Anorectal Function In Patients Research Articles

Long-Term Anorectal Function in Rectal Cancer Patients Managed by a Watch-and-Wait Strategy after Neoadjuvant Therapy: A Cross-Sectional Study

Rectal cancer patients reaching complete clinical response (cCR) after neoadjuvant chemoradiotherapy can be offered a nonoperative watch-and-wait (W&W) strategy. As evidence of good oncological outcomes accumulates, the functional outcomes remain less explored. The aim of this study is to comprehensively assess the long-term rectal toxicity and anorectal function in patients managed by a W&W strategy and to investigate the clinical risk factors for anorectal dysfunction. Seventy W&W patients who were disease-free at the moment of recruitment were included. A minimum 2-year follow-up was considered. We graded late rectal toxicity according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) scale and the Late Effects of Normal Tissue/Subjective Objective Management Analytic (LENT/SOMA) system. Long-term anorectal function was assessed with the Wexner score, the Low Anterior Resection Syndrome score (LARS score), and the Memorial Sloan Kettering Bowel Function Instrument (MSK BFI). All patients received standard chemoradiotherapy consisting of a total dose of 5000 cGy in 25 fractions. The median tumor distance from the anal verge was 3 (IQR 2-4) cm. After a median follow-up of 43 (IQR 28-66) months, less than half of patients developed Grade 1 (40.0%) or Grade 2 (1.4%) late rectal toxicity, and no patients complained of higher grades. LENT/SOMA criteria also identified more patients with mild symptoms. The most frequent symptoms were sphincter control problems, mainly manifested as fecal urgency, reported by 60.0% of patients. For long-term anorectal function, the median LARS score was 16 (IQR 4-25). 17.1% of patients reported minor LARS and 15.7% reported major LARS. The median Wexner score was 2 (IQR 0-3). The median MSK BFI total score was 82 (IQR 77-86). Smoking history was an independent risk factor for anorectal dysfunction in multivariate analyses (OR = 6.491, 95% CI 1.536-27.432). Rectal cancer patients managed by a watch-and-wait strategy after neoadjuvant chemoradiotherapy have retained satisfactory anorectal function. However, fecal urgency might be a common problem. Smoking history was an independent risk factor for long-term anorectal dysfunction. Prospective studies with emphasis on bowel function outcomes containing a larger number of patients are needed.

Clinical and manometric evaluation of postoperative anorectal function in patients after trans-anal pull-through for Hirschsprung disease

BackgroundTransanal endorectal pull-through (TEPT) surgery is a new trend in the treatment of Hirschsprung disease, and evaluating its functional outcome is difficult. The purpose of this study is to evaluate the defecation pattern after TEPT surgery in pediatrics.Material and methodsIn this cross-sectional survey, 40 patients with Hirschsprung disease were studied. They underwent a one-stage transanal pull-through procedure from May 2007 till April 2015 in Namazi hospital by the same surgeon. All the patients had the aganglionic segment in the rectosigmoid, confirmed by pre-operation barium enema and post-operation histopathology. The patients were 40 children with mean operation age of 36.6 months old. The success rate of surgery was evaluated by following the questionnaire form. Clinical evaluation with bowel function score and anorectomanometry were carried out.ResultOne hundred percent of them had a daily stool. Eighty-five percent of patients never experienced pain during defecation, 10% experienced occasional pain, and the rest felt pain with every defecation. Just one case (5%) reported using a laxative. Regarding improvements after the operation, 75% were completely okay, 20% felt much better, and 5% reported some improvements. The average National Health Service score was 8.375, which seems satisfactory. The mean average anal sphincter in the group with soiling was 39.67 and in the group without soiling was 34.83, which is in the normal range in both groups, and there was no significant difference between these groups (P > 0.05).ConclusionThe defecation pattern after TEPT surgery were satisfactory in almost all cases, even in infancy. Most patients had satisfactory manometry and clinical result.

Long-term results of sacral neuromodulation for the treatment of anorectal diseases.

