Questionnaires to Assess Urinary and Anal Incontinence: Review and Recommendations

Purpose

We reviewed and provide recommendations about the most scientifically robust and appropriate questionnaires for evaluating symptoms and the quality of life impact of urinary and/or anal incontinence, and vaginal and pelvic floor problems. We also investigated the use of these questionnaires in randomized, controlled trials of treatment strategies.

Materials and Methods

The Symptom and Quality of Life Committee of the International Consultation on Incontinence performed a systematic review of questionnaires related to urinary and anal incontinence, and vaginal and pelvic floor problems, searching MEDLINE, The Cochrane Library® and other electronic databases between 2001 and 2004.

Results

A total of 23 robust and relevant questionnaires could be recommended in clinical practice and research. The development of questionnaires to assess anal incontinence, and pelvic floor and vaginal problems has been limited with some promising measures but with none achieving the highest level of rigor. From 2001 to 2004 there were 150 published randomized trials of treatments for incontinence. Increasingly trials of incontinence are using recommended measures (38% of those for urinary incontinence and 22% of those for anal incontinence used the highest quality questionnaires in 2001 to 2004) but none of vaginal and pelvic floor problems used recommended questionnaires.

Conclusions

With increasing acknowledgment of the value of patient based assessment much attention has been given to the development of questionnaires to assess symptoms and quality of life. Sufficient measures are now available for urinary incontinence, and researchers and clinicians are encouraged to use the 18 achieving the highest level of rigor and their validated translations. In contrast, the development of questionnaires for anal incontinence and pelvic/vaginal problems is in its infancy and further study in this area is needed. Randomized trials of treatments for incontinence should use only questionnaires achieving the highest level of scientific rigor.

Key Words: bladder, urinary incontinence, fecal incontinence, outcome assessment (health care), questionnaires

Abbreviations and Acronyms: BFLUTS, Bristol Female LUTS Questionnaire, FES, functional electrical stimulation, ICI, International Consultation on Incontinence, ICIQ, ICI Questionnaire, IIQ, Incontinence Impact Questionnaire, I-QOL, QOL in persons with UI questionnaire, KHQ, King’s Health Questionnaire, LUTE, lower urinary tract exercise, LUTS, lower urinary tract symptoms, OAB, overactive bladder, PF, pelvic floor, PFM, PF muscle, PFME, PFM exercises, PFMT, PFM training, QOL, quality of life, RCT, randomized, controlled trial, SEAPI-QMM, incontinence classification system, SF, Short Form, TVT, transvaginal tape, UDI, Urogenital Distress Inventory, UI, urinary incontinence, UISS, UI Severity Score, VAS, visual analog scale