Abstract
PurposeRadiotherapy to the pelvis and especially the anal sphincters can result in long-term faecal incontinence. The aim of this study was to assess the effectiveness of biofeedback anal strengthening exercises in radiotherapy-related faecal incontinence.MethodsA retrospective cohort study was performed on seven patients with radiotherapy-related faecal incontinence. Education and biofeedback based anal strengthening exercises were provided. Baseline and follow-up measurements were performed assessing anal sphincter fatigue time, resting, squeeze, and cough pressure. Continence scores and quality of life measures were assessed. Patients were followed up at five months.ResultsThe radiotherapy target varied between prostate, uterus, and rectum. Four of the seven patients were female. Pescatori (0-10) and St Mark’s (0-10) continence scores had a median improvement of 2 (range 0-5) and 1 (range 0-8) respectively. Self-completed patient continence scores (0-10mm) had a median improvement of 2mm (1-6mm). Anal fatigue time measurements (Isotonic Fatigue Time (seconds) and Isometric Fatigue Time (Cycles)) showed a median improvement of three seconds (-4 - 36 seconds) and three seconds (-1 - 6 seconds), respectively. Resting Pressure (mmHg), Squeeze Pressure (mmHg) and Cough Pressure (mmHg) showed median improvement of 10mmHg (-10-21mmHg), 15mmHg (-16 - 100mmHg) and 21mmHg (-3 - 53mmHg), respectively. Patient-defined quality of life (QOL) measures showed a median change of 0.2 (range 0-0.5).ConclusionPatients in this pilot study with radiotherapy-related faecal incontinence had improved anal pressure metrics, continence, and QOL following biofeedback based anal strengthening exercises. These early results suggest a benefit for anal strengthening in patients undergoing pelvic radiotherapy.
Highlights
Faecal incontinence is the involuntary loss of solid or liquid faeces
We retrospectively evaluated the effect of biofeedback on patients with faecal incontinence following pelvic radiotherapy
Patients were included in the study if they had faecal incontinence following radiotherapy and were engaged in the biofeedback retraining program
Summary
Faecal incontinence is the involuntary loss of solid or liquid faeces. Individuals with this condition suffer significant embarrassment and morbidity and it places significant burden on carers and health services [1]. The risk factors for developing faecal incontinence include advancing age, diarrhoea, urinary incontinence, diabetes, hormone therapy, rectal resection, and pelvic radiation therapy [1]. Damage to normal tissue during radiation therapy can lead to chronic gastrointestinal problems such as incontinence [3]. Radiation induces changes in the normal physiological functions of continence and subclinical disease can be destabilised [4]. Assessment of anorectal function is rarely comprehensive and loss to follow up makes it very difficult to assess [3]
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