Sacral neuromodulation (SNM) aims to improve anorectal function in patients with disorders of anal continence and rectal emptying. The mechanism of action of SNM is not well known, and its indications are still under evaluation. We report the functional results and morbidity of a prospective cohort treated between 2002 and 2019. A total of 284 patients (of 423 tested) had implantation of a SNM. Five patients (1.8%) were lost to follow-up. Among those who had implantation, the indications for SNM were anal incontinence (n=376), refractory constipation (n=17), anterior resection syndrome (n=13), solitary rectal ulcer syndrome (n=7), and chronic inflammatory bowel disease (IBD) (n=10). The morbidity rate was 2.7% (Dindo-Clavien>2), 33 patients (11%) required explantation for infection (n=5), pain (n=2), inefficacy (n=24) or other reasons (rectal cancer) (n=3). It was necessary to change the stimulator in 68 patients (24%) during the follow-up period. Regarding the group of patients with anal incontinence, functional results showed improvement of the incontinence score in 40% and of quality of life in 25% after a mean follow-up of 55months. SNM constitutes a mini-invasive treatment associated with low morbidity. Its' efficacy in anal incontinence makes it a priority approach. Other indications are still under evaluation; while results are promising, they are highly variable.

Anorectal Function with High-Resolution Anorectal Manometry in Active Ulcerative Colitis and after Remission: A Pilot Study.

Ulcerative colitis may impair anorectal function, causing disabling symptoms such as incontinence and/or increase in the stool frequency, urgency and tenesmus. Data on anorectal function in these patients evaluated by conventional anorectal manometry are conflicting. The aim of this prospective study was to assess by means of high resolution anorectal manometry the anorectal function in patients with mild-to-moderate ulcerative colitis at presentation and after remission. Anorectal function of ulcerative colitis patients was compared to that observed in healthy volunteers. 20 patients with mild to moderate left-sided ulcerative colitis or proctitis and 20 healthy volunteers were prospectively enrolled. All ulcerative colitis patients underwent high resolution anorectal manometry before treatment and after clinical remission. Ulcerative colitis patients showed similar values for anal sphincter function as healthy volunteers, whereas rectal threshold volume for the first sensation, desire to defecate, urgency to defecate and maximum discomfort were significantly lower than in healthy volunteers (p<0.05). Rectal compliance was significantly lower in ulcerative colitis than in healthy volunteers (p<0.05). After remission, rectal threshold volumes, as well as rectal compliance, significantly increased. An inverse linear correlation was found between regression of urgency and stool frequency and rectal compliance (r=0.811; p<0.05). Ulcerative colitis patients show altered rectal function, with increased rectal sensitivity and lower compliance, compared to controls. This altered function is restored after successful treatment of the underlying inflammatory process. Finally high resolution anorectal manometry provides useful information on anorectal functionality and, in our opinion, should be preferred over conventional manometry.

Development of a Simple, Point-of-Care Device to Test Anorectal Function in Patients with Constipation: Randomized Clinical Trial

Functional constipation (FC) is one of the most frequently encountered gastrointestinal conditions in practice.1 Practice guidelines universally recommend that patients with typical constipation symptoms and no alarm features be treated empirically with dietary/lifestyle interventions and laxative therapy.2,3 Unfortunately, by the time a patient reaches a gastroenterologist, these treatments frequently have already been tried. Anorectal function testing (anorectal manometry [ARM] and balloon expulsion test [BET]) is the next best step in management guidelines in this all-too-common scenario, because treatment can then be targeted toward pelvic floor dysfunction or colon transit abnormalities. Unfortunately, more than 95% of patients continue to take only over-the-counter laxatives and receive empirical dietary advice, whereas fewer than 2% undergo physiologic evaluation to ascertain the cause of their symptoms.4 Indeed, more than 90% of patients desire more effective treatment options. These observations call into question the wisdom of a management strategy that fails to recognize the intrinsic diversity of the constipation universe and reinforces the misguided "one size fits all" empirical treatment strategy.

Clinical presentation and characteristics of pelvic floor myofascial pain in patients presenting with constipation.

