Fecal Incontinence Severity Index (FISI)

Assesses the impact of adult incontinence leakage on life quality.

In the text below the calculator there is more information about the index and about the original study.

The FISI evaluates the impact of adult incontinence leakage on the quality of life of patients suffering from fecal incontinence. This is based on a matrix system of 4 types of leakage and 6 frequencies.

The index is applied for monitoring purposes and has been built based on colon and rectal surgeon and patient input.

The FISI score ranges between 0 and 61 points. The original study by Rockwood et al. does not provide a specific cut off and the rule of thumb is that the higher the score, the greater the degree of severity of the fecal incontinence.

A subsequent study by Cavanaugh et al. set a cut-off at 30 points, where patients scoring above the cut-off point are more likely to be associated with an impaired quality of life.


Incontinent to gas


Incontinent for mucus


Incontinent for liquid stool


Incontinent for solid stool

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FISI explained

The fecal incontinence severity index helps quantify the impact of adult incontinence leakage on quality of life. It describes the severity of different types of incontinence for bowel contents.

The FISI can be applied for monitoring purposes as well as a response to different therapeutic options.

The model consists in a type x frequency matrix which includes four types of leakage and five frequencies plus an added “never” choice.

Types of incontinence:

(1) gas;

(2) mucus;

(3) liquid stool;

(4) solid stool.

Frequency of incontinence:

(1) never;

(2) 1 to 3 times per month;

(3) once a week;

(4) 2 or more times per week but not daily;

(5) once a day;

(6) 2 or more times per day.

The numeric result obtained after the model is applied, tends to correlate with the severity of other physical symptoms in adult incontinence.


Result interpretation

Each of the four items (types of leakage) is awarded a number of points, depending on the frequency at which that type of incontinence is experienced.

The maximum of points that can be awarded for one individual item is 19, for liquid stool incontinence with a frequency of 2 or more times per week.

The final result is the sum of all points and varies from 0 to 61, where the higher the score, the higher the perceived severity of the fecal incontinence.

The original study by Rockwood et al. does not provide a specific cut off and the rule of thumb is the one introduced above.

Patients who score closer to 61 are likely to have their quality of life severely impacted by the fecal incontinence they suffer from.

A subsequent study by Cavanaugh et al. found that FISI scores above 30 are more likely to be associated with an impaired quality of life than scores of 30 and below.

There is also a Fecal Incontinence Quality of Life Questionnaire (FIQL) published by the American Society of Colon and Rectal Surgeons.


About the study

In 1999, Rockwood et al. analysed the performance of the Fecal Incontinence Severity Index on a cohort of 118 patients diagnosed with fecal incontinence. The FISI is based on a type of incontinence x frequency matrix.

The types of leakage are gas, mucus, and liquid and solid stool and the five frequencies are the ones already explained in the first section.

The index was developed using input from both colon and rectal surgeons and also patient input.

The application of the index on the study cohort showed significant correlations with three of the four scales found in a fecal incontinence quality-of-life scale. Thus, the FISI model can be used to accurately assess the severity of fecal incontinence.


Fecal incontinence

This is one of the main debilitating problems that affects patients of over 65 years. Due to the embarrassing nature of the symptoms, often cases are left unreported and undertreated, until they become very severe.

FI can be caused by an impairment in the sphincter function, not enough rectal capacity and compliance or neurologic factors.

The main causes of FI are:

■ Traumatic (obstetric surgery, side effect of poorly performed anorectal surgery);

■ Congenital;

■ Neurological;

■ Iatrogenic etiology.

The clinician may also need to check for signs of chronic diarrhea or other medical comorbidities that affect the functioning of the bowels.

An efficient therapeutic option needs to ensure restoration of function for the pelvic floor musculature, the external and internal sphincters and the local innervation.


Original source

Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum. 1999; 42(12):1525-32.

Other references

1. Cavanaugh M, Hyman N, Osler T. Fecal incontinence severity index after fistulotomy: a predictor of quality of life. Dis Colon Rectum. 2002; 45(3):349-53.

2. Hayden DM, Weiss EG. Guest Editor Isenberg GA. Anorectal Disease: Fecal Incontinence: Etiology, Evaluation, and Treatment. Clin Colon Rectal Surg. 2011; 24(1): 64–70.

3. Norton C, Whitehead WE, Bliss DZ, Harari D, Lang J; Conservative Management of Fecal Incontinence in Adults Committee of the International Consultation on Incontinence. (2010) Management of fecal incontinence in adults. Neurourol Urodyn. 2010; 29(1):199-206.

Specialty: Gastroenterology

System: Digestive

Objective: Evaluation

Type: Index

No. Of Items: 4

Year Of Study: 1999

Abbreviation: FISI

Article By: Denise Nedea

Published On: July 3, 2017 · 10:31 AM

Last Checked: July 3, 2017

Next Review: July 3, 2023