutaneous tibial nerve stimulation for the treatment of faecal incontinence. Colorectal Dis 2010; 12: 1236–1241.

166.

Graf

Mellgren

Matzel

, et al. Efficacy of dextranomer in stabilised hyaluronic acid for treatment of faecal incontinence: a randomised, sham-controlled trial. Lancet 2011; 377: 997–1003.

167.

Grande

Cadeddu

Sileri

, et al. Anal vector volume analysis: an effective tool in the management of pelvic floor disorders. Tech Coloproctol 2011; 15: 31–37.

168.

Guinet

Jousse

Damphousse

, et al. Modulation of the rectoanal inhibitory reflex (RAIR): qualitative and quantitative evaluation in multiple sclerosis. Int J Colorectal Dis 2011; 26: 507–513.

169.

Gyhagen

Bullarbo

Nielsen

, et al. Faecal incontinence 20 years after one birth: a comparison between vaginal delivery and caesarean section. Int Urogynecol J 2014; 25: 1411–1418.

170.

Habr-Gama

Lynn

Jorge

JMN

, et al. Impact of organ-preserving strategies on anorectal function in patients with distal rectal cancer following neoadjuvant chemoradiation. Dis Colon Rectum 2016; 59: 264–269.

171.

Heilbrun

Nygaard

Lockhart

, et al. Correlation between levator ani muscle injuries on magnetic resonance imaging and fecal incontinence, pelvic organ prolapse, and urinary incontinence in primiparous women. Am J Obstet Gynecol 2010; 202: 488.e1–488.e6.

172.

Heymen

Scarlett

Jones

, et al. Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence. Dis Colon Rectum 2009; 52: 1730–1737.

173.

Chan

Choy

Yiu

, et al. Pelvic floor disorders related to pregnancy: a prospective observational study. Hong Kong Med J 2017; 23 (Suppl. 2): 42–46.

174.

Horisberger

Rothenhoefer

Kripp

, et al. Impaired continence function five years after intensified chemoradiation in patients with locally advanced rectal cancer. Eur J Surg Oncol 2014; 40: 227–233.

175.

Hornung

Mitchell

Carlson

, et al. Comparative study of anal acoustic reflectometry and anal manometry in the assessment of faecal incontinence. Br J Surg 2012; 99: 1718–1724.

176.

Hornung

Carlson

Mitchell

, et al. Anal acoustic reflectometry predicts the outcome of percutaneous nerve evaluation for faecal incontinence. Br J Surg 2014; 101: 1310–1316.

177.

Horrocks

Chadi

Stevens

, et al. Factors associated with efficacy of percutaneous tibial nerve stimulation for fecal incontinence, based on post-hoc analysis of data from a randomized trial. Clin Gastroenterol Hepatol 2017; 15: 1915–1921.e2.

178.

Hotouras

Thaha

Allison

, et al. Percutaneous tibial nerve stimulation (PTNS) in females with faecal incontinence: the impact of sphincter morphology and rectal sensation on the clinical outcome. Int J Colorectal Dis 2012; 27: 927–930.

179.

Hotouras

Murphy

Thin

, et al. Outcome of sacral nerve stimulation for fecal incontinence in patients refractory to percutaneous tibial nerve stimulation. Dis Colon Rectum 2013; 56: 915–920.

180.

How

Stelzner

Branagan

, et al. Comparative quality of life in patients following abdominoperineal excision and low anterior resection for low rectal cancer. Dis Colon Rectum 2012; 55: 400–406.

181.

Hull

Giese

Wexner

, et al. Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence. Dis Colon Rectum 2013; 56: 234–245.

182.

Huser

Janku

Hudecek

, et al. Pelvic floor dysfunction after vaginal and cesarean delivery among singleton primiparas. Int J Gynaecol Obstet 2017; 137: 170–173.

183.

Hussain

Lim

Mussa

, et al. The use of Permacol® injections for the treatment of faecal incontinence. Updates Surg 2012; 64: 289–295.

184.

Hyman

O’Brien

Osler

Outcomes after fistulotomy: results of a prospective, multicenter regional study. Dis Colon Rectum 2009; 52: 2022–2027.

185.

Jamieson

Schluter

Pyun

, et al. Fecal incontinence is associated with mortality among older adults with complex needs: an observational cohort study. Am J Gastroenterol 2017; 112: 1431–1437.

186.

Jelovsek

Piccorelli

Barber

, et al. Prediction models for postpartum urinary and fecal incontinence in primiparous women. Female Pelvic Med Reconstr Surg 2013; 19: 110–118.

187.

Jelovsek

Chen

Markland

, et al. Minimum important differences for scales assessing symptom severity and quality of life in patients with fecal incontinence. Female Pelvic Med Reconstr Surg 2014; 20: 342–348.

188.

Joh

H-K

Seong

M-K

S-W.

Fecal incontinence in elderly Koreans. J Am Geriatr Soc 2010; 58: 116–121.

189.

Johannessen

Wibe

Stordahl

, et al. Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study. Br J Obstet Gynaecol 2014; 121: 269–279.

190.

Johannessen

Mørkved

Stordahl

, et al. Anal incontinence and quality of life in late pregnancy: a cross-sectional study. Br J Obstet Gynaecol 2014; 121: 978–987.

191.

Johannessen

Wibe

Stordahl

, et al. Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial. Br J Obstet Gynaecol 2017; 124: 686–694.

192.

Johannessen

Stafne

Falk

, et al. Prevalence and predictors of double incontinence 1 year after first delivery. Int Urogynecol J 2018; 29: 1529–1535.

193.

Johannsson

HÖ

Påhlman

Graf

Functional and structural abnormalities after Milligan hemorrhoidectomy: a comparison with healthy subjects. Dis Colon Rectum 2013; 56: 903–908.

194.

Kahlke

Bock

Peleikis

, et al. Six years after: complications and long-term results after stapled hemorrhoidopexy with different devices. Langenbecks Arch Surg 2011; 396: 659–667.