Patients with pelvic floor myofascial pain (PFMP) have puborectalis tenderness on digital rectal examination (DRE). Little is known about its significance to anorectal function in patients presenting with constipation. To characterize demographics, clinical characteristics, findings on anorectal manometry (ARM), diagnosis of rectal evacuation disorder (RED), colonic transit [normal (NTC) or slow (STC)], and imaging in constipated patients with PFMP and compare these features to constipation without PFMP. We performed an electronic medical records review of patients with constipation evaluated by a single gastroenterologist between January 2008 and February 2019. Patients with PFMP were compared to controls with constipation but without PFMP (1:2 ratio). A total of 98 PFMP cases and 196 controls were identified. Constipated patients with PFMP were more likely to have RED [OR 7.59 (3.82-15.09), P<.01]; controls were more likely to have either NTC [OR 4.25 (1.45-12.42), P<.01] or STC [OR 3.57 (1.45-8.78), P<.01]. RED in patients with PFMP is supported by comparison to controls: On DRE, they had increased resting tone [OR 2.25 (1.33-3.83), P<.01] and paradoxical contraction of the puborectalis upon simulated evacuation [OR 3.41 (1.94-6.00), P<.01]; on ARM, they had higher maximum resting pressure (102.9mmHg vs 90.7mmHg, P<.01) and lower rectoanal pressure gradient (-39.4mmHg vs -24.7mmHg, P<.01). In constipated patients, PFMP is highly associated with RED. Its presence provides a valuable clue regarding the etiology of a patient's constipation; it should be assessed in all patients with constipation and should also be an additional target for management.

The Influence of Neoadjuvant Chemoradiation for Middle and Lower Rectal Cancer on Anorectal Function.

To date, there is no clear understanding whether preoperative long-course chemoradiotherapy combined with surgery for rectal cancer is detrimental to anorectal function. The purpose of this study was to clarify the influence of preoperative chemoradiotherapy and surgery for middle and lower rectal cancer on postoperative anorectal function. Data of 113 patients with middle or lower rectal cancer treated with preoperative chemoradiotherapy plus surgery or surgery alone between January 2013 and December 2016 were analyzed. A total of 84 and 29 patients underwent low anterior resection and intersphincteric resection, respectively. In patients with T3 or deeper and with any N stage cancer below peritoneal reflection, surgery plus lateral lymph node dissection or preoperative radiation (total: 50.4 Gy/28 fractions) to the pelvis with chemoradiotherapy plus surgery was treated. Anorectal function was assessed prior to treatment and 6 and 12 months postoperatively. Specifically, maximum resting pressure and maximum squeezing pressures were measured. The Wexner score was recorded prior to treatment and 12 months postoperatively. maximum resting pressure and maximum squeezing pressure decreased post-surgery in both groups. Maximum resting pressure and maximum squeezing pressure at 12 months and the Wexner score at 12 months post-surgery were comparable among patients treated with chemoradiotherapy plus surgery and those treated with surgery alone. Preoperative chemoradiotherapy did not clearly impair postoperative anorectal function in patients who underwent low anterior resection and intersphincteric resection.

Intervention effect of biofeedback combined with pelvic floor muscle exercise on low anterior resection syndrome in patients with low anus-preserving rectal cancer

