Solid Stool Incontinence Research Articles

Does routine partial lateral sphincterotomy with open hemorrhoidectomy improve postoperative pain?

Objective In this study we aimed to detect the difference regarding the postoperative pain and continence in patients with third and fourth degree hemorrhoidal disease who underwent either hemorrhoidectomy alone or combined hemorrhoidectomy with partial internal sphincterotomy for the treatment of hemorrhoidal disease. Patients and methods This prospective comparative randomized clinical trial was conducted at hospitals of Tanta University during the period from March 2021 to August 2022 on 100 patients with third or fourth degree hemorrhoids who were randomly assigned either to group A, patients who only underwent hemorrhoidal excision by the classical technique of Milligan–Morgan or group B, with added partial lateral sphincterotomy to the classic technique. All patients in both groups underwent anorectal manometry both preoperatively and postoperatively. Pain following surgery was analyzed by using visual analog scale system at 24 h, 48 h, and on 10th postoperative day, other complications including incontinence, infection, hematoma, bleeding, and anal stricture were evaluated at 24 h, 48 h, 10th postoperative day, 1 month, and after 3 months. Results Total 100 patients were divided among both groups. The mean age of the patients was 37.7±11.3 and 36.3±11.3 years in group A and group B, respectively. Thirty-two males and 18 females were in group A in comparison to 33 males and 17 females in group B. During follow-up periods, patients in group B had less postoperative pain than those in group A with statistically significant difference. None of the patients developed fecal incontinence for solid or liquid stools in both groups, except for nine patients developed only mild degree of incontinence for flatus in the first week that improved gradually till completely resolved before the end of the 3 months follow up. Conclusion The addition of partial internal sphincterotomy to the classical haemorrhoidectomy technique significantly improves postoperative pain without increasing overall related morbidity.

Tight Cutting Seton for Anal Fistulae Revisited

Abstract Background: Anal fistulas are a common medical problem affecting thousands of patients annually well over 2000 years. There are many new novel approaches to this old condition but none with overwhelming success and low complication rates. The aim of this retrospective review was to revisit our experience in the treatment of anal fistulas with a tight cutting seton. Objectives: Observational study of retrospective collected data. Design: Retrospective study. Patients and Methods: Between 2008 - 2018 a retrospective study included all patients with primary or recurrent fistulas who were treated using tight seton were analyzed. Main Outcome Measures: The primary outcomes measured were healing rate, procedure-related complications, and incontinence. Sample Size: The study included 41 cases of anal fistula treated with a tight cutting and complete records of follow-up. Results: Firty-one patients with a median age of 37.9 years with a median follow up of 14.37 months were identified and included in the study. Among these, 66% of the fistulas were primary and 34% persisting or recurrent fistulas. Fistulas were classified as trans-sphincteric in 71% of patients, inter-sphincteric in 20%, horseshoe in 7%, and extra-sphincteric in 2% of the patients. All patients were treated with a cutting seton. The total healing rate was 95%. Two patients developed a persistent fistula. Four patients (9.8%) complained of different degrees of incontinence. There were no incidents of solid stool incontinence. In one case, the cause of fecal incontinence was keyhole deformity which was resolved after a buried island transposition flap. Conclusion: Our study evaluates a series of patients who were treated by a single surgeon in nonrandomized studies, emphasizing that tight cutting seton technique first described by Hippocrates in 430 BCE is a simple, highly effective, and safe procedure that should not be abandoned. Limitations: This study has limitations, including its retrospective nature. We collected data for this study from electronic records and databases of patients after completion of followup. Conflict of Interest Statement: The authors declare that there is no conflict of interests in this study.

A comparison of faecal incontinence scoring systems.

Questionnaires designed to score the severity of faecal incontinence (FI) are widely used to provide an evaluation of symptoms across settings, studies and time. The Pelvic Floor Disorders Consortium have recommended the use of multiple questionnaires despite some overlap of questions. This study aimed to evaluate whether patient responses to these questionnaires are consistent. A retrospective analysis was undertaken of patients with FI who attended a dedicated pelvic floor unit between January 2018 and December 2019 and completed the Fecal Incontinence Severity Index, Cleveland Clinic Florida Incontinence Score and St Mark's Incontinence Score simultaneously. For each questionnaire the frequency of incontinence episodes to solid stool, liquid stool and gas was divided into five categories to allow direct comparison. Answers were deemed equivalent if the allocated response was identical, slightly different if the response was in an adjacent category or very different if the response differed to a greater extent. There were 193 patients who simultaneously completed all three FI questionnaires. There were statistically significant differences between the responses regarding frequency of solid stool, liquid stool and gas incontinence on all three questionnaires (p<0.005). Across all domains, between 58.0% and 69.9% of responses were equivalent, 14.1%-34.0% of answers were slightly different and 8.0%-18.8% were very different. Even when completed at the same time, and by the same person, similar questions are answered differently a significant proportion of the time. The utility of using multiple questionnaires simultaneously in the clinical setting to assess FI symptoms should be questioned.

Transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA) for ulcerative colitis: medium term functional outcomes in a single centre

BackgroundTransanal dissection of the rectum has been recently introduced for ileal pouch-anal anastomosis (IPAA) in UC showing promising results. Thanks to the precise identification of the rectotomy site the risk of long rectal stump is avoided, and a single stapled anastomosis is performed easily. The aim of this study is to analyze our initial experience of transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA), considering postoperative complications and medium-term functional outcomes.MethodsOur Center has experienced the transanal approach for proctectomy and IPAA since August 2018. All patients underwent Enhanced Recovery After Surgery (ERAS) protocol. Postoperative complications occurring within 30 days after surgery were taken into consideration. Fecal continence, genito-urinary activity and global quality of life at 1 and 6 months after ileostomy reversal have been assessed.ResultsUntil March 2019, 8 patients underwent transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA). In all cases the laparoscopic approach was performed during the transabdominal phase; abdominal drainage was never used. At the time of the pouch construction a defunctioning loop ileostomy was created in all patients. Stoma closure was performed in all cases at a median time of 6 months after surgery. Postoperative complications occurred in only one patient, who showed rectal bleeding, not required a re-invertation. There were no cases of anastomotic leakage. Medium-term functional outcomes were determined prospectively using previously validated quality of life questionnaires (Cleveland Global Quality of Life). Fecal incontinence for liquid or solid stool, genitourinary and sexual functions were also investigated, showing comparable results with the literature data.ConclusionsIn our experience, transanal proctocolectomy and ileal pouch-anal anastomosis provided good short and medium-term functional results in UC.

Effects of an anal fistula plug on anal function after surgery for treatment of a trans-sphincteric anal fistula.

The aim of this study was to evaluate the anal function in patients with trans-sphincteric anal fistulas who underwent an anal fistula plug procedure, and analyze risk factors that might affect post-operative anal function. This was an observational, retrospective study of patients diagnosed with trans-sphincteric anal fistulas and initially underwent anal fistula plug procedures between August 2008 and September 2012 at our institute. The analysis includes clinical characteristics, anal fistula healing, and the Wexner score for pre- and post-operative anal function (0 = no incontinence to 20 = complete incontinence). A total of 123 patients who had an adequate follow-up in the end were included. The median duration of follow-up was 8years (range 72-121months). The overall healing rate was 56% (69/123), and 33 (26.8%) patients had decreased anal function after surgery. The post-operative Wexner score on anal function was significantly higher than that before the operation (p < 0.001), as well as scores of gas, liquid stool, solid stool incontinence, and alteration in lifestyle (p < 0.05). Based on multiple logistic regression analysis, a high body mass index (p < 0.001) and long distance between the external opening and anal verge (p = 0.003) were significantly associated with a decline in post-operative anal function. As a sphincter-preserving technique for the treatment of anal fistulas, the anal fistula plug procedure might impair the anal function. Especially for patients with obesity or long distance between the external opening of anal fistula and anal verge, the reduced anal function is more likely to occur after treatment with anal fistula plug therapy.