195.

Kahlke

Topic

Peleikis

, et al. Sacral nerve modulation for fecal incontinence: results of a prospective single-center randomized crossover study. Dis Colon Rectum 2015; 58: 235–240.

196.

Kauff

Kronfeld

Gorbulev

, et al. Continuous intraoperative monitoring of pelvic autonomic nerves during TME to prevent urogenital and anorectal dysfunction in rectal cancer patients (NEUROS): a randomized controlled trial. BMC Cancer 2016; 16: 323.

197.

Khan

Amatya

, et al. Rehabilitation outcomes in persons with spina bifida: a randomised controlled trial. J Rehabil Med 2015; 47: 734–740.

198.

Khoury

Gilshtein

Nordkin

, et al. Repeated transanal endoscopic microsurgery is feasible and safe. J Laparoendosc Adv Surg Tech A 2013; 23: 216–219.

199.

Kim

Yoon

, et al. Levator–sphincter reinforcement after ultralow anterior resection in patients with low rectal cancer: the surgical method and evaluation of anorectal physiology. Surg Today 2012; 42: 547–553.

200.

Kim

Lim

S-B

Yoon

, et al. Completely abdominal intersphincteric resection for lower rectal cancer: feasibility and comparison of robot-assisted and open surgery. Surg Endosc 2014; 28: 2734–2744.

201.

Kirss

Pinta

Rautio

, et al. Impact of sphincter lesions and delayed sphincter repair on sacral neuromodulation treatment outcomes for faecal incontinence: results from a Finnish national cohort study. Int J Colorectal Dis 2018; 33: 1709–1714.

202.

Kneist

Kauff

Juhre

, et al. Is intraoperative neuromonitoring associated with better functional outcome in patients undergoing open TME? Results of a case-control study. Eur J Surg Oncol 2013; 39: 994–999.

203.

Knowles

Horrocks

Bremner

, et al. Percutaneous tibial nerve stimulation versus sham electrical stimulation for the treatment of faecal incontinence in adults (CONFIDeNT): a double-blind, multicentre, pragmatic, parallel-group, randomised controlled trial. Lancet 2015; 386: 1640–1648.

204.

Koch

Melenhorst

Uludağ

, et al. Sacral nerve modulation and other treatments in patients with faecal incontinence after unsuccessful pelvic floor rehabilitation: a prospective study. Colorectal Dis 2010; 12: 334–341.

205.

Koyama

Murata

Sakamoto

, et al. Long-term clinical and functional results of intersphincteric resection for lower rectal cancer. Ann Surg Oncol 2014; 21 (Suppl. 3): S422–S428.

206.

Kuo

L-J

Lin

Y-C

Lai

C-H

, et al. Improvement of fecal incontinence and quality of life by electrical stimulation and biofeedback for patients with low rectal cancer after intersphincteric resection. Arch Phys Med Rehabil 2015; 96: 1442–1447.

207.

Kye

B-H

Kim

H-J

Kim

, et al. The effect of biofeedback therapy on anorectal function after the reversal of temporary stoma when administered during the temporary stoma period in rectal cancer patients with sphincter-saving surgery: the interim report of a prospective randomized controlled trial. Medicine (Baltimore) 2016; 95: e3611.

208.

Laforest

Bretagnol

Mouazan

, et al. Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life? Colorectal Dis 2012; 14: 1231–1237.

209.

Lam

Visscher

Meurs-Szojda

, et al. Clinical response and sustainability of treatment with temperature-controlled radiofrequency energy (Secca) in patients with faecal incontinence: 3 years follow-up. Int J Colorectal Dis 2014; 29: 755–761.

210.

Lamb

Trabinino

Hackford

Patients’ perspectives on fecal incontinence after brachytherapy for localized prostate cancer. Dis Colon Rectum 2011; 54: 615–621.

211.

Lambrescak

Wyart

Meurette

, et al. Sacral nerve stimulation for fecal incontinence: how long should the test phase be? Dis Colon Rectum 2017; 60: 1314–1319.

212.

La Torre

de laPortilla

Long-term efficacy of dextranomer in stabilized hyaluronic acid (NASHA/Dx) for treatment of faecal incontinence. Colorectal Dis 2013; 15: 569–574.

213.

Martínez-Vilalta

Maestre

Royo

, et al. Does correlation exist between anorectal manometry and endoanal ultrasound findings in healthy subjects according to age? Rev Esp Enferm Dig 2011; 103: 304–309.

214.

Lehur

P-A

McNevin

Buntzen

, et al. Magnetic anal sphincter augmentation for the treatment of fecal incontinence: a preliminary report from a feasibility study. Dis Colon Rectum 2010; 53: 1604–1610.

215.

Lenisa

Espìn-Basany

Rusconi

, et al. Anal fistula plug is a valid alternative option for the treatment of complex anal fistula in the long term. Int J Colorectal Dis 2010; 25: 1487–1493.

216.

Leroi

A-M

Lenne

Dervaux

, et al. Outcome and cost analysis of sacral nerve modulation for treating urinary and/or fecal incontinence. Ann Surg 2011; 253: 720–732.

217.

Leroi

Siproudhis

Etienney

, et al. Transcutaneous electrical tibial nerve stimulation in the treatment of fecal incontinence: a randomized trial (CONSORT 1a). Am J Gastroenterol 2012; 107: 1888–1896.

218.

Leroi

Melchior

Charpentier

, et al. The diagnostic value of the functional lumen imaging probe versus high-resolution anorectal manometry in patients with fecal incontinence. Neurogastroenterol Motil 2018; 30: e13291.

219.

Liang

Church

JM.

Lateral internal sphincterotomy for surgically recurrent chronic anal fissure. Am J Surg 2015; 210: 715–719.

220.

Lin

Y-H

Yang

H-Y

Hung

S-L

, et al. Effects of pelvic floor muscle exercise on faecal incontinence in rectal cancer patients after stoma closure. Eur J Cancer Care (Engl) 2016; 25: 449–457.