Objective: To explore the effect of biofeedback training combined with pelvic floor muscle exercise on the recovery of anorectal function in patients with middle and low rectal cancer undergoing sphincter-preserving surgery, and to find the best way to prevent low anterior resection syndrome. Methods: A single-center prospective randomized controlled study was conducted. One hundred and nine patients with mid-low rectal cancer in Sun Yat-sen University Cancer Centre from June 2015 to December 2016 were enrolled in the study, who were going to undergo sphincter-preserving surgery or preventive ostomy after preoperative chemoradiotherapy. They were divided into three groups: blank control group, pelvic floor muscle exercise group and biofeedback training combined with pelvic floor muscle exercise group. Intervention and follow-up were conducted for 16 months. High-resolution anorectal manometry was used to measure the objective anorectal pressure and sensory index of patients, and the Chinese version of MSKCC Intestinal Function Questionnaire was used to evaluate the intestinal function of patients. The differences of objective anorectal manometry index and subjective intestinal function between the three groups were compared, and the occurrence of low anterior rectal resection syndrome was evaluated. Results: At the end of the intervention, the total scores of anal resting pressure, rectal resting pressure, anal maximum systolic pressure, anal maximum systolic time, initial rectal volume, rectal fecal sensory capacity, rectal maximum tolerance capacity, rectal compliance, anorectal hypertensive zone and total score of intestinal function in the biofeedback training combined with pelvic floor muscle exercise group were (44.83±9.01) mmHg, (4.31±1.75) mmHg, (130.46±10.00) mmHg, (19.94±4.30) s, (32.71±5.00) ml, (74.26±8.30) ml, (188.4±12.68) ml, (5.69±1.18) ml/kPa, (3.31±0.96) cm and (68.09±6.38) points respectively. The main effects of the changes of five indices, including anal resting pressure, rectal resting pressure, anal maximum systolic pressure, anal maximum systolic time and anal high pressure zone, were time. Significant differences were found in initial rectal capacity, sensory capacity of rectal defecation, maximum tolerance capacity of rectum, rectal compliance and total score of intestinal function in every time point of measurement in the biofeedback training group combined with pelvic floor muscle exercise group. They were significantly higher than those in the blank control group (P<0.05); the score of the biofeedback training group combined with pelvic floor muscle exercise group at one month after operation, perioperative period and 3 months after operation were significantly higher than those in pelvic floor muscle exercise group (P<0.05). Biofeedback training combined with pelvic floor muscle exercise reduced the incidence of low anterior resection syndrome of rectum (P<0.05). Conclusion: Biofeedback training combined with pelvic floor muscle exercise can significantly improve the sensory indicators of patients with mid-low rectal cancer, promote the recovery of intestinal function, and alleviate low anterior resection syndrome of rectal cancer patients, which is worthy of popularization and application.

Impact of radiotherapy on anorectal function in patients with rectal cancer following a watch and wait programme

Background and purposeTo assess the long-term anorectal function in rectal cancer patients following a watch-and-wait policy after chemoradiotherapy and to investigate the dose–volume effects of radiotherapy on the anorectal function. Methods and materialsThirty-three patients with primary rectal cancer who were treated with chemoradiotherapy and a watch-and-wait policy with minimum follow-up of 2 years were included. We assessed the anorectal function using anorectal manometry and patient reported outcomes (Vaizey and LARS score). Dose–volume histograms were calculated for the rectum and anal sphincter complex, and associations between the dose–volume parameters and anorectal function were assessed. ResultsDmean to the rectum and anal sphincter complex was 50.5 Gy and 44.7 Gy, respectively. After a median follow-up of 38 (range 23–116) months, 33.3% of the patients reported major LARS. Mean LARS score was 23.4 ± 11.3 and mean Vaizey score was 4.3 ± 4.1. The most frequent complaints were clustering of defaecation and faecal urgency. Trends towards a higher Vaizey and LARS score after higher anal sphincter complex dose were observed, although these associations were not statistically significant. ConclusionsThis is the first study to investigate the late dose-volume effects of radiotherapy specifically on the anorectal function in rectal cancer patients. One-third of the patients had major LARS and the most frequent reported complaints were clustering and faecal urgency. Additionally, we observed trends towards worse long-term anorectal function after higher anal sphincter complex radiotherapy dose. However, this should be evaluated on a larger scale. Future efforts to minimise the dose to the sphincters could possibly reduce the impact of radiotherapy on the anorectal function.

Effects of Stapled Hemorrhoidopexy on Anorectal Function: A Prospective Randomized Controlled Trial.

