Original research
Improvement of Fecal Incontinence and Quality of Life by Electrical Stimulation and Biofeedback for Patients With Low Rectal Cancer After Intersphincteric Resection

https://doi.org/10.1016/j.apmr.2015.03.013Get rights and content

Abstract

Objective

To assess the efficacy and benefits of pelvic rehabilitation programs in terms of functional outcomes and quality of life for patients with fecal incontinence and defecation disorders after rectal cancer surgery.

Design

Prospective, observational study.

Setting

University hospital physiotherapy clinics.

Participants

Patients (N=32) who experienced fecal incontinence after sphincter-saving surgery with the intersphincteric resection (ISR) technique and could follow and cooperate with the treatment schedule were included in the present study.

Interventions

Pelvic rehabilitation programs included electrical stimulation (ES) and biofeedback (BF).

Main Outcome Measures

Functional results, Wexner score, and anorectal manometry were used to assess the clinical outcomes of rehabilitation treatment.

Results

Maximum squeeze pressure improved after rehabilitation training (P=.014). There were no statistical differences in resting pressure, resting muscle electromyography, and maximum squeeze electromyography (P=.061, P=.76, and P=.99, respectively). The mean stool frequency was 18.8 per 24 hours before the pelvic intervention program and 7.8 per 24 hours after ES and BF training (P<.001). Of the 32 patients, 27 required antidiarrheal medications before treatment, and after completion of the training, only 9 patients still needed antidiarrheal medications (P<.001). Significant improvements were observed in the Wexner score (17.74 vs 12.93; P<.001).

Conclusions

Our data show that ES and BF are effective in the treatment of fecal incontinence, leading to improvement of quality of life for patients with low rectal cancer after ISR.

Section snippets

Methods

Radical proctectomy with the ISR technique was performed in patients with low rectal cancer, which showed no external sphincter or levator ani muscle invasion. Patients who experienced frequent defecation, urgency, incomplete evacuation, stool fragmentation, or uncontrolled loss of stool after sphincter-saving surgery with the ISR technique were selected to undergo the present rehabilitation training program. Patients were excluded if they had the following conditions: anorectal injury after

Results

Between November 2009 and December 2013, 85 patients with very low rectal malignancy received a sphincter-saving operation by the ISR technique with hand-sewn coloanal anastomosis. There were 31 patients who received a laparoscopic procedure, and 54 patients had robot-assisted surgery. Thirty-two patients were included in the present study. The demographic characteristics of the patients are listed in table 1. There were 15 women (46.9%) and 17 men (53.1%), with a mean age of 56.5 years (range,

Discussion

More than 75% of patients receiving radical proctectomy and sphincter-saving surgery experience anorectal symptoms and defecatory disorders to some extent.10, 11, 12, 13, 14 These dysfunctions may result from irradiation effects on the anal sphincter, dysfunctional pelvic floor, and anal sphincter muscle after operation, autonomic nerve insult during operation, anatomic changes of the reservoir, adjuvant treatment, food intake, physical condition, or time interval after surgery.6, 13, 14, 15, 16

Conclusions

Our data show that NMES plus BF effectively improves both functional results and QOL for patients undergoing sphincter-saving rectal cancer resection. Large prospective randomized trials are needed to assess the long-term functional outcomes and clarify and standardize the result of pelvic rehabilitation programs.

Suppliers

  • a.

    Myomed 932; Enraf Nonius International.

  • b.

    SAS version 9.3; SAS Institute.

References (46)

  • R. Schiessel et al.

    Intersphincteric resection for low rectal tumours

    Br J Surg

    (1994)
  • M.G. Haddock et al.

    Patient assessment of bowel function during and after pelvic radiotherapy: results of a prospective phase III North Central Cancer Treatment Group Clinical Trial

    J Clin Oncol

    (2007)
  • A. Laforest et al.

    Functional disorders after rectal cancer resection: does a rehabilitation programme improve continence and quality of life?

    Colorectal Dis

    (2012)
  • J.S. Varma et al.

    Function of the anal sphincters after chronic radiation injury

    Gut

    (1986)
  • Q. Denost et al.

    Risk factors for fecal incontinence after intersphincteric resection for rectal cancer

    Dis Colon Rectum

    (2011)
  • N. Saito et al.

    Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy

    Dis Colon Rectum

    (2004)
  • R. Chamlou et al.

    Long-term results of intersphincteric resection for low rectal cancer

    Ann Surg

    (2007)
  • F. Bretagnol et al.

    Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer

    Dis Colon Rectum

    (2004)
  • J.H. Vironen et al.

    Impact of functional results on quality of life after rectal cancer surgery

    Dis Colon Rectum

    (2006)
  • C. Dumoulin et al.

    Pelvic floor rehabilitation, Part 2: Pelvic-floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women–a cohort study

    Phys Ther

    (1995)
  • J.M. Jorge et al.

    Etiology and management of fecal incontinence

    Dis Colon Rectum

    (1993)
  • J. Rothbarth et al.

    What is the impact of fecal incontinence of quality of life?

    Dis Colon Rectum

    (2001)
  • E.M. Bols et al.

    Responsiveness and interpretability of incontