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Rehabilitation of fecal incontinence after sphincter-saving surgery for rectal cancer: encouraging results.
Dis Colon Rectum. 2008 Oct; 51(10):1552-8.DC

Abstract

PURPOSE

Some patients, having undergone sphincter-saving operations for rectal cancer, may suffer from fecal incontinence. This study was designed to evaluate the results of rehabilitative treatment in patients with fecal incontinence after sphincter-saving operations and to identify the negative factors that influence therapeutic success.

METHODS

Between January 2000 and June 2007, 88 incontinent patients (54 women; age range, 47-73 years; 69 had received a low anterior rectal resection; 19 a straight coloanal anastomosis) were included in the study. After a preliminary clinical evaluation, including the Wexner Incontinence Scale score, anorectal manometry was performed. All 88 patients underwent rehabilitative treatment according to the "multimodal rehabilitative program" for fecal incontinence. At the end of program, all 88 patients were reassessed by means of a clinical evaluation and anorectal manometry; their results were compared with the clinical and manometric data from ten healthy control subjects. Postrehabilitative Wexner Incontinence Scale scores were used for an arbitrary schedule of patients divided into three classes: Class I, good (score </=3); Class II, fair (score >3 to </=6); Class III, poor (score >6).

RESULTS

After rehabilitation, there was a significant improvement in the overall mean Wexner Incontinence Scale score (P < 0.03) for both surgical operation types (low anterior rectal resection: P < 0.05; coloanal anastomosis: P < 0.02). Only 21 patients (23.8 percent) were symptom-free, and 37 (42 percent) were considered Class III. A significant postrehabilitative direct correlation was found between: 1) Wexner Incontinence Scale score and degree of genital relaxation (rrho (s) 0.78; P < 0.001); 2) Wexner Incontinence Scale score and irradiation (rrho (s) 0.72; P < 0.01); and 3) Wexner Incontinence Scale score and pelvic (rrho (s) 0.65; P < 0.01) or anal surgery (rrho (s) 0.68; P < 0.01). No significant differences were found between prerehabilitative and postrehabilitative anal pressures in low anterior rectal resection and coloanal anastomosis patients.

CONCLUSIONS

After rehabilitation, some patients become symptom-free, many patients show an improvement in the Wexner Incontinence Scale score, and others exhibit the highest grades of fecal incontinence. Genital relaxation, radiotherapy, and previous pelvic, and/or anal surgery are impeding factors to rehabilitative success.

Authors+Show Affiliations

Department of Medical and Surgical Critical Care, University of Florence, Viale Morgagni 85, 50134, Florence, Italy. pucciani@unifi.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18452041

Citation

Pucciani, Filippo, et al. "Rehabilitation of Fecal Incontinence After Sphincter-saving Surgery for Rectal Cancer: Encouraging Results." Diseases of the Colon and Rectum, vol. 51, no. 10, 2008, pp. 1552-8.
Pucciani F, Ringressi MN, Redditi S, et al. Rehabilitation of fecal incontinence after sphincter-saving surgery for rectal cancer: encouraging results. Dis Colon Rectum. 2008;51(10):1552-8.
Pucciani, F., Ringressi, M. N., Redditi, S., Masi, A., & Giani, I. (2008). Rehabilitation of fecal incontinence after sphincter-saving surgery for rectal cancer: encouraging results. Diseases of the Colon and Rectum, 51(10), 1552-8. https://doi.org/10.1007/s10350-008-9312-6
Pucciani F, et al. Rehabilitation of Fecal Incontinence After Sphincter-saving Surgery for Rectal Cancer: Encouraging Results. Dis Colon Rectum. 2008;51(10):1552-8. PubMed PMID: 18452041.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rehabilitation of fecal incontinence after sphincter-saving surgery for rectal cancer: encouraging results. AU - Pucciani,Filippo, AU - Ringressi,Maria Novella, AU - Redditi,Stefania, AU - Masi,Attilio, AU - Giani,Iacopo, Y1 - 2008/05/02/ PY - 2007/10/09/received PY - 2008/01/09/accepted PY - 2007/12/20/revised PY - 2008/5/3/pubmed PY - 2008/10/22/medline PY - 2008/5/3/entrez SP - 1552 EP - 8 JF - Diseases of the colon and rectum JO - Dis Colon Rectum VL - 51 IS - 10 N2 - PURPOSE: Some patients, having undergone sphincter-saving operations for rectal cancer, may suffer from fecal incontinence. This study was designed to evaluate the results of rehabilitative treatment in patients with fecal incontinence after sphincter-saving operations and to identify the negative factors that influence therapeutic success. METHODS: Between January 2000 and June 2007, 88 incontinent patients (54 women; age range, 47-73 years; 69 had received a low anterior rectal resection; 19 a straight coloanal anastomosis) were included in the study. After a preliminary clinical evaluation, including the Wexner Incontinence Scale score, anorectal manometry was performed. All 88 patients underwent rehabilitative treatment according to the "multimodal rehabilitative program" for fecal incontinence. At the end of program, all 88 patients were reassessed by means of a clinical evaluation and anorectal manometry; their results were compared with the clinical and manometric data from ten healthy control subjects. Postrehabilitative Wexner Incontinence Scale scores were used for an arbitrary schedule of patients divided into three classes: Class I, good (score </=3); Class II, fair (score >3 to </=6); Class III, poor (score >6). RESULTS: After rehabilitation, there was a significant improvement in the overall mean Wexner Incontinence Scale score (P < 0.03) for both surgical operation types (low anterior rectal resection: P < 0.05; coloanal anastomosis: P < 0.02). Only 21 patients (23.8 percent) were symptom-free, and 37 (42 percent) were considered Class III. A significant postrehabilitative direct correlation was found between: 1) Wexner Incontinence Scale score and degree of genital relaxation (rrho (s) 0.78; P < 0.001); 2) Wexner Incontinence Scale score and irradiation (rrho (s) 0.72; P < 0.01); and 3) Wexner Incontinence Scale score and pelvic (rrho (s) 0.65; P < 0.01) or anal surgery (rrho (s) 0.68; P < 0.01). No significant differences were found between prerehabilitative and postrehabilitative anal pressures in low anterior rectal resection and coloanal anastomosis patients. CONCLUSIONS: After rehabilitation, some patients become symptom-free, many patients show an improvement in the Wexner Incontinence Scale score, and others exhibit the highest grades of fecal incontinence. Genital relaxation, radiotherapy, and previous pelvic, and/or anal surgery are impeding factors to rehabilitative success. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/18452041/Rehabilitation_of_fecal_incontinence_after_sphincter_saving_surgery_for_rectal_cancer:_encouraging_results_ L2 - http://link.springer.com/article/10.1007/s10350-008-9312-6 DB - PRIME DP - Unbound Medicine ER -