Quality of life of patients with rectal cancer after surgical treatment

Objective: to analyze functional surgical outcomes in patients with distal rectal cancer and their quality of life at different time-points postoperatively.Materials and methods. This retrospective study included all patients with rectal cancer that underwent either abdominoanal resection of the rectum (with their sigmoid colon brought down into the anal canal) or low intraabdominal resection of the rectum with the formation of a mechanical coloanal anastomosis in Irkutsk Regional Oncology Dispensary between 1999 and 2012. Study participants were divided into two groups: the experimental group included patients who had low intraabdominal resection of the rectum, whereas the control group consisted of patients who had abdominoanal resection of the rectum. We evaluated 5-year survival and patients' quality of life (using the Wexner and FIQL scales).Results. One year postoperatively, 17 patients (25 %) from the control group had unsatisfactory sphincter function (Wexner score 11–20). Sixty-three patients from the control group (95 %) reported fecal incontinence of varying severity. In the experimental group, 40 patients out of 88 (45 %) that survived during the first year had normal sphincter function. The remaining patients had solid stool incontinence or inability to retain feces for a long time (Wexner score &lt;10).Conclusions. Low resections of the rectum ensured better functional outcomes and patients' quality of life than abdominoanal resections of the rectum did.

Secondary sphincter repair for anal incontinence following obstetric sphincter injury: functional outcome and quality of life at 18 years of follow‐up

Secondary sphincter repair has been the conventional management of anal incontinence (AI) when a structural defect in the sphincter is recognized. However, disappointing long-term results have contributed to a tendency towards an increasing use of alternative treatment methods. This study aimed to assess the long-term functional outcomes following a secondary sphincter repair in women with AI after obstetric sphincter injury. This is a questionnaire study of women who underwent a secondary sphincter repair in Denmark between January 1990 and December 2005. Patients were identified through the Danish National Patient Registry. Functional outcomes were assessed by a self-administered questionnaire in 2010 and 2018. Primary outcomes were Wexner and St. Mark's scores. Impact on quality of life was assessed using the Fecal Incontinence Quality of Life Scale. Functional outcome was assessed in 370 women in 2010 and 255 women in 2018. At 18.3[interquartile range (IQR 15.0-22.0)] years of follow-up, the mean ± SD Wexner score was 8.8 ±4.8 and the mean St. Mark's score was 11.7±5.0. Flatus incontinence was the most frequent symptom, reported by 97%. Incontinence for liquid and solid stools was reported by 75% and 54%, respectively. There were no significant changes in incontinence frequencies over time. Women with a Wexner scoreof ≥9 had a significantly lower quality of life score in all domains than did women with a Wexner scoreof <9 (P<0.001). At long-term follow-up, few patients are fully continent following a secondary sphincter repair. However, it appears that the functional results remain stable at very long-term follow-up.

The relationship of defecation symptoms and posterior vaginal wall prolapse in women undergoing pelvic organ prolapse surgery

Defecation symptoms are common among women with pelvic organ prolapse. However, the relationship between posterior vaginal wall prolapse and defecation symptoms remains debatable. Even though there is a plausible biomechanical rationale for posterior wall prolapse to cause obstructed defecation, previous studies have drawn contradictory conclusions regarding the association. We aimed to examine the association between posterior vaginal wall prolapse and defecation symptoms by assessing the following: (1) does prevalence of defecation symptoms increase along with posterior wall prolapse severity, (2) is postoperative symptom improvement greater in women who underwent posterior compartment procedures in comparison with those who did not, and (3) is symptom improvement related to the symptom's correlation with the degree of prolapse? We used data from a nationwide longitudinal cohort study with 3515 women undergoing pelvic organ prolapse surgery. We measured the prevalence of 9 defecation symptoms at baseline and at 6 and 24 months after surgery using the short form of the Pelvic Floor Distress Inventory. Baseline degree of prolapse was categorized in stages as defined by the Pelvic Organ Prolapse Quantification System. The relationship between the degree of posterior wall prolapse and prevalence of bothersome defecation symptoms was studied with logistic regression and adjusted for patient characteristics and severity of anterior wall and apical prolapse. Generalized estimating equations were used to assess the longitudinal change in symptom prevalence in groups of participants with and without repair for posterior vaginal compartment. Correlations between symptom improvement and symptom dependency on the degree of prolapse was assessed by calculating Pearson's correlation coefficient. The stage of posterior wall prolapse (stage 2 vs stage 0) correlated with splinting, straining, incomplete evacuation, fecal incontinence of liquid stool, pain during defecation, fecal urgency, and anorectal prolapse (adjusted odds ratios, 2.7, 2.1, 2.0, 1.5, 2.1, 1.4, and 2.2, respectively; P ≤ .007 for all). Flatal incontinence and fecal incontinence of solid stool were not associated with the severity of posterior vaginal wall prolapse. Obstructed defecation symptoms (splinting, straining, and incomplete evacuation) improved more in women undergoing posterior compartment surgery compared with women undergoing repair for other compartments. The greatest improvement at follow-up was observed for those symptoms that showed strongest association with the degree of prolapse at baseline. Obstructed defecation symptoms are dependent on the posterior wall anatomy. Women presenting with posterior wall prolapse, and these symptoms can expect to improve after surgery. Other defecation symptoms also improve after pelvic organ prolapse surgery, but they are not as specific to posterior wall anatomy as obstructed defecation symptoms.