Stapled hemorrhoidopexy is a safe and acceptable alternative to traditional hemorrhoidectomy with shorter hospital stay, better satisfaction, and less postoperative pain. There have, however, been reports on early and late complications. Therefore, the present study was designed to assess the impact of stapled hemorrhoidopexy on anorectal function and continence. Sixty-one patients with rectal prolapse and/or symptomatic circumferential hemorrhoidal disease, as validated by the Wexner incontinence score, were included. Anal manometric indices were measured. The Wexner scores and anal manometric measures were compared pre- and postoperatively using the Mann-Whitney U test. (A P<0.05 was considered significant.). Mean age was 46.8 years (range=18-80 y), with a mean follow-up time of 3 months. Fifty-one patients completed their follow-ups. For 45 patients with a Wexner score of 0 and no history of incontinence, the anal maximum squeezing pressure (AMD) was 125.3±43.1 mm Hg, the anal resting pressure (ARD) was 27.8±12.8 mm Hg, and the mean pressure was 40.0±16.8 mm Hg. The changes in the anorectal manometric indices before and 3 months after the operation were not statistically significant (P=0.99, P=0.55, and P=0.32, respectively). In 6 patients with Wexner scores of 1 or higher, the mean values of the AMD, ARD, and mean pressure not only decreased but also increased postoperatively, but the changes were not statistically significant (P=0.32, P=0.42, and P=0.45, correspondingly). These data represent a series of patients with 3 months' follow-up after stapled hemorrhoidopexy and suggest that this technique is safe in experienced hands. It may have protective effects on anorectal function in patients with imperfect continent scores. Trial Registration Number: IRCT2015101324504N1.

Stool patterns and symptoms of disordered anorectal function in patients with inflammatory bowel diseases.

Crohn's disease (CD) and ulcerative colitis (UC) typically clinically manifest with symptoms like chronic diarrhea, cramps, abdominal pain, and rectal bleeding. However, symptoms of abnormal anorectal function seem to be of equal importance, regardless of the presence or absence of perianal disease. The aim of this study was to assess stool patterns and the prevalence of symptoms of disordered anorectal function, particularly urgency and fecal incontinence, and their severity in patients with inflammatory bowel diseases (IBDs). Thirty-three patients with CD and 38 patients with UC completed a questionnaire. A push/strain maneuver was performed on all patients and 20 controls. Thirty-three patients had more than 3 bowel movements a day; 44 had loose/watery stools. Two patients had fewer than 3 bowel movements a week, 8 had hard/lumpy stools, and 3 used laxatives. Excessive straining and incomplete evacuation were reported by 17 and 38 patients, respectively. Fifty-two patients complained of urgency and 32 of tenesmus. Significantly, more UC patients than CD patients had urgency at least once a day (p < 0.04). The following symptoms were reported by patients in the following numbers: fecal incontinence (31), passive (20) and urge incontinence (16), incontinence to gas (24), as well as liquid (33) and solid stool (7). Stool/gas discrimination was defective in 28 patients. Eleven patients had to wear pads. Everyday functioning was worsened because of urgency/tenesmus in 39 patients and because of fecal incontinence in 28 patients. The push/strain maneuver was abnormal in 12 patients with CD, 15 patients with UC and 1 control subject. The differences between the 2 study groups and the controls were significant (p < 0.03 and p < 0.01). A majority of patients with IBD complain of urgency. Fecal incontinence is reported by over 50% of patients. Both worsen patients' everyday functioning. A relevant proportion of patients have symptoms consistent with constipation, which is in connection with an abnormal push/strain maneuver in more than 1/3 of them.

Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study).

The aim was to evaluate the impact of radiotherapy (RT) on anorectal function of patients with low rectal cancer undergoing low anterior resection (LAR). Prospective clinical cohort study conducted to assess the functional outcome by means of high-resolution anorectal manometry and LARS score. In total, 65 patients were enrolled in the study (27 patients underwent LAR without RT, 38 patients underwent RT and LAR). There were no statistically significant differences between study subgroups regarding demographic and clinical data; postoperative morbidity was significantly higher in irradiated patients. One year after the surgery, mean LARS score was significantly higher in patients who underwent RT and surgery. Major LARS was detected in 37.0% of irradiated patients and in 14.8% of patients after surgery alone. Anorectal manometry revealed significantly lower resting pressures in patients after RT and LAR; the squeeze pressures were similar. Rectal compliance and all volumes describing rectal sensitivity (first sensation, urge to defecate, and discomfort volume) were significantly lower in irradiated patients. RT significantly deteriorates the functional outcome of patients after LAR. Manometry revealed internal sphincter dysfunction, reduced capacity, and compliance of neorectum, which seem to have a significant correlation with LARS presence/seriousness.