221.

Lin

K-Y

Denehy

Frawley

, et al. Pelvic floor symptoms, physical, and psychological outcomes of patients following surgery for colorectal cancer. Physiother Theory Pract 2018; 34: 442–452.

222.

Lipschuetz

Cohen

Liebergall-Wischnitzer

, et al. Degree of bother from pelvic floor dysfunction in women one year after first delivery. Eur J Obstet Gynecol Reprod Biol 2015; 191: 90–94.

223.

Luglio

Tarquini

Giglio

, et al. Ventral mesh rectopexy versus conventional suture technique: a single-institutional experience. Aging Clin Exp Res 2017; 29: 79–82.

224.

Lukacz

Segall

Wexner

SD.

Evaluation of an anal insert device for the conservative management of fecal incontinence. Dis Colon Rectum 2015; 58: 892–898.

225.

Madbouly

El Shazly

Abbas

, et al. Ligation of intersphincteric fistula tract versus mucosal advancement flap in patients with high transsphincteric fistula-in-ano: a prospective randomized trial. Dis Colon Rectum 2014; 57: 1202–1208.

226.

Madbouly

Hussein

AM.

Changing operative strategy from abdominoperineal resection to sphincter preservation in T3 low rectal cancer after downstaging by neoadjuvant chemoradiation: a preliminary report. World J Surg 2015; 39: 1248–1256.

227.

Maeda

Vaizey

Hollington

, et al. Physiological, psychological and behavioural characteristics of men and women with faecal incontinence. Colorectal Dis 2009; 11: 927–932.

228.

Magdy

El Nakeeb

Fouda

, et al. Comparative study of conventional lateral internal sphincterotomy, V-Y anoplasty, and tailored lateral internal sphincterotomy with V-Y anoplasty in the treatment of chronic anal fissure. J Gastrointest Surg 2012; 16: 1955–1962.

229.

Manceau

d’Annunzio

Karoui

, et al. Elective subtotal colectomy with ileosigmoid anastomosis for colon cancer preserves bowel function and quality of life. Colorectal Dis 2013; 15: 1078–1085.

230.

Markland

Greer

Vogt

, et al. Factors impacting quality of life in women with fecal incontinence. Dis Colon Rectum 2010; 53: 1148–1154.

231.

Markland

Richter

Burgio

, et al. Weight loss improves fecal incontinence severity in overweight and obese women with urinary incontinence. Int Urogynecol J 2011; 22: 1151–1157.

232.

Markland

Burgio

Beasley

, et al. Psychometric evaluation of an online and paper accidental bowel leakage questionnaire: the ICIQ-B questionnaire. Neurourol Urodyn 2017; 36: 166–170.

233.

Markland

Jelovsek

Rahn

, et al. Irritable bowel syndrome and quality of life in women with fecal incontinence. Female Pelvic Med Reconstr Surg 2017; 23: 179–183.

234.

Masoni

Mari

Nigri

, et al. Preservation of the inferior mesenteric artery via laparoscopic sigmoid colectomy performed for diverticular disease: real benefit or technical challenge: a randomized controlled clinical trial. Surg Endosc 2013; 27: 199–206.

235.

Matsuda

Hotta

Takifuji

, et al. Randomized clinical trial of defaecatory function after anterior resection for rectal cancer with high versus low ligation of the inferior mesenteric artery. Br J Surg 2015; 102: 501–508.

236.

Matsuoka

Masaki

Kobayashi

, et al. Neurophysiologic investigation of anal function following double stapling anastomosis. Dig Surg 2010; 27: 320–323.

237.

McManus

Allison

Hernánchez-Sánchez

Anterior sphincteroplasty for fecal incontinence: predicting incontinence relapse. Int J Colorectal Dis 2015; 30: 513–520.

238.

Mehmood

Parker

Bhuvimanian

, et al. Short-term outcome of laparoscopic versus robotic ventral mesh rectopexy for full-thickness rectal prolapse. Is robotic superior? Int J Colorectal Dis 2014; 29: 1113–1118.

239.

Melchior

Bridoux

Touchais

, et al. MRI defaecography in patients with faecal incontinence. Colorectal Dis 2015; 17: O62–O69.

240.

Mellgren

Wexner

Coller

, et al. Long-term efficacy and safety of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2011; 54: 1065–1075.

241.

Mellgren

Matzel

Pollack

, et al. Long-term efficacy of NASHA Dx injection therapy for treatment of fecal incontinence. Neurogastroenterol Motil 2014; 26: 1087–1094.

242.

Mellgren

Zutshi

Lucente

, et al. A posterior anal sling for fecal incontinence: results of a 152-patient prospective multicenter study. Am J Obstet Gynecol 2016; 214: 349.e1–349.e8.

243.

Meurette

La Torre

Regenet

, et al. Value of sacral nerve stimulation in the treatment of severe faecal incontinence: a comparison to the artificial bowel sphincter. Colorectal Dis 2009; 11: 631–635.

244.

Michelsen

Maeda

Lundby

, et al. Retention test in sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2009; 52: 1864–1868.

245.

Michot

Lefebure

Bridoux

, et al. Artificial anal sphincter for severe fecal incontinence implanted by a transvaginal approach: experience with 32 patients treated at one institution. Dis Colon Rectum 2010; 53: 1155–1160.

246.

Mion F, Garros A, Brochard C, et al. 3D High-definition anorectal manometry: Values obtained in asymptomatic volunteers, fecal incontinence and chronic constipation. Results of a prospective multicenter study (NOMAD). Neurogastroenterol Motil 2017; 29: 10.1111/nmo.13049.

247.

Mistrangelo

Tonello

Brachet Contul

, et al. Perineal stapled prolapse resection for full-thickness external rectal prolapse: a multicentre prospective study. Colorectal Dis 2016; 18: 1094–1100.