Closed Lateral Internal Anal Sphincterotomy Under Local Anesthesia for Treatment Of Chronic Anal Fissure: Our 10 Years Experience

Background: Chronic anal fissure is one of the most frequent proctological disorders worldwide. Closed Lateral Internal Sphincterotomy (LIS) is one of the therapeutic options accepted as the treatment of choice for Chronic Anal Fissure (CAF) as it reduces the hypertonia of the internal anal sphincter, decreases anal pain, and allows the fissure to heal. LIS can be done under general anesthesia or local anesthesia. Aim of this study was to see the post operative outcome of closed LIS done under local anaesthesia. Materials and methods : This retrospective study was conducted in Department of Surgery of Chattogram Medical College hospital and some private hospitals of Chattogram city from January 2008 to December 2017. Total 550 patients of CAF who underwent closed LIS under local anesthesia were included. Atypical fissures associated with other disease were excluded. Results: The mean duration of hospital stay was 3.38 ± 1.2 hours. Sentinel skin tag was excised in 296 patients. The fissure was posterior in 73.63% patients and anterior in 7.81% patients. Recurrence was noted in 1.3% patients within four months. 63.27% patients experienced normal continence except occasional lack of fecal control postoperatively and only one patient developed gross incontinence of solid and liquid stool. Conclusion : This study concluded that closed LIS under local anaesthesia is the procedure of choice for management of CAF as it is cost effective and time saving.&#x0D; JCMCTA 2018 ; 29 (2) : 53-56

A surgical technique for secondary repair of obstetric anal sphincter injuries; sphinctero-vagino-perineoplasty.

Objective:This study was conducted to present the preliminary results of seven patients treated with sphinctero-vagino-perineoplasty for secondary repair of obstetric anal sphincter injuries.Materials and Methods:This retrospective study was conducted on the records of seven patients who underwent secondary repair of obstetric anal sphincter injuries at the colorectal surgery unit of a tertiary care center between February 2015 and December 2017.Results:All patients with solid stool incontinence were fully recovered at postoperative month 3. The Wexner incontinence score was significantly improved (decreased from 14.12 [range: 8-20] to 2.28 [range: 1-4]). The complication rate was 85.7% (wound infection, abscess, hematoma, detachment).Conclusion:Combined repair of anal sphinchters, perineal body, superficial transverse perineal muscles, and bulbospongious muscles, which contribute to anal continence, may improve surgical outcomes in patients with obstetric anal sphincter injuries.