Peri-treatment change of anorectal function in patients with rectal cancer after preoperative chemoradiotherapy.

Preoperative chemoradiotherapy (PCRT) is a standard treatment for locally advanced rectal cancer. The influence of PCRT on anorectal function has not been objectively assessed. We evaluated the short-term influence of PCRT on anorectal function in patients with locally advanced rectal cancer using anorectal manometry. We included 310 patients with locally advanced mid and lower rectal cancer who underwent PCRT from 2012 to 2015. We compared anorectal function based on anorectal manometry between before and after PCRT according to tumor location, clinical T (cT) stage, and tumor response after PCRT. Lower rectal cancer was common in the cohort of 310 patients (n = 228, 73.5%). Sphincter length (p = 0.003) and maximal resting pressure (p < 0.001) increased and maximal tolerated volume (p = 0.036) decreased after PCRT regardless of tumor location. Maximal squeezing pressure and rectal compliance slightly decreased, without statistical significance. Changes in manometric parameters after PCRT were not associated with changes of cT stage after PCRT. However, minimal sensory volume (p = 0.042) and maximal tolerated volume (p = 0.025) increased significantly in 143 patients (46.1%) with changes in the distance of the cancer from the anal verge after PCRT. PCRT did not impair the overall short-term anorectal manometric parameters in patients with locally advanced rectal cancer. Further study is required to investigate postoperative anorectal function after sphincter-preserving surgery to evaluate the long-term effects of PCRT on anorectal function.

Manometric evaluation of anorectal function in patients treated with neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer

BackgroundAn altered anorectal function is reported after chemoradiotherapy (CRT) and surgery for rectal cancer. AimThe aim of this study was to clarify the relative contribution of neoadjuvant chemoradiation and surgical resection on the impairment of anorectal function as evaluated by anorectal manometry. MethodsThirty-nine patients with rectal cancer, who underwent neoadjuvant CRT and laparoscopic rectal resection, were evaluated with the Pescatori Faecal Incontinence score, and with anorectal manometry: before neoadjuvant therapy (T0), after neoadjuvant therapy and before surgery (T1), 12 months after stoma closure (T2). ResultsResting and/or maximum squeeze pressure and/or volume thresholds for urgency were below the normal values in 12 (30%) patients at baseline. After CRT the mean resting pressure significantly decreased (p=0.007). Surgery determined a significantly decrease of the resting pressure (p=0.001), of the maximum squeeze pressure (p=0.001) and of the volume threshold for urgency (p=0.001). Impairment of continence was reported by 5, 11 and 18 patients at T0, T1 and T2, with a mean incontinence score of 3, 3.8 and 3.9 respectively. ConclusionsCRT is detrimental to the function of the internal anal sphincter. Rectal resection significantly affects both internal and external anal sphincter function and the maximum tolerated volume of the neo-rectum, particularly in patients with low rectal cancer, significantly impairing anal continence.

Efficacy of Cranial Electrotherapy Stimulation Combined with Biofeedback Therapy in Patients with Functional Constipation.

Background/AimsA large number of studies have shown that function constipation (FC) has an extremely high incidence of mental and psychological disorders. Cranial electrotherapy stimulation (CES) was applied to the treatment of psychological disorders such as anxiety and depression. We explored the effects of CES combined with biofeedback therapy (BFT) on the psychological state, clinical symptoms, and anorectal function in patients with FC.MethodsA total of 74 patients with FC were randomly divided into 2 groups. The control group received BFT. CES combined with BFT was carried out in the experiment group. All patients were assessed using the self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Wexner constipation score at baseline and the end of each course. Anorectal manometry and balloon expulsion tests were performed before and after treatment.ResultsAfter treatment, the participants in the experiment group had significantly lower score SAS, SDS, and Wexner constipation scores than the control group (all P < 0.05). The number of successful expulsion in the experiment group was larger than the control group (P = 0.016).ConclusionsCES combined with BFT was effective in improving the psychological status of anxiety, depression, and bowel symptoms in patients with FC.

