Is the St. Mark’s Scoring System Suitable for Assessment of Anal Incontinence following Repair of Obstetric Anal Sphincter Injuries (oasis)?

Hypothesis / aims of study Several scoring systems have been designed to quantify and objectively assess anal incontinence in symptomatic patients. The St. Mark’s grading system for fecal incontinence has shown the highest correlation with the physician’s clinical impression when compared to three other grading systems (1). The main focus of continence grading systems is on physical aspects, but whether this correlates with the impact of anal incontinence on quality of life (QoL) is questionable. Most studies to establish this relationship were done in a middle-aged population seeking medical attention for fecal incontinence. In a study including 259 subjects with longstanding fecal incontinence, an increase in St. Mark’s score was related to more reported problems in usual activities, more pain/discomfort and anxiety/depression (2). Furthermore there was a significant but moderate correlation between St. Mark’s score and patients’ subjective perception of bowel control, irrespective of type of incontinence (3). However women who sustain obstetric anal sphincter injuries (OASIS) and report symptoms of anal incontinence are mostly young and healthy and therefore differ from subjects in previous studies. It remains to be established whether the St. Mark’s scoring system is a reliable indicator of severity of symptoms affecting QoL in women with predominantly minor symptoms. The aim of this study was to assess the relationship between severity of anal incontinence, as measured with the St. Mark’s grading system, and the disease specific impact on different domains of QoL, following primary repair of OASIS.