Management of Complex Fistula in Ana with Fistulotomy and Stage Procedure

Background: Complex fistula in ano is a troublesome disease and is difficult to treat. Complex fistula in ano occurs in various forms like multiple external and/or internal openings, internal opening above the dentate line, external opening far away from anal verge, anterior tract etc. They are almost invariably recurrent and frequently associated with other systemic diseases like tuberculosis, inflammatory bowel disease, malignancy etc.A complex fistula in ano has various modalities of treatments like application of setons, fistulotomy or fistulectomy, endorectal advancement flap, anocutaneous advancement flap, fistula plug, fibrin glue, electrocauterization of tract/laser and ligation of intersphincteric fistula tract (LIFT).&#x0D; Objective: The purpose of the study is to evaluate the outcome of complex fistula in ano by fistulotomy and staged procedure.&#x0D; Methods: The study was held in Dhaka medical college Hospital and various private hospitals located in Dhaka and Brahmonbaria within duration of 8 years (from January, 2011 to January, 2018). Among 256 patients (221 male, 35 female) with median age 48 years (30 to 72 years) with the diagnosis of complex fistula in ano, 135 underwent fistulotomy with application of Seton with stage procedure. 121 patients underwent single stage fistulotomy. 158 patients had history of previous operations. After stage procedure, regular follow up was done every week until wound healing occurred.&#x0D; Result: Among 256 patients 121 patients (47%) underwent single stage, 133 (52%) patients underwent two stage and 2 patients underwent three stage procedure during the trial period. Majority of the patients had minor incontinence; that is flatus and/or loose stool incontinence. But they only persisted for an average of 10 to 16 days and subsided spontaneously. None of the patient had any major (solid stool) incontinence. 4 patients (2%) had recurrence of fistula on an average of 3-6 months after complete healing. Recurrence occurred in the form of abscess, automatically burst internally, recurrent fistula.2 patients developed bleeding after single stage procedure and was managed by cauterization.&#x0D; Conclusion: With adequate postoperative care and regular follow up, application of Seton with ‘staged procedure’ in cases of complex fistula in ano is very effective and has very minimal complications. Chance of major incontinence and recurrence is also less.&#x0D; J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 83-87

Cable Tie Seton in Surgical Treatment of High Perianal Fistula

Background: Seton is any string-like material which when tied through the fistula tract causes an inflammatory reaction which stimulates fibrosis that fixes and prevents retraction of the sphincter continuity when it is divided. In this way, it maintains sphincter continuity during cutting process. Aim of work: was to evaluate the cable tie seton technique in surgical treatment of high perianal fistula, regarding the rate of fecal incontinences and recurrence. Patients and Methods: This prospective study included a total of 20 cases having single tract, high perianal fistula, primary or recurrent and who were managed by cable tie seton from October 2016 till September 2017. Patients were enrolled from General Surgery Department, Al-Hussein Hospital. Patients were instructed to follow up weekly for 10 weeks with continuous tightening of the seton. Results: All the patients were followed up for the state of incontinence for flatus, liquid and solid stool and follow up for recurrence, slippage of cable: Incontinence: There is 3 cases noticed in early 2 weeks incontinent for flatus. Incontinence for liquid stool noticed in 2 cases in early 1 week. Incontinence for solid stool not noticed in our study. In all cases, the cable tie seton was kept in its position and didn’t dislodged or slipped. Conclusion: It could be concluded that cable tie seton is safe, low cost, ubiquitous, pragmatic, precise, and accost effective option for the treatment of high perianal fistula. We there for recommended it for treating fistula in ano requiring the placement of aseton. It does not carry the disadvantages of repeated anesthesia and visits to the operating theater and reduce the morbidity, inconvenience, and cost to the patient.

Cable Tie Seton in Surgical Treatment of High Perianal Fistula

Background: Seton is any string-like material which when tied through the fistula tract causes an inflammatory reaction which stimulates fibrosis that fixes and prevents retraction of the sphincter continuity when it is divided. In this way, it maintains sphincter continuity during cutting process. Aim of work: was to evaluate the cable tie seton technique in surgical treatment of high perianal fistula, regarding the rate of fecal incontinences and recurrence. Patients and Methods: This prospective study included a total of 20 cases having single tract, high perianal fistula, primary or recurrent and who were managed by cable tie seton from October 2016 till September 2017. Patients were enrolled from General Surgery Department, Al-Hussein Hospital. Patients were instructed to follow up weekly for 10 weeks with continuous tightening of the seton. Results: All the patients were followed up for the state of incontinence for flatus, liquid and solid stool and follow up for recurrence, slippage of cable: Incontinence: There is 3 cases noticed in early 2 weeks incontinent for flatus. Incontinence for liquid stool noticed in 2 cases in early 1 week. Incontinence for solid stool not noticed in our study. In all cases, the cable tie seton was kept in its position and didn’t dislodged or slipped. Conclusion: It could be concluded that cable tie seton is safe, low cost, ubiquitous, pragmatic, precise, and accost effective option for the treatment of high perianal fistula. We there for recommended it for treating fistula in ano requiring the placement of aseton. It does not carry the disadvantages of repeated anesthesia and visits to the operating theater and reduce the morbidity, inconvenience, and cost to the patient.