Anal sphincter dysfunction in multiple sclerosis: an observation manometric study.

Constipation, obstructed defecation, and fecal incontinence are frequent complaints in multiple sclerosis. The literature on the pathophysiological mechanisms underlying these disorders is scant. Using anorectal manometry, we compared the anorectal function in patients with and without multiple sclerosis.136 patients referred from our Center for Multiple Sclerosis to the Coloproctology Outpatient Clinic, between January 2005 and December 2011, were enrolled. The patients were divided into four groups: multiple sclerosis patients with constipation (group A); multiple sclerosis patients with fecal incontinence (group B); non-multiple sclerosis patients with constipation (group C); non-multiple sclerosis patients with fecal incontinence (group D). Anorectal manometry was performed to measure: resting anal pressure; maximum squeeze pressure; rectoanal inhibitory reflex; filling pressure and urge pressure. The difference between resting anal pressure before and after maximum squeeze maneuvers was defined as the change in resting anal pressure calculated for each patient.ResultsGroup A patients were noted to have greater sphincter hypotonia at rest and during contraction compared with those in group C (p=0.02); the rectal sensitivity threshold was lower in group B than in group D patients (p=0.02). No voluntary postcontraction sphincter relaxation was observed in either group A or group B patients (p=0.891 and p=0.939, respectively).ConclusionsThe decrease in the difference in resting anal pressure before and after maximum squeeze maneuvers suggests post-contraction sphincter spasticity, indicating impaired pelvic floor coordination in multiple sclerosis patients. A knowledge of manometric alterations in such patients may be clinically relevant in the selection of patients for appropriate treatments and for planning targeted rehabilitation therapy.

Clinical and manometric evaluations of anorectal function in patients after transanal endorectal pull-through operation for Hirschsprung's disease: A multicentre study

Aim Transanal endorectal pull-through (TEPT) operation is one the most popular operations for Hirschsprung's disease. This aim of the present study was to evaluate its outcome by clinical and manometric assessments. Patients and Methods This study was a multicentred study involving all three paediatric surgical centres under the Hospital Authority in Hong Kong. All patients, over the age of 3 years, who had undergone primary TEPT operation for more than 1 year, were included in the present study. Clinical evaluation with bowel function score (BFS) and anorectomanometry were carried out. A BFS > 18 and sphincter resting pressure between 30 mmHg and 60 mmHg were considered normal. Those with concomitant anorectal/neurological anomaly or who could not cooperate were excluded. Results A total of 37 patients were enrolled in this study. The median age was 60 months (range: 36–144 months), and the median age at the time of operation was 3 months (range: 0.5–60 months). With respect to functional outcomes, six patients (16.2 per cent) suffered from constipation, but more than two-thirds of patients had satisfactory stool consistency, as well as frequency. Sixteen patients (43.2 per cent) had no report of any soiling. For the BFS, 26 patients had a BFS above 18, with the median value being 16 (range: 7–20). Manometric assessment revealed that 27 patients (72.9 per cent) had sphincteric resting pressure within the normal value, and the median value was 45 mmHg (range: 14–79 mmHg). Rectoanal inhibitory reflex was present in six patients (16.2 per cent), and the median value for the volume of air to elicit the first anal sensation was 41 mL (range: 18–126 mL). Using univariate analysis, long segment disease was identified as a risk factor for developing soiling of more than two times per week [relative risk (RR): 1.87, 95 per cent confidence interval (CI):1.03–2.22, P = 0.05], whereas the creation of stoma (RR: 1.69, 95 per cent CI: 1.41–2.14, P = 0.04) and occurrence of postoperative enterocolitis (RR: 1.58, 95 per cent CI: 1.36–1.0, P = 0.04) were risk factors for abnormal bowel function score. There was no significant risk factor identified for abnormal manometric results. Lastly, patients with abnormal sphincter resting pressure detected in the anorectomanometry study were also more likely to have an abnormal BFS. Conclusion Most patients have satisfactory clinical and manometric outcomes after primary TEPT operation. Anorectomanometry findings can predict clinical outcomes. Patients with long segment disease, development of enterocolitis and stoma creation before operation will need more attention, as they are prone to develop abnormal bowel function. Early interventions, such as manometric assessment and proper bowel management, are recommended in order to correct bowel dysfunction, as well enabling patients to have a better quality of life.

