Garg incontinence scores: New scoring system on the horizon to evaluate fecal incontinence. Will it make a difference?

Table 1 Wexner scoring[25]

	Never	Rarely	Sometimes	Usually	Always
Solid	0	1	2	3	4
Liquid	0	1	2	3	4
Gas	0	1	2	3	4
Wears a pad	0	1	2	3	4
Lifestyle alteration	0	1	2	3	4

Rarely: < 1/mo; sometimes: < 1/wk to ≥ 1/mo; usually: < 1/d to ≥ l/wk; always: ≥ l/d. Citation: Garg P, Sudol-Szopinska I, Kolodziejczak M, Bhattacharya K, Kaur G. New objective scoring system to clinically assess fecal incontinence. World J Gastroenterol 2023; 29: 4593-4603. Copyright ©The Authors 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

Table 2 Vaizey’s scoring[25]

	Never	Rarely	Sometimes	Weekly	Daily
Solid stool incontinence	0	1	2	3	4
Liquid stool incontinence	0	1	2	3	4
Gas incontinence	0	1	2	3	4
Alteration in lifestyle	0	1	2	3	4
	No	Yes
Need to wear a pad or plug	0	2
Constipating medication	0	2
Lack of ability to defer defecation for 15 min	0	4

Never: No episodes in last 4 wk; rarely: 1 episode in last 4 wk; sometimes: ≥ 1 in last 4 wk but < 1/wk; weekly: ≥ 1/wk to < 1/d; always: ≥ 1/d. Citation: Garg P, Sudol-Szopinska I, Kolodziejczak M, Bhattacharya K, Kaur G. New objective scoring system to clinically assess fecal incontinence. World J Gastroenterol 2023; 29: 4593-4603. Copyright ©The Authors 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

Table 3 Fecal incontinence severity index scoring[25]

	≥ 2 times/d (patient/surgeon scores)	Once/d (patient/surgeon scores)	≥ 2 times/wk (patient/surgeon scores)	Once/wk (patient/surgeon)	1-3 times/mo (patient/surgeon scores)
Gas	12/9	11/8	8/6	6/4	4/2
Mucous	12/11	10/9	7/7	5/7	3/5
Liquid	19/18	17/16	13/14	10/13	8/10
Solid	18/19	16/17	13/16	10/14	8/11

Citation: Garg P, Sudol-Szopinska I, Kolodziejczak M, Bhattacharya K, Kaur G. New objective scoring system to clinically assess fecal incontinence. World J Gastroenterol 2023; 29: 4593-4603. Copyright ©The Authors 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

Table 4 Garg incontinence scores[25]

Incontinence type	Weight	Frequency			Maximum score
		Never (points)	Occasional (points) (≤ 1 episode/wk)	Common (points) (> 1 episode/wk)
Solid	8	0	1	2	16
Liquid	8	0	1	2	16
Urge	7	0	1	2	14
Flatus	6	0	1	2	12
Mucus	6	0	1	2	12
Stress	5	0	1	2	10
Total					80

Score in a cell = Weight for that incontinence type × frequency points. For example, a person with occasional liquid incontinence would have an 8 × 1 = 8 score. Maximum possible score = 80 (total incontinence), minimum score possible = 0 (no incontinence). Citation: Garg P, Sudol-Szopinska I, Kolodziejczak M, Bhattacharya K, Kaur G. New objective scoring system to clinically assess fecal incontinence. World J Gastroenterol 2023; 29: 4593-4603. Copyright ©The Authors 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

Table 5 Comparison of existing scoring systems with new scoring system[25]

	Wexner	Vaizey	FISI	GIS
Comprehensive	No	No	No	Yes
FI type included: Urge FI	No	Yes	No	Yes
FI type included: Mucous FI	No	No	Yes	Yes
Presence of confounding parameters like “Need to wear a pad”, “Need to take constipating medicine”, and “Alteration of lifestyle”	Yes	Yes	No	No
Assigning weights to each FI by an objective method	No	No	No	Yes
Inclusion of patient perceptions (n)	0	0	34	50
Inclusion of laypersons’ perceptions (n)	0	0	0	50
Simple and easy to use	+++++	+++++	+	+++++
Detailed structured definitions	No	No	No	Yes
In-depth disability scores based on an objective description system	No	No	No	4D3L [modified EQ-5D+ (EuroQol)] used

FI: Fecal incontinence; FISI: Fecal Incontinence Severity Index; NSS: New scoring system. Citation: Garg P, Sudol-Szopinska I, Kolodziejczak M, Bhattacharya K, Kaur G. New objective scoring system to clinically assess fecal incontinence. World J Gastroenterol 2023; 29: 4593-4603. Copyright ©The Authors 2020. Published by Baishideng Publishing Group Inc. All rights reserved.