Cutting seton in management of complex perianal fistula – is it a safe procedure?

Objective The aim of this study was to evaluate the effectiveness, frequency of incontinence, and recurrence after treatment of complex perianal fistula with cutting seton. Background Cutting seton commonly is prescribed for complex perianal fistula, because it is simple and cheap, but high incontinence rates suggest that cutting seton can damage continence musculature. Patients and methods A study was carried out in Damanhur Medical National Institute Colorectal Unit from October 2013 to October 2016 and included 30 patients with complex anal fistula. Patients were treated with cutting silk seton. Patients were followed-up for tightening or change of seton and for observing complications like incontinence and recurrence. Results There were 24 male and six female. Mean age was 38 years. There were 14 high intersphincteric, 12 trans-sphincteric, and four suprasphincteric fistulas. Time taken for seton to cut through the fistulous tract varied from 4 to 10 weeks. Fistulas completely healed in 90% of the patients in 12 weeks. Recurrence of fistula developed in 10% of patients during the follow-up period. A total of six patients experienced minor incontinence, with two from each type of fistula in the study. Incontinence was to flatus in two patients and to liquid stool in four patients. There were no incidents of solid stool incontinence. Conclusion Use of cutting seton in treatment of complex perianal fistula is simple and cheap. This commonly used technique can damage continence musculature. Other techniques that do not cut the sphincter, when available, should be performed for higher fistula and anterior fistula in female.

Anal incontinence in Tunisian women: Prevalence and risk factors

The aim of this study is to determine the prevalence and risk factors of anal incontinence (AI), and to assess its impact on quality of life in Tunisian women. In this cross-sectional study, 402 women (321 nurses and 81 doctors) from 2 university hospitals were interviewed through a self-administered questionnaire. AI assessment was based on the Wexner score (SW) while the SF-12 score was used to assess quality of life. The data were evaluated by Chi 2 test and multiple logistic regression analysis. The prevalence rate of AI (SW ≥ 5) was 10.9% ( n = 44) with incontinence of liquid stool (56.8%) being more prevalent than flatus incontinence 41% and incontinence of solid stool (2.2%). The physical health was impaired in 54.5% of incontinent women, while the mental health was impaired in 72.7%. AI was significantly associated with the profession of nursery (OR = 3.3; 95% CI 1.1–11.2), history of obstetric tears (OR = 2.8; 95% CI 1.2–6.1), urinary incontinence (OR = 6; 95% CI 2–18), impaired physical health (OR = 2.5; 95% CI 1.2–5.5) and impaired mental health (OR = 2.7; 95% CI 1.2–6.1). Data on the prevalence of anal incontinence in women in Tunisia are scarce. AI affects approximately one of ten Tunisian women. The results emphasize the need for taking preventive measures for AI.

Prevalence of anal incontinence during pregnancy and 1 year after delivery in a cohort of primiparous women and a control group of nulliparous women

The aim of the study was to examine the prevalence of anal incontinence (AI) during pregnancy and 1 year after delivery in primiparous women and to compare it with the prevalences in nulliparous women. A validated questionnaire regarding AI was filled in by 1018 primiparous women after delivery and by 1836 nulliparous women (baseline). A similar questionnaire was filled in 1 year later by both groups. At baseline the prevalence of flatus incontinence was significantly higher in the primiparous than the nulliparous women (35 vs. 25%), while incontinence for liquid stools was significantly less frequent (8 vs. 20%). Prevalences of incontinence for solid stools were similar. One year later the prevalence of AI was similar in the two groups (flatus incontinence 24 vs. 25%, incontinence for liquid stools 18 vs. 19% and incontinence for solid stools 4 vs. 3%). AI 1 year after the delivery was not related to the mode of delivery. Women with grade 3 or 4 perineal lesions had a significantly higher prevalence of flatus incontinence 1 year after the delivery compared with women without such lesions (48 vs. 23%, p = 0.00). This prospective cohort study showed remarkably high prevalences of AI during pregnancy and 1 year after delivery in primiparous women and likewise in nulliparous women at baseline and 1 year later. These results may indicate that factors other than pregnancy and delivery are of importance for AI in young women.