Effects of neoadjuvant chemoradiotherapy on anorectal function in patients with mid and low rectal cancer

To evaluate the effects of neoadjuvant chemoradiotherapy on anorectal function in patients with mid and low rectal cancer. A total of 22 patients with mid and low rectal cancer were enrolled into this study from October 2012 to November 2013. There were 14 males and 8 females with a mean age of (59 ± 10) years. We collected the defecation-related symptoms with questionnaire interview and evaluated the anorectal function with three-dimensional high-resolution manometry before neoadjuvant chemoradiotherapy and at 6 weeks after radiotherapy. The defecation-related symptoms (including increase in stool frequency, change in stool form, hematochezia and urgency, etc.) improved significantly after neoadjuvant chemoradiotherapy (n = 21). Among those with lower rectal cancer (n = 8), the length of high-pressure zone in manometry increased significantly after neoadjuvant chemoradiotherapy ((3.84 ± 0.61) vs (2.96 ± 0.80) cm, P = 0.003). However, there was no significant change for other parameters in anorectal function (all P > 0.05). In patients with mid and low rectal cancer, neoadjuvant chemoradiotherapy may improve the defecation symptoms and enhance anal sphincter high-pressure zone for lower rectal cancer. And it is probably due to its tumor-downsizing effect.

Evaluation of long-term anorectal function after low anterior resection: a 5-year follow-up of a randomized multicenter trial.

Anorectal function after rectal surgery with low anastomosis is often impaired. Outcome of long-term anorectal function is poorly understood but may improve over time. We evaluated anorectal function 5 years after low anterior resection for cancer with regard to whether patients had a temporary stoma at initial resection. The objective of this study was to assess changes in anorectal function over time by comparing the results with anorectal function 1 year after rectal resection. This study was a secondary end point of a randomized, multicenter controlled trial. The study was conducted at 21 Swedish hospitals performing rectal cancer surgery from 1999 to 2005. Patients included were those operated on with low anterior resection. Patients were randomly assigned to receive or not receive a defunctioning stoma. We evaluated anorectal function in patients who were initially randomly assigned to the defunctioning stoma or no stoma group, who had been free of stoma for 5 years, by means of using a standardized patient questionnaire. Questions addressed stool frequency, urgency, fragmentation of bowel movements, evacuation difficulties, incontinence, lifestyle alterations, and patient preference regarding permanent stoma formation. Results were compared with the same patient cohort at 1-year follow-up. A total of 123 patients answered the bowel function questionnaire (65 in the no-stoma group and 58 in the stoma group). No differences were found between groups regarding the number of passed stools, need for medication to open the bowel, evacuation difficulties, incontinence, and urgency. General well-being was significantly better in the no-stoma group (p = 0.033). Comparison with anorectal function at 1 year showed no further changes over time. The study was based on a limited sample size (n = 123) and formed a secondary end point of a randomized trial. Anorectal function was impaired for many patients, but the temporary presence of a defunctioning stoma after rectal resection did not affect long-term outcome. Anorectal function did not change between 1-year and 5-year follow-up.

Sa2044 Anal Incontinence, Sexual Complaints, and Anorectal Function in Patients With a Third Degree Anal Sphincter Rupture: Long Term Follow-up

Sa2044 Anal Incontinence, Sexual Complaints, and Anorectal Function in Patients With a Third Degree Anal Sphincter Rupture: Long Term Follow-up