Fecal Incontinence and Constipation Questionnaire

Original Editor - Ajay Upadhyay

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Background[edit | edit source]

Fecal incontinence (FI) is defined as the involuntary loss of solid or liquid feces or mucus[1]. Fecal constipation (FC) is a decreased frequency of bowel actions (<1 every 3 days) that also may be associated with excessive straining during the passage of stool.[2] Fecal incontinence and functional constipation are relatively common symptoms in the community, particularly in the elderly[3] affecting approximately 2.2–11.3% and 15% of the population respectively.[4][5]. Moreover, the prevalence of both FI and FC increases with age[6][7][8][9][10][11] and is more frequent in women than men.[11] Several scales measure the severity of fecal incontinence, but the best measure is unknown. Furthermore, there is an increasing demand for patient-reported outcome measures during routine clinical practice to assist with planning patient outcomes.[11][12][13]

Objective[edit | edit source]

The Fecal Incontinence and constipation questionnaire (FICQ), developed by Focus on Therapeutic Outcomes Inc. in conjunction with a physical therapist, aims to evaluate how bowel dysfunction affects patient-perceived functional status related to pelvic floor dysfunction.[11]

Intended Population[edit | edit source]

Patients above 18 years with Pelvic-floor dysfunction.

Method of Use[edit | edit source]

The FICQ is a self-report questionnaire that consists of 20 items: 15 items related to bowel leakage problems and 5 items related to constipation problems.[11] Each item on the questionnaire has its own Likert scale and definition.[11]

Question Items[edit | edit source]

The bowel leakage items include:[11]

  • Frequency of bowel leakage while awake and while asleep (FI-OFTENWAKE, FI-OFTENSLEEP)
  • The extent bowel leakage affects the individual while awake and while asleep (FI- PROBLEMWAKE, FI-PROBLEMSLEEP)
  • Frequency of bowel leakage after defecation and before getting access to a toilet (FI- FINISH,FI-TOILET)
  • Frequency of bowel leakage during physical activity and with what intensity of physical activity leakage occurs (El-ACTIVE, Fl-ACTIVITY )
  • The protection gamier used and the amount of protection used throughout the day (FI-TYPEPROTC, FI-NUMPROTECT)
  • Overall impact of bowel leakage on life, sex, and confidence (Fl-LIFE, Fl-SEX, Fl-CONFIDENCE)
  • Voluntary control over bowel leakage and ability to delay defecation (FI-CONTROL,FI-DELAY)

The constipation items include:[11]

  • Frequency of bowel movements (FC-OFTEN)
  • Frequency of use of enemas and laxatives per month (FC-ENEMAS, EC- LAXATIVE)
  • The level of strain during a bowel movement and whether manual assistance is required (FC- STRAIN, FC-MANUAL)

Scoring System[edit | edit source]

As mentioned above, the FICQ asks patients to subjectively rate their symptoms with a Likert scale.[11] A Likert Scale allows individuals to express how much they agree or disagree with a statement. A example of how the scale is used in this questionnaire is written below:

Item #19 of the FICQ: "Do you have strain to have a bowel movement?"[11]

  1. Rarely or never
  2. Occasionally
  3. Sometimes
  4. Always

Evidence[edit | edit source]

Research regarding the psychometric properties of the FICQ is limited. A study by Wang and colleagues (2014)[11] conducted a preliminary analysis of the psychometric properties of the FICQ in patients seeking outpatient rehabilitation services due to pelvic floor dysfunction.[11] The following psychometric properties were assessed:[11]

  1. Unidimensionality: The scale or questionnaire represents only one construct.[11][14]
  2. Local Independence: The items in a scale are independent of each other.[14] An individual’s response to one item should not be correlated with the response of another item.[14]This quality can be measured via residual correlations, whereby a residual correlation of greater than 0.10 suggests local dependency.[11]
  3. Differential Item Functioning (DIF): All individuals should have an equal probability of scoring positively on each item regardless of patient groupings (i.e. age).[15]Items are marked as “significant DIF” when this requirement is not met.[11]
  4. Item Hierarchical Structure: This assesses the difficulty of each item in the questionnaire in a hierarchical order.[11] It helps to measure the construct validity of the questionnaire, which indicates how well a questionnaire measures what it is supposed to.[11]
  5. Precision Testing: Precision testing provides the reliability or the degree of consistency of a measure.[11] Test information function, which is the amount of information provided by the item responses on a questionnaire about the construct being measured (i.e. bowel function), and standard error can be used to estimate precision testing.[11][16]