Long-term anorectal, urinary and sexual dysfunction causing distress after radiotherapy for anal cancer: a Danish multicentre cross-sectional questionnaire study.

The objective of primary radiotherapy for anal cancer is to remove cancer while maintaining anorectal function. However, little is known about anorectal function among long-term survivors without colostomy. Using a cross-sectional questionnaire study, we examined symptoms and distress related to the dysfunction of pelvic organs after radiotherapy for anal cancer. A questionnaire regarding anorectal, urinary and sexual symptoms was sent to anal cancer patients without recurrence or colostomy, diagnosed during 1996-2003, and treated with curative intent (chemo)radiotherapy at three Danish centres. For each symptom we assessed frequency and severity and the level of symptom-induced distress (no, little, moderate or great distress). Of 94 eligible patients, 84 (89%) returned the completed questionnaire at a median of 33 months after radiotherapy. Incontinence for solid stools, liquid stools and gas occurred at least monthly in 31%, 54% and 79% of patients, respectively. Overall 40% of patients reported great distress from incontinence for solid or liquid stools at least monthly. Faecal urgency occurring at least monthly was experienced by 87% of patients and caused great distress in 43%. Stress, urge or another type of urinary incontinence occurred at least monthly in 45% and caused great distress in 21%. Urinary urgency occurred at least monthly in 48% but only caused great distress in 14%. Sexual desire was severely decreased in 58% and only 24% were satisfied with their sexual function. Distressing long-term anorectal and sexual dysfunction was common after radiotherapy for anal cancer, and morbidity due to urinary dysfunction was moderate.

Long-term effects of neoadjuvant chemoradiotherapy followed by sphincter-preserving resection on anal sphincter function in relation to quality of life among locally advanced rectal cancer patients: a cross-sectional analysis.

BackgroundThere is growing recognition for the consequences of rectal cancer treatment to maintain an adequate functional sphincter in the long-term rather than preserving the anal sphincter itself. This study aims to evaluate long-term effects of neoadjuvant chemoradiotherapy (nCRT) followed by sphincter-preserving resection on anal sphincter function in relation to quality of life (QoL) among locally advanced rectal cancer patients.MethodsTwenty-nine patients treated with nCRT followed by low anterior resection surgery were included in this study. Data on patient demographics, tumor location and symptoms of urgency and fecal soiling were recorded and evaluated with respect to Wexner Fecal Incontinence Scoring Scale, European Organization for Research and Cancer (EORTC) cancer-specific (EORTC QLQ-C30) and colorectal cancer-specific (EORTC QLQ-CR38) questionnaires and anorectal manometrical findings. Correlation of manometrical findings with Wexner Scale, EORTC QLQ-CR38 scores and EORTC QLQ-C30 scores was also evaluated.ResultsMedian follow-up was 45.6 months (ranged 7.5–98 months. Higher scores for incontinence for gas (p = 0.001), liquid (p = 0.048) and solid (p = 0.019) stool, need to wear pad (p = 0.001) and alteration in life style (p = 0.004) in Wexner scale, while lower scores for future perspective (p = 0.010) and higher scores for defecation problems (p = 0.001) in EORTC QLQ-CR38 were noted in patients with than without urgency. Manometrical findings of resting pressure (mmHg) was positively correlated with body image (r = 0.435, p = 0.030) and sexual functioning (r = 0.479, p = 0.011) items of functional scale, while rectal sensory threshold (RST) volume (mL) was positively correlated with defecation problems (r = 0.424, p = 0.031) items of symptom scale in EORTC QLQ-CR38 and negatively correlated with social function domain (r = −0.479, p = 0.024) in EORTC QLQ-C30. RST volume was also positively correlated with Wexner scores including incontinence for liquid stool (r = 0.459, p = 0.024), need to wear pad (r = 0.466, p = 0.022) and alteration in lifestyle (r = 0.425, p = 0.038).ConclusionThe high risk of developing functional anal impairment as well as the systematic registration of not only oncological but also functional and QoL related outcomes seem important in rectal cancer patients in the long-term disease follow-up.

