Persisting anorectal dysfunction after rectal cancer surgery

Colorectal Dis. 2013 Nov;15(11):e672-9. doi: 10.1111/codi.12291.

Abstract

Aim: Sphincter-saving rectal cancer management affects anorectal function. This study evaluated persisting anorectal dysfunction and its impact on patients' well-being.

Method: Seventy-nine patients with a follow-up of 12-37 (median 22) months and 79 age- and sex-matched control subjects completed questionnaires.

Results: The median number of diurnal bowel movements was three in patients and one in controls (P < 0.0001). Nocturnal defaecation occurred in 53% of patients. The median Vaizey score was 8 in patients and 4 in controls (P < 0.0001). Urgency without incontinence was reported by 47% of patients and 49% of controls (P = 0.873), soiling by 28% of patients and 3% of controls (P < 0.0001), incontinence for flatus by 73% of patients and 49% of controls (P = 0.0019), and incontinence for solid stools by 16% of patients and 4% of controls (P = 0.0153). Incontinence of liquid stools occurred in 17 of 20 patients and in one of five controls who had liquid stools (P = 0.0123). Incontinence for gas, liquid or solid stool occurred once or more weekly in 47%, 19% and 6% of patients respectively. Evacuation difficulties were reported by 98% of patients, but also by 77% of controls. Neoadjuvant radio(chemo)therapy adversely affected defaecation frequency and continence. Incontinence was associated with severe discomfort in 50% of patients, severe anxiety in 40% and severe embarrassment in 48%.

Conclusion: Anorectal dysfunction is a frequent problem after management of rectal cancer with an impact on the well-being of patients.

Keywords: Rectal cancer; adverse effects in colorectal surgery; anorectal function; constipation; faecal incontinence; personal satisfaction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anal Canal / physiopathology*
  • Anal Canal / surgery*
  • Anastomosis, Surgical
  • Case-Control Studies
  • Colon / surgery*
  • Colonic Pouches
  • Defecation
  • Fecal Incontinence / etiology*
  • Fecal Incontinence / physiopathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Organ Sparing Treatments
  • Postoperative Complications / etiology*
  • Postoperative Complications / physiopathology
  • Quality of Life
  • Radiotherapy, Adjuvant
  • Rectal Neoplasms / radiotherapy
  • Rectal Neoplasms / surgery*
  • Surveys and Questionnaires