248.

Morris

Smith

Draganic

Comparison of bulking agents in the treatment of fecal incontinence: a prospective randomized clinical trial. Tech Coloproctol 2013; 17: 517–523.

249.

Moya

Arroyo

Lacueva

, et al. Sacral nerve stimulation in the treatment of severe faecal incontinence: long-term clinical, manometric and quality of life results. Tech Coloproctol 2014; 18: 179–185.

250.

Moya

Parra

Arroyo

, et al. Sacral nerve stimulation versus percutaneous posterior tibial nerve stimulation in the treatment of severe fecal incontinence in men. Tech Coloproctol 2016; 20: 317–319.

251.

Murad-Regadas

da S Fernandes

Regadas

FSP

, et al. How much of the internal sphincter may be divided during lateral sphincterotomy for chronic anal fissure in women? Morphologic and functional evaluation after sphincterotomy. Dis Colon Rectum 2013; 56: 645–651.

252.

Murad-Regadas

da S Fernandes

Regadas

FSP

, et al. Assessment of pubovisceral muscle defects and levator hiatal dimensions in women with faecal incontinence after vaginal delivery: is there a correlation with severity of symptoms? Colorectal Dis 2014; 16: 1010–1018.

253.

Murad-Regadas

Regadas

FSP

Regadas Filho

FSP

, et al. Predictors of unsuccessful of treatment for fecal incontinence biofeedback for fecal incontinence in female. Arq Gastroenterol 2019; 56: 61–65.

254.

Cheung

RYK

Lee

, et al. An observational follow-up study on pelvic floor disorders to 3–5 years after delivery. Int Urogynecol J 2017; 28: 1393–1399.

255.

Richter

Dunivan

Brown

, et al. A 12-Month clinical durability of effectiveness and safety evaluation of a vaginal bowel control system for the nonsurgical treatment of fecal incontinence. Female Pelvic Med Reconstr Surg 2019; 25: 113–119.

256.

Nishigori

Ishii

Kokado

, et al. Effectiveness of pelvic floor rehabilitation for bowel dysfunction after intersphincteric resection for lower rectal cancer. World J Surg 2018; 42: 3415–3421.

257.

Noelting

Zinsmeister

Bharucha

AE.

Validating endpoints for therapeutic trials in fecal incontinence. Neurogastroenterol Motil 2016; 28: 1148–1156.

258.

Nordenstam

Altman

Mellgren

, et al. Impaired rectal sensation at anal manometry is associated with anal incontinence one year after primary sphincter repair in primiparous women. Dis Colon Rectum 2010; 53: 1409–1414.

259.

Norderval

Behrenbruch

Brouwer

, et al. Efficacy of cyclic sacral nerve stimulation for faecal incontinence. Tech Coloproctol 2013; 17: 511–516.

260.

Oakley

Ghodsi

Crisp

, et al. Impact of pelvic floor physical therapy on quality of life and function after obstetric anal sphincter injury: a randomized controlled trial. Female Pelvic Med Reconstr Surg 2016; 22: 205–213.

261.

Oliveira

LCC

Neves Jorge

Yussuf

, et al. Anal incontinence improvement after silicone injection may be related to restoration of sphincter asymmetry. Surg Innov 2009; 16: 155–161.

262.

Oom

DMJ

Steensma

Zimmerman

DDE

, et al. Anterior sphincteroplasty for fecal incontinence: is the outcome compromised in patients with associated pelvic floor injury? Dis Colon Rectum 2010; 53: 150–155.

263.

Oom

DMJ

West

Schouten

, et al. Detection of anal sphincter defects in female patients with fecal incontinence: a comparison of 3-dimensional transperineal ultrasound and 2-dimensional endoanal ultrasound. Dis Colon Rectum 2012; 55: 646–652.

264.

Otto

Clewing

Gröne

, et al. Repeatability of anorectal manometry in healthy volunteers and patients. J Surg Res 2013; 185: e85–e92.

265.

Richard

Hudson

Gyger

, et al. Clinical correlates of faecal incontinence in systemic sclerosis: identifying therapeutic avenues. Rheumatology (Oxford) 2017; 56: 581–588.

266.

Paka

Kamisan Atan

Rios

, et al. Relationship of anatomy and function: external anal sphincter on transperineal ultrasound and anal incontinence. Female Pelvic Med Reconstr Surg 2017; 23: 238–243.

267.

Parc

Zutshi

Zalinski

, et al. Preoperative radiotherapy is associated with worse functional results after coloanal anastomosis for rectal cancer. Dis Colon Rectum 2009; 52: 2004–2014.

268.

Patton

Wiklendt

Arkwright

, et al. The effect of sacral nerve stimulation on distal colonic motility in patients with faecal incontinence. Br J Surg 2013; 100: 959–968.

269.

Patton

Abraham

Lubowski

DZ.

Sacral nerve stimulation for faecal incontinence: medium-term follow-up from a single institution. ANZ J Surg 2017; 87: 462–466.

270.

Peirce

Murphy

Fitzpatrick

, et al. Randomised controlled trial comparing early home biofeedback physiotherapy with pelvic floor exercises for the treatment of third-degree tears (EBAPT Trial). Br J Obstet Gynaecol 2013; 120: 1240–1247; discussion 1246.

271.

Perrenot

Germain

Scherrer

M-L

, et al. Long-term outcomes of robot-assisted laparoscopic rectopexy for rectal prolapse. Dis Colon Rectum 2013; 56: 909–914.

272.

Pinedo

García

Zárate

, et al. Are topical oestrogens useful in faecal incontinence? Double-blind randomized trial. Colorectal Dis 2009; 11: 390–393.

273.

Pinedo

Zarate

Inostroza

, et al. New treatment for faecal incontinence using zinc-aluminium ointment: a double-blind randomized trial. Colorectal Dis 2012; 14: 596–598.

274.

