Reviewer ’s report  
 
Title: Understanding what impacts on disclosing anal incontinence for women when comparing 
bowel screening tools: A phenomenological study  
 
Version: 0 Date: 06 Aug 2019  
 
Reviewer: Krzysztof NOWOSIELSKY  
 
Reviewer's report:  
 
The paper presented for the review covers an interesting issue of AI in women. The authors 
conducted a study on 16 women diagnosed with AI to picture potential problems in disclosing AI 
in that group of women using bow el incontinence screening tool. Although the paper is well 
written, there are several issues that must be addressed.  
 
Major remarks  
1. The aim of the study is vague. Was the study conducted to develop the new screening 
questionnaire? Or was it conducted to see how the questionnaire is understood? Or maybe indeed 
to see what are the barriers in disclosing AI? The authors have to be more specific about that.  
2. Thera is some misunderstanding of the available questionnaires on AI. Both The St. Mark's 
(Vaizey) s core and The Jorge -Wexner incontinence score are more grading not screening tool 
that are mostly use by specialists to assess the results of treatment (pre and post operation). 
Please correct if applicable. The other question is "do we really need a screen ing tool"? Most 
women after the delivery is seen by the doctors and are asked about delivery complications. Not 
disclosing AI would rather apply for extremely low income sub -African countries not Australia. 
That needs some additional explanation as well.  
3. There are no data on education level and residency of the participants. It seems that, as the 
authors stated, all patients came from "low socioeconomical population" and for that reason the 
results and conclusions must not be generalized for all women w ith AI - please correct and ad 
that information  
4. The authors were using BSQ but there is no data on validation of that scale. Has it been 
previously used? If yes, please give the psychometric properties?  
5. Conclusions - please rephrase all paragraph, e .g. first sentence in lines 51 -53, page 12, does 
not corresponded with the results (that conclusion is based on the results of another studies). 
Similarly, the last sentence of that paragraph on page 13.  The conclusions have to correspond 
with the aim of the study. Please correct.  
Minor remarks.  
1. Please give references in line 7, page 4  
2. Please provide SD (standard deviation) for age, BMI, gestational week in Table 3.  
3. Please add footnote for Table 3 explaining OASIS, AI and BMI  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by  the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended,  please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary 
from an organisation th at may in any way gain or lose financially from the 
publication of this manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, eith er now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of 
the manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating t o the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the  above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare tha t I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will  be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available und er an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ).  I understand that any comments 
which I do not wish to be included in my named report can be include d as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal