Wexner Score

Wexner Incontinence Score

Frequency scale: Never=0 | Rarely (<1/month)=1 | Sometimes (≥1/month <1/week)=2 | Usually (≥1/week <1/day)=3 | Always (≥1/day)=4

Type of Incontinence (rate frequency)

1. Solid stool incontinence

2. Liquid stool incontinence

3. Gas / flatus incontinence

4. Need to wear a pad or plug

5. Lifestyle alteration due to incontinence

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Wexner Score (0–20)

Interpretation

Wexner Score	Severity	Clinical Action
0	Perfect continence	No intervention required
1–7	Minor FI	Dietary modification; pelvic floor exercises; biofeedback
8–14	Moderate FI	Specialist referral; sphincter assessment; consider SNM
15–20	Severe FI	Comprehensive pelvic floor assessment; surgical options; stoma discussion

Score ≥ 9 is associated with significant quality of life impairment and warrants specialist colorectal or pelvic floor referral.

Type	Rarely	Sometimes	Usually	Always
Solid stool	1	2	3	4
Liquid stool	1	2	3	4
Gas/flatus	1	2	3	4
Pad use	1	2	3	4
Lifestyle alt.	1	2	3	4

Frequency definitions: Rarely = <1/month; Sometimes = ≥1/month but <1/week; Usually = ≥1/week but <1/day; Always = ≥1/day.

Validated use: The Wexner Score is recommended by the American Society of Colon and Rectal Surgeons (ASCRS) and is used in research trials, clinical audits, and pre/post-treatment comparisons.
Investigation pathway (score ≥ 8): Anorectal manometry; endoanal ultrasound (to assess sphincter integrity); pudendal nerve terminal motor latency; MRI pelvis if indicated.
Treatment ladder:
- Mild (1–7): dietary fibre, antidiarrhoeals, pelvic floor exercises, biofeedback
- Moderate (8–14): biofeedback; sacral nerve modulation (SNM); sphincter repair if structural defect
- Severe (15–20): SNM; PTNS; sphincteroplasty; antegrade colonic enema (ACE); stoma
Sacral nerve modulation (SNM): Indicated for FI with intact sphincter or minor defects. SNM can reduce FI episodes by >50% in 60–80% of patients.
Comparison with St Mark's Score: The St Mark's (Vaizey) Score adds urgency and antidiarrhoeal use but the Wexner Score remains more widely cited. Both are acceptable for clinical use.

Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77–97.
Vaizey CJ, et al. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44(1):77–80.
Mellgren A, et al. ASCRS Clinical Practice Guidelines for Fecal Incontinence. Dis Colon Rectum. 2022.