Prichard

Lee

Parthasarathy

, et al. High-resolution anorectal manometry for identifying defecatory disorders and rectal structural abnormalities in women. Clin Gastroenterol Hepatol 2017; 15: 412–420.

275.

Pucciarelli

Del Bianco

Efficace

, et al. Patient-reported outcomes after neoadjuvant chemoradiotherapy for rectal cancer: a multicenter prospective observational study. Ann Surg 2011; 253: 71–77.

276.

Ramage

Yen

Qiu

, et al. Functional and quality of life outcomes following obstetric anal sphincter injury (OASI): does the grade of injury affect outcomes? Int Urogynecol J 2017; 28: 1709–1717.

277.

Rao

SSC

Coss-Adame

Tantiphlachiva

, et al. Translumbar and transsacral magnetic neurostimulation for the assessment of neuropathy in fecal incontinence. Dis Colon Rectum 2014; 57: 645–652.

278.

Ratto

Litta

Parello

, et al. Sacral nerve stimulation is a valid approach in fecal incontinence due to sphincter lesions when compared to sphincter repair. Dis Colon Rectum 2010; 53: 264–272.

279.

Ratto

Buntzen

Aigner

, et al. Multicentre observational study of the Gatekeeper for faecal incontinence. Br J Surg 2016; 103: 290–299.

280.

Reddymasu

Singh

Waheed

, et al. Comparison of anorectal manometry to endoanal ultrasound in the evaluation of fecal incontinence. Am J Med Sci 2009; 337: 336–339.

281.

Rezaie

Iriana

Pimentel

, et al. Can three-dimensional high-resolution anorectal manometry detect anal sphincter defects in patients with faecal incontinence? Colorectal Dis 2017; 19: 468–475.

282.

Ribaric

D’Hoore

Schiffhorst

, et al. STARR with CONTOUR® TRANSTAR™ device for obstructed defecation syndrome: one-year real-world outcomes of the European TRANSTAR registry. Int J Colorectal Dis 2014; 29: 611–622.

283.

Richter

Matthews

Muir

, et al. A vaginal bowel-control system for the treatment of fecal incontinence. Obstet Gynecol 2015; 125: 540–547.

284.

Rimmer

Knowles

Lamparelli

, et al. Short-term outcomes of a randomized pilot trial of 2 treatment regimens of transcutaneous tibial nerve stimulation for fecal incontinence. Dis Colon Rectum 2015; 58: 974–982.

285.

Robert-Yap

Zufferey

Rosen

, et al. Sacral nerve modulation in the treatment of fecal incontinence following repair of rectal prolapse. Dis Colon Rectum 2010; 53: 428–431.

286.

Rodrigues

Chadi

Cracco

, et al. Faecal incontinence in patients with a sphincter defect: comparison of sphincteroplasty and sacral nerve stimulation. Colorectal Dis 2017; 19: 456–461.

287.

Rogers

Leeman

Borders

, et al. Contribution of the second stage of labour to pelvic floor dysfunction: a prospective cohort comparison of nulliparous women. Br J Obstet Gynaecol 2014; 121: 1145–1153; discussion 1154.

288.

Roman

Vassilieff

Tuech

, et al. Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum. Fertil Steril 2013; 99: 1695–1704.

289.

Roman

Milles

Vassilieff

, et al. Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis. Am J Obstet Gynecol 2016; 215: 762.e1–762.e9.

290.

Roos

A-M

Abdool

Thakar

, et al. Predicting anal sphincter defects: the value of clinical examination and manometry. Int Urogynecol J 2012; 23: 755–763.

291.

Ros

Martínez-Franco

Wozniak

, et al. Postpartum two- and three-dimensional ultrasound evaluation of anal sphincter complex in women with obstetric anal sphincter injury. Ultrasound Obstet Gynecol 2017; 49: 508–514.

292.

Rosato

Piccinini

Oliveira

, et al. Initial results of a new bulking agent for fecal incontinence: a multicenter study. Dis Colon Rectum 2015; 58: 241–246.

293.

Rosenblatt

Schumacher

Lucente

, et al. A preliminary evaluation of the TOPAS system for the treatment of fecal incontinence in women. Female Pelvic Med Reconstr Surg 2014; 20: 155–162.

294.

Roy

A-L

Gourcerol

Menard

J-F

, et al. Predictive factors for successful sacral nerve stimulation in the treatment of fecal incontinence: lessons from a comprehensive treatment assessment. Dis Colon Rectum 2014; 57: 772–780.

295.

Ruiz

Pinto

Hull

, et al. Does the radiofrequency procedure for fecal incontinence improve quality of life and incontinence at 1-year follow-up? Dis Colon Rectum 2010; 53: 1041–1046.

296.

Rybakov

Pikunov

Fomenko

, et al. Side-to-end vs. straight stapled colorectal anastomosis after low anterior resection: results of randomized clinical trial. Int J Colorectal Dis 2016; 31: 1419–1426.

297.

Rydningen

Dehli

Wilsgaard

, et al. Sacral neuromodulation compared with injection of bulking agents for faecal incontinence following obstetric anal sphincter injury – a randomized controlled trial. Colorectal Dis 2017; 19: O134–O144.

298.

Rygh

Körner

The overlap technique versus end-to-end approximation technique for primary repair of obstetric anal sphincter rupture: a randomized controlled study. Acta Obstet Gynecol Scand 2010; 89: 1256–1262.

299.

Ryu

Akagi

Yagi

, et al. Fecoflowmetric analysis of anorectal motor function in postoperative anal-preserving surgery patients with low rectal cancer comparison with the wexner score and anorectal manometry. Int Surg 2015; 100: 29–37.

300.

Sansoni

Hawthorne

Fleming

, et al. The revised faecal incontinence scale: a clinical validation of a new, short measure for assessment and outcomes evaluation. Dis Colon Rectum 2013; 56: 652–659.

301.

