Non-Oral Poster 26

Abstract

OBJECTIVES: Our primary goal was to assess the prevalence of anal incontinence (fecal or flatal incontinence) in women treated for cervical cancer. Our secondary goals were to assess the prevalence of other pelvic floor symptoms in women treated for cervical cancer and to determine if radiation therapy affected the prevalence of these symptoms. MATERIALS AND METHODS: We performed a prospective cross-sectional study of women attending the Gynecological Oncology clinic at the LAC+USC Medical Center between July 2007 and July 2009. Women with a documented history of stage IA2 to IIB cervical cancer with no evidence of disease for at least one year were asked to complete the short form of the Pelvic Floor Distress Inventory (PFDI-20), a validated questionnaire assessing the presence and degree of bother of bladder, bowel, and prolapse symptoms, in either English or Spanish, depending on participant preference. Power analysis indicated that we would need to enroll 96 women in order to detect a 15% prevalence of anal incontinence with a 5% margin of error and alpha 0.05 The institutional review board at the University of Southern California approved this protocol. RESULTS: One hundred eligible women completed the PFDI-20. Eighty-eight women completed the questionnaire in Spanish. Mean (standard deviation) age and BMI were 52.8 (10.5) years and 30.7 (6.8) kg/m2, respectively. Median parity was 4 (Range 0–13). The median time since last treatment was 4 (range 1–29) years. Twenty-three women received surgical treatment alone, 23 women received definitive chemoradiation, and 54 women received a combination. 19 women had diabetes mellitus; one woman had a history of a cerebrovascular accident; and two women had previous incontinence surgery. Thirty-six (36%) women reported anal incontinence, and 18 (18%) women reported fecal incontinence (loss of solid or liquid stool). Thirty-one of 36 (86%) women with anal incontinence found the symptoms to be bothersome. All but one (94%) woman with fecal incontinence found the symptom to be bothersome. The most common pelvic floor symptoms reported in this group of women were frequent urination (61%), loss of urine with cough, sneeze, or other activity (42%), strong sense of urgency to have a bowel movement (41%), sensation of incomplete bowel evacuation (41%), and needing to strain hard to have a bowel movement (39%). We found no significant difference in median PFDI-20 score or prevalence of pelvic floor symptoms between women who did and did not receive radiation as part of their treatment. CONCLUSION: Anal incontinence and fecal incontinence affect 36% and 18% of women at a median of 4 years after treatment for cervical cancer, respectively. The most common pelvic floor symptoms in this group of women are frequent urination, stress urinary incontinence, fecal urgency, and sensation of incomplete bowel evacuation.