Management of faecal incontinence in adults: summary of NICE guidance

Norton et al's recommendation to "Try to improve the patient's bowel
habit, aiming for ideal stool consistency and satisfactory bowel emptying
at a predictable time" is praiseworthy but too vague to be helpful for
most people.
Consistency presumably means hardness/softness but this is a research
procedure, never assessed in clinical practice. However hardness/softness
is correlated with stool form or appearance and this is easily assessed
using a validated scale, such as the Bristol Stool Form Scale. On this
Scale, the ideal stool is type 3 or 4 (like a sausage or snake but with a
cracked surface, or like a sausage or snake, smooth and soft). These are
the ideal types because, as shown by the Bristol group (Gut 1991, 32:73-
9), they are the ones least often associated with symptoms like straining,
urgency and feelings of incomplete evacuation. The last symptom can be
called rectal dissatisfaction and I take it that it is the absence of this
which Norton et al mean when they refer to "satisfactory bowel emptying"
(another vague term).

Competing interests:
None declared