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Three hundred and fifty-five papers were eligible for inclusion after the elimination of duplicates and screening of all titles. A total of 1727 articles were investigated (Pubmed: 1022 Embase: 426 Cochrane Library: 279). Patient demographics and main characteristics of non-IBD and IBD studies are reported in Tables 1 and and2, 2, respectively. The flow chart of the search process is shown in Figure 1. 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. 18 A correct FI evaluation is essential to obtain an early diagnosis of disease and to ensure a rapid treatment. 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. Anorectal manometry allows us to measure resting and squeeze pressure, duration of the voluntary contraction and length of the anal canal. 15 Tools such as the validated Wexner score, 15 Vaizey score 16 and fecal incontinence quality of life (FIQL) questionnaire 17 assess FI measuring severity and impact on quality of life.
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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. 5 – 7, 14 A combination of different tests may be necessary to diagnose FI and to attribute the incontinence to a specific aetiology. 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. 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. 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. 8 A study by the British National Crohn’s and Colitis UK Organization 8 including over 3000 subjects showed that 74% of IBD patients reported at least one episode of FI in their life. Although 18.8% might seem a high prevalence, in patients with inflammatory bowel disease (IBD) FI occurs in an even higher percentage of patients. 3, 4 However, more recent population-based studies 5 – 7 have revealed an incidence of 18.8% in adult women in the USA. 2 FI was traditionally thought to affect about 2–10% of the general population and to increase in incidence with age. 1 It represents not only an embarrassing and humiliating symptom for patients, but also a serious social problem impacting considerably on everyday life. Fecal incontinence (FI) is defined as the involuntary loss of liquid or solid stool.