Sauter

Heinrich

Fox

, et al. Toward more accurate measurements of anorectal motor and sensory function in routine clinical practice: validation of high-resolution anorectal manometry and Rapid Barostat Bag measurements of rectal function. Neurogastroenterol Motil 2014; 26: 685–695.

302.

Schiano di Visconte

Santoro

Cracco

, et al. Effectiveness of sacral nerve stimulation in fecal incontinence after multimodal oncologic treatment for pelvic malignancies: a multicenter study with 2-year follow-up. Tech Coloproctol 2018; 22: 97–105.

303.

Schwandner

König

Heimerl

, et al. Triple target treatment (3T) is more effective than biofeedback alone for anal incontinence: the 3T-AI study. Dis Colon Rectum 2010; 53: 1007–1016.

304.

Schwandner

Hemmelmann

Heimerl

, et al. Triple-target treatment versus low-frequency electrostimulation for anal incontinence: a randomized, controlled trial. Dtsch Arztebl Int 2011; 108: 653–660.

305.

Schwandner

Sacral neuromodulation for fecal incontinence and “low anterior resection syndrome” following neoadjuvant therapy for rectal cancer. Int J Colorectal Dis 2013; 28: 665–669.

306.

Schwandner

Schrinner

Rectal mucosal prolapse in males: surgery is effective for fecal incontinence but not for obstructed defecation. Tech Coloproctol 2014; 18: 907–914.

307.

Senapati

Gray

Middleton

, et al. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis 2013; 15: 858–868.

308.

Sileri

Franceschilli

de Luca

, et al. Laparoscopic ventral rectopexy for internal rectal prolapse using biological mesh: postoperative and short-term functional results. J Gastrointest Surg 2012; 16: 622–628.

309.

Siproudhis

Graf

Emmanuel

, et al. Libertas: a phase II placebo-controlled study of NRL001 in patients with faecal incontinence showed an unexpected and sustained placebo response. Int J Colorectal Dis 2016; 31: 1205–1216.

310.

Soerensen

Lundby

Buntzen

, et al. Intersphincteric injected silicone biomaterial implants: a treatment for faecal incontinence. Colorectal Dis 2009; 11: 73–76.

311.

Soerensen

Buntzen

Bek

, et al. Complete obstetric anal sphincter tear and risk of long-term fecal incontinence: a cohort study. Dis Colon Rectum 2013; 56: 992–1001.

312.

Stafne

Salvesen

KÅ

Romundstad

, et al. Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy? A randomised controlled trial. Br J Obstet Gynaecol 2012; 119: 1270–1280.

313.

Stedenfeldt

Pirhonen

Blix

, et al. Anal incontinence, urinary incontinence and sexual problems in primiparous women – a comparison between women with episiotomy only and women with episiotomy and obstetric anal sphincter injury. BMC Womens Health 2014; 14: 157.

314.

Stephens

Rieger

Farmer

, et al. Implantation of ethylene vinyl alcohol copolymer for faecal incontinence management. ANZ J Surg 2010; 80: 324–330.

315.

Sturkenboom

Wilt

AA van der

Kuijk SMJ van , et al. Long-term outcomes of a Malone antegrade continence enema (MACE) for the treatment of fecal incontinence or constipation in adults. Int J Colorectal Dis 2018; 33: 1341–1348.

316.

Sunesen

Nørgaard

Lundby

, et al. Long-term anorectal, urinary and sexual dysfunction causing distress after radiotherapy for anal cancer: a Danish multicentre cross-sectional questionnaire study. Colorectal Dis 2015; 17: O230–O239.

317.

Sze

EHM

Hobbs

Efficacy of methylcellulose and loperamide in managing fecal incontinence. Acta Obstet Gynecol Scand 2009; 88: 766–771.

318.

Sze

EHM

Barker

Hobbs

A cross-sectional survey of the relationship between fecal incontinence and constipation. Int Urogynecol J 2013; 24: 61–65.

319.

Dedemadi

Takano

Efficacy of bilateral transcutaneous posterior tibial nerve stimulation for fecal incontinence. Perm J 2018; 22: 17–231.

320.

Tate

Forchheimer

Rodriguez

, et al. Risk factors associated with neurogenic bowel complications and dysfunction in spinal cord injury. Arch Phys Med Rehabil 2016; 97: 1679–1686.

321.

Thin

Taylor

SJC

Bremner

, et al. Randomized clinical trial of sacral versus percutaneous tibial nerve stimulation in patients with faecal incontinence. Br J Surg 2015; 102: 349–358.

322.

Thomas

Dudding

Bradshaw

, et al. A pilot study to compare daily with twice weekly transcutaneous posterior tibial nerve stimulation for faecal incontinence. Colorectal Dis 2013; 15: 1504–1509.

323.

Thomas

Duelund-Jakobsen

Dudding

, et al. A double-blinded randomized multicentre study to investigate the effect of changes in stimulation parameters on sacral nerve stimulation for constipation. Colorectal Dis 2015; 17: 990–995.

324.

Tjandra

Chan

MKY

Yeh

HCH.

Injectable silicone biomaterial (PTQ) is more effective than carbon-coated beads (Durasphere) in treating passive faecal incontinence–a randomized trial. Colorectal Dis 2009; 11: 382–389.

325.

Torrisi

Minini

Bernasconi

, et al. A prospective study of pelvic floor dysfunctions related to delivery. Eur J Obstet Gynecol Reprod Biol 2012; 160: 110–115.

326.

Townsend

Carrington

Grossi

, et al. Pathophysiology of fecal incontinence differs between men and women: a case-matched study in 200 patients. Neurogastroenterol Motil 2016; 28: 1580–1588.

327.

Trenti

Biondo

Noguerales

, et al. Outcomes of Gatekeeper™ prosthesis implantation for the treatment of fecal incontinence: a multicenter observational study. Tech Coloproctol 2017; 21: 963–970.

328.

Tsunoda

Kamiyama

Narita

, et al. Prospective randomized trial for determination of optimum size of side limb in low anterior resection with side-to-end anastomosis for rectal carcinoma. Dis Colon Rectum 2009; 52: 1572–1577.

329.

Tsunoda

Sada

Sugimoto

, et al. Anal function after ligation of the intersphincteric fistula tract. Dis Colon Rectum 2013; 56: 898–902.

330.

Tuech

J-J

Karoui

Lelong

, et al. A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg 2015; 261: 228–233.

331.

Delft

K van

Sultan

Thakar

, et al. The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction. Br J Obstet Gynaecol 2014; 121: 1164–1171; discussion 1172.

332.

van der Hagen

Soeters

Baeten

, et al. Conservative treatment of patients with faecal soiling. Tech Coloproctol 2011; 15: 291–295.

333.

van der Hagen

van der Meer

Soeters

, et al. A prospective non-randomized two-centre study of patients with passive faecal incontinence after birth trauma and patients with soiling after anal surgery, treated by elastomer implants versus rectal irrigation. Int J Colorectal Dis 2012; 27: 1191–1198.

334.

van der Wilt

Giuliani

Kubis

, et al. Randomized clinical trial of percutaneous tibial nerve stimulation versus sham electrical stimulation in patients with faecal incontinence. Br J Surg 2017; 104: 1167–1176.

335.

van Iersel

de Witte

Verheijen

, et al. Robot-assisted sacrocolporectopexy for multicompartment prolapse of the pelvic floor: a prospective cohort study evaluating functional and sexual outcome. Dis Colon Rectum 2016; 59: 968–974.

336.

van Koperen

, Bemelman

Gerhards

, et al. The anal fistula plug treatment compared with the mucosal advancement flap for cryptoglandular high transsphincteric perianal fistula: a double-blinded multicenter randomized trial. Dis Colon Rectum 2011; 54: 387–393.

337.

van Meegdenburg

, Heineman

Broens

PMA.

Pudendal neuropathy alone results in urge incontinence rather than in complete fecal incontinence. Dis Colon Rectum 2015; 58: 1186–1193.

338.

Visscher

Lam

Meurs-Szojda

, et al. Temperature-controlled delivery of radiofrequency energy in fecal incontinence: a randomized sham-controlled clinical trial. Dis Colon Rectum 2017; 60: 860–865.

339.

Vitton

Ben Hadj Amor

Baumstarck

, et al. Water-perfused manometry vs three-dimensional high-resolution manometry: a comparative study on a large patient population with anorectal disorders. Colorectal Dis 2013; 15: e726–e731.

340.

Wahed

Ahmad

Mohiuddin

, et al. Short-term results for laparoscopic ventral rectopexy using biological mesh for pelvic organ prolapse. Colorectal Dis 2012; 14: 1242–1247.

341.

Wei

Cai

Yang

, et al. A prospective comparison of short term results and functional recovery after laparoscopic subtotal colectomy and antiperistaltic cecorectal anastomosis with short colonic reservoir vs. long colonic reservoir. BMC Gastroenterol 2015; 15: 30.

342.

Whitcomb

Horgan

Donohue

, et al. Impact of surgically induced weight loss on pelvic floor disorders. Int Urogynecol J 2012; 23: 1111–1116.

343.

Whitebird

Bliss

Savik

, et al. Comparing community and specialty provider-based recruitment in a randomized clinical trial: clinical trial in fecal incontinence. Res Nurs Health 2010; 33: 500–511.

344.

Wijffels

WAT

Jones

Cunningham

, et al. What are the symptoms of internal rectal prolapse? Colorectal Dis 2013; 15: 368–373.

345.

Wilson

Swarup

Wilson

, et al. The effect of nonoperative management of chronic anal fissure and hemorrhoid disease on bowel function patient-reported outcomes. Dis Colon Rectum 2018; 61: 1223–1227.

346.

Savoye-Collet

Savoye

Koning

, et al. Gender influence on defecographic abnormalities in patients with posterior pelvic floor disorders. World J Gastroenterol 2010; 16: 462–466.

347.

Muñoz-Yagüe

Solís-Muñoz

Ciriza de los Ríos

, et al. Fecal incontinence in men: causes and clinical and manometric features. World J Gastroenterol 2014; 20: 7933–7940.

348.

Awad

Camacho

Flores

, et al. Rectal tone and compliance affected in patients with fecal incontinence after fistulotomy. World J Gastroenterol 2015; 21: 4000–4005.

349.

Wong

MTC

Meurette

Stangherlin

, et al. The magnetic anal sphincter versus the artificial bowel sphincter: a comparison of 2 treatments for fecal incontinence. Dis Colon Rectum 2011; 54: 773–779.

350.

Wong

MTC

Meurette

Wyart

, et al. Does the magnetic anal sphincter device compare favourably with sacral nerve stimulation in the management of faecal incontinence? Colorectal Dis 2012; 14: e323–e329.

351.

Yeoh

Holloway

Fraser

, et al. Anorectal function after three- versus two-dimensional radiation therapy for carcinoma of the prostate. Int J Radiat Oncol Biol Phys 2009; 73: 46–52.

352.

Young

Zahid

Koh

, et al. A randomized controlled trial of four different regimes of biofeedback programme in the treatment of faecal incontinence. Colorectal Dis 2018; 20: 312–320.

353.

Youssef

Thabet

, et al. Randomized clinical trial of transcutaneous electrical posterior tibial nerve stimulation versus lateral internal sphincterotomy for treatment of chronic anal fissure. Int J Surg 2015; 22: 143–148.

354.

Youssef

Emile

Thabet

, et al. Comparative study between trans-perineal repair with or without limited internal sphincterotomy in the treatment of type I anterior rectocele: a randomized controlled trial. J Gastrointest Surg 2017; 21: 380–388.

355.

Zutshi

Salcedo

Hammel

, et al. Anal physiology testing in fecal incontinence: is it of any value? Int J Colorectal Dis 2010; 25: 277–282.

