A new fecal incontinence scoring on the horizon: Garg Incontinence Scores (GIS)

Fecal incontinence (FI) is fairly common; as per estimates, it affects up to 13-15% of the population (1-6). The common causes of FI are perianal tears after obstetric injuries, post-anal surgery, especially after anal fistula surgery, post-radiotherapy, etc. Understandably, FI causes immense physical, mental, and emotional turmoil in the sufferer’s life. To date, neither the evaluation nor the management of FI is satisfactory, and a lot needs to be done in this field.

Understandably, the clinical evaluation of FI is the first step in the management. Since FI can have several types like solid stool FI, liquid, flatus FI, etc., it becomes important to clinically assess it as objectively as possible. To achieve this purpose, several scoring systems have been developed and utilized for the last three decades (7-9). The first scoring system to become popular was the Cleveland Clinic or Wexner scoring system (7). It was published by Jorge and Wexner in 1993 (tab. 1). The next scoring was published by Vaizey et al. in 1999 and was popularized as St. Marks Hospital or Vaizey’s (8) scores (tab. 2). Though more scoring methods were published, the significant one was published in 1999 by Rockwood et al. and was known as Fecal Incontinence Severity Index (FISI) (tab. 3) (9). Recently, a new scoring system to assess FI has been published by Garg et al. (tab. 4) (10).