Wang and colleagues (2014)[11] reported unidimensionality in the questionnaire. However, the researchers suggested that refinement of the items is needed to further improve unidimensionality.[11] In regards to local independence, only 5 items on the questionnaire were free of local dependency.[11] No differential item functioning was observed when grouped by sex, age group, acuity, and the number of pelvic floor co-morbid conditions, except for 2 items assessing functional incontinence.[11] When assessing the individual’s ability level to complete the questionnaire, the FI and FC items were at the individual’s overall ability level.[11] No ceiling effect or floor effects were observed while using the FICQ.[11] As well, the FICQ produced reliable and precise measurements of functional status related to bowel function.[11] Overall, Wang and colleagues (2014)[11] supported the use of the FICQ in an outpatient rehabilitation setting, yet, stated that test developers should aim to improve the quality of existing FICQ items, especially for the fecal constipation dimension.[11] Furthermore, they suggested that more fecal constipation items should be added to increase content coverage.[11] Further research is still required to validate this questionnaire.[11]

Resources[edit | edit source]

A copy of the FICQ questionnaire can be found in the appendix section of the following resource: Wang YC, Deutscher D, Yen SC, Werneke MW, Mioduski JE. The self-report fecal incontinence and constipation questionnaire in patients with pelvic-floor dysfunction seeking outpatient rehabilitation. Physical therapy. 2014 Feb 1;94(2):273-88.

References[edit | edit source]

  1. Markland AD, Goode PS, Burgio KL, et al. Incidence and risk factors for fecal incontinence in black and white older adults: a population-based study. J Am Geriatr Soc.2010;58:1341–1346.
  2. Brady CM. Constipation and fecal incontinence. In: Munsat TL, ed. Neurologic Bladder, Bowel and Sexual Dysfunction.Vol 1. Oxfordshire, United Kingdom: Elsevier Science Ltd; 2001:27–37.
  3. Bharucha A. Fecal Incontinence Gastroenterology 2003; 124: 1672–85.
  4. Drossman DA, Li Z, Andruzzi E, et al.US householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993; 38: 1569–80.
  5. Nelson R, Norton N, Cautley E, Furner S. Community‐based prevalence of anal incontinence. JAMA 1995; 274: 559–61.
  6. Perry S, Shaw C, McGrother C, Matthews RJ, Assassa RP, Dallosso H, Williams K, Brittain KR, Azam U, Clarke M, Jagger C. Prevalence of faecal incontinence in adults aged 40 years or more living in the community. Gut. 2002 Apr 1;50(4):480-4.
  7. Bharucha AE, Zinsmeister AR, Locke GR, Seide BM, McKeon K, Schleck CD, Melton III LJ. Prevalence and burden of fecal incontinence: a population-based study in women. Gastroenterology. 2005 Jul 1;129(1):42-9.
  8. Botlero R, Bell RJ, Urquhart DM, Davis SR. Prevalence of fecal incontinence and its relationship with urinary incontinence in women living in the community. Menopause. 2011 Jun 1;18(6):685-9.
  9. Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol. 2011;25:3–18.
  10. Harari D, Gurwitz JH, Avorn J, et al. Bowel habit in relation to age and gender: find- ings from the National Health Interview Survey and clinical implications. Arch Intern Med. 1996;156:315–320.
  11. 11.00 11.01 11.02 11.03 11.04 11.05 11.06 11.07 11.08 11.09 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 Wang YC, Deutscher D, Yen SC, Werneke MW, Mioduski JE. The self-report fecal incontinence and constipation questionnaire in patients with pelvic-floor dysfunction seeking outpatient rehabilitation. Physical therapy. 2014 Feb 1;94(2):273-88.
  12. Abrams P, Avery K, Gardener N, Donovan J, ICIQ Advisory Board. The international consultation on incontinence modular questionnaire: www. iciq. net. The Journal of urology. 2006 Mar;175(3):1063-6.
  13. Coyne K, Kelleher C. Patient reported outcomes: the ICIQ and the state of the art. Neurourology and Urodynamics: Official Journal of the International Continence Society. 2010 Apr;29(4):645-51.
  14. 14.0 14.1 14.2 Lord FM. Applications of item response theory to practical testing problems. Routledge; 1980.
  15. Holland PW, Wainer H. Differential Item Functioning. Lawrence Erlbaum Associates Ince, New Jersey. 1993.
  16. Hambleton RK, Swaminathan H, Rogers HJ. Fundamentals of item response theory. Sage; 1991.