356.

Litta F, Scaldaferri F, Parello A, et al. Anorectal function and quality of life in IBD patients with a perianal complaint. J Invest Surg 2019; 1--6. doi:10.1080/08941939.2019.1658830

357.

Brochard

Siproudhis

Ropert

, et al. Anorectal dysfunction in patients with ulcerative colitis: impaired adaptation or enhanced perception? Neurogastroenterol Motil 2015; 27: 1032–1037.

358.

Dibley

Norton

Cotterill

, et al. Development and initial validation of a disease-specific bowel continence questionnaire for inflammatory bowel disease patients: the ICIQ-IBD. Eur J Gastroenterol Hepatol 2016; 28: 233–239.

359.

Dibley

Norton

Experiences of fecal incontinence in people with inflammatory bowel disease: self-reported experiences among a community sample. Inflamm Bowel Dis 2013; 19: 1450–1462.

360.

Khanna

Schroeder

, et al. Manometric evaluation of evacuatory difficulty (dyschezia) in ileal pouch patients. Inflamm Bowel Dis 2013; 19: 569–575.

361.

Kozeluhova

Kotyza

Balihar

, et al. Risk of anal incontinence in women with inflammatory bowel diseases after delivery. Bratisl Lek Listy 2017; 118: 328–333.

362.

Lam

van Bodegraven

Felt-Bersma

RJF.

Anorectal complications and function in patients suffering from inflammatory bowel disease: a series of patients with long-term follow-up. Int J Colorectal Dis 2014; 29: 923–929.

363.

Papathanasopoulos

Katsanos

Tatsioni

, et al. Increased fatigability of external anal sphincter in inflammatory bowel disease: significance in fecal urgency and incontinence. J Crohns Colitis 2010; 4: 553–560.

364.

Papathanasopoulos

Van Oudenhove

Katsanos

, et al. Severity of fecal urgency and incontinence in inflammatory bowel disease: clinical, manometric and sonographic predictors. Inflamm Bowel Dis 2013; 19: 2450–2456.

365.

Perera

Ananthakrishnan

Guilday

, et al. Dyssynergic defecation: a treatable cause of persistent symptoms when inflammatory bowel disease is in remission. Dig Dis Sci 2013; 58: 3600–3605.

366.

Quinn

Tse

Lightner

, et al. Nonrelaxing pelvic floor dysfunction is an underestimated complication of ileal pouch–anal anastomosis. Clin Gastroenterol Hepatol 2017; 15: 1242–1247.

367.

Raffals

Bharucha

Timmons

, et al. Mo1236 Ileal pouch anal anastomosis and non-relaxing pelvic floor dysfunction. Gastroenterology 2014; 146: S594.

368.

Tremaine

Raffals

Bharucha

, et al. 561 Inflammatory bowel disease and non-relaxing pelvic floor dysfunction. Gastroenterology 2013; 144: S104.

369.

Vollebregt

Visscher

van Bodegraven

, et al. Validation of risk factors for fecal incontinence in patients with Crohn’s disease. Dis Colon Rectum 2017; 60: 845–851.

370.

Subasinghe

Navarathna

NMM

Samarasekera

DN.

Faecal incontinence and health related quality of life in inflammatory bowel disease patients: findings from a tertiary care center in South Asia. World J Gastrointest Pharmacol Ther 2016; 7: 447–452.

371.

Andersson

Lunde

Johnson

, et al. Long-term functional outcome and quality of life after restorative proctocolectomy with ileo-anal anastomosis for colitis. Colorectal Dis 2011; 13: 431–437.

372.

Chung

Sun

, et al. Outcomes of anal fistula surgery in patients with inflammatory bowel disease. Am J Surg 2010; 199: 609–613.

373.

Cornish

Wooding

Tan

, et al. Study of sexual, urinary, and fecal function in females following restorative proctocolectomy. Inflamm Bowel Dis 2012; 18: 1601–1607.

374.

Kariv

Remzi

Strong

, et al. Ileal pouch rectal anastomosis: a viable alternative to permanent ileostomy in Crohn’s proctocolitis patients. J Am Coll Surg 2009; 208: 390–399.

375.

Kuruvilla

Osler

Hyman

NH.

A comparison of the quality of life of ulcerative colitis patients after IPAA vs ileostomy. Dis Colon Rectum 2012; 55: 1131–1137.

376.

Vitton

Damon

Roman

, et al. Transcutaneous posterior tibial nerve stimulation for fecal incontinence in inflammatory bowel disease patients: a therapeutic option? Inflamm Bowel Dis 2009; 15: 402–405.

377.

Kuenzig

Kaplan

, et al. Fecal Incontinence in inflammatory bowel disease: a systematic review and meta-analysis. Inflamm Bowel Dis 2018; 24: 1280–1290.

378.

Cotterill

Madersbacher

Wyndaele

, et al. Neurogenic bowel dysfunction: clinical management recommendations of the Neurologic Incontinence Committee of the Fifth International Consultation on Incontinence 2013. Neurourol Urodyn 2018; 37: 46–53.

379.

National Collaborating Centre for Acute Care (Great Britain). Faecal incontinence: the management of faecal incontinence in adults. London, UK: National Collaborating Centre for Acute Care (UK), 2007.

380.

Saunders

Darakhshan

Eccersley

AJP

, et al. The Colorectal Development Unit: impact on functional outcome for the electrically stimulated gracilis neoanal sphincter. Colorectal Dis 2006; 8: 46–55.

381.

Van Koughnett

Boutros

Wexner

SD.

Signs and symptoms in coloproctology: data collection and scores. In: Ratto

Parrello

Dionisi

, et al. (eds) Coloproctology: Colon, Rectum and Anus: Anatomic, Physiologic and Diagnostic Bases for Disease Management. Cham: Springer International Publishing; 2014: pp. 1–28. https://doi.org/10.1007/978-3-319-10154-5_15-1 (accessed 5 July 2020).

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