Fecal Incontinence and Quality of Life in Adults With Rectal Cancer After Lower Anterior Resection.

The purpose of this study was to explore the prevalence of fecal incontinence (FI) and its impact on health-related quality of life in rectal cancer patients following low anterior resection surgery for colorectal cancer. Descriptive, cross-sectional study. Patients who were diagnosed with rectal cancer and underwent low anterior resection were recruited from a 1264-bed hospital in southern Taiwan. Potential participants were mailed a questionnaire survey. They were followed up 8 to 16 months postoperatively. Some clinical data were collected via retrospective review of their medical records. Questionnaires were mailed to 172 patients, and 71 with colorectal cancer underwent low anterior resection and agreed to participate and completed questionnaires in the research, reflecting a return rate of 41%. Data were collected on demographic characteristics and disease-related variables. Participants were asked if they had experienced FI during the past week. Fecal incontinence health-related quality of life was measured using the Cleveland Clinic Incontinence Score (CCIS) and the Fecal Incontinence Quality of Life Index. Completion of the questionnaire required approximately 15 minutes. More than half of the 71 participants (n = 45; 63.4%) experienced incontinence of flatus, 42.3% (n = 30) reported incontinence of liquid stool, and 14.1% (n = 10) stated that they experienced incontinence of solid stool. Based on mean CCIS scores, 35.2% (n = 25) experienced moderate to severe FI. One-third wore pads to contain FI and 21.1% changed daily activities because of FI. Nearly two-thirds reported FI during the week prior to completing the research questionnaire. The average Fecal Incontinence Quality of Life Index cumulative score was significantly lower in the FI group (2.62 ± 0.61) than in the without-FI group (3.32 ± 0.77; P < .001), as were all subscale mean scores (all P < .01-.001). Fecal incontinence is prevalent among persons undergoing low anterior resection for colorectal cancer. Persons with FI report poor health-related quality of life compared to persons who retained fecal continence. Health care providers should assess these patients for FI and treat or refer those who experience this common problem.

Re-evaluation of lateral subcutaneous sphincterotomy in treating anal fissure

Background: Anal fissure is a common disease and has a myriad of treatment options. The aim of this study was to re-evaluate lateral subcutaneous sphincterotomy in the treatment of anal fissure. Patients and Methods: We retrospectively studied143 patients with chronic anal fissure at King Abdulaziz University Hospital between March 1995 and April 2011, to determine the outcome of lateral subcutaneous sphincterotomy. These patients were studied using file data, operative notes, post operative course, OPD follow up. Variables studied were age, sex, nationality, History of previous surgery, recurrence, open or closed sphincterotomy, healing of wound, duration of healing [weeks], post op pain, post op bleeding, incontinence of flatus, liquid or solid stool, length of incontinence, duration of surgery, and weather admitted or treated as a day case. Results: In our study the youngest patient was 18 years old and the oldest 67 years old with mean age 42.5 years. Majority were females 65% and males 35%. Saudis were 52.4% and non Saudis were 47.5%. 55.4% of patients had previous surgery. Recurrence occurred in 5.4% of patients. 42.3% underwent closed surgery and 57.7% open surgery. Duration of operation was minimum 4 minutes and maximum 25 minutes with mean duration of 14.5 minutes. 11.9% of patients needed admission while 88.1% were treated as day case. Healing occurred in 72.8% while 27.2% did not have healing of wounds. Majority of wound healed in one week-57.6% and 18.4 had healing in two weeks while longest healing occurred in 52 weeks. Longest follow up was 180 weeks. Post op pain occurred in 50% of cases and no pain in 50% of cases. Post op bleeding occurred in 23.9% of patients. There was no incontinence in 80.4% of cases while 14.1 % of patients had incontinence of flatus, 4.3% of liquid stools 1% incontinence of solid stool. Length of incontinence was one to sixteen weeks. In 16.3% cases incontinence was resolved and in 3.2% cases it did not resolve. 73.9% of patients expressed satisfaction of treatment while 17.3% were partially satisfied and 8.6% patients were not satisfied with the treatment. Conclusion: Lateral sphincterotomy is a safe, effective treatment of anal fissure and evolving as a gold standard treatment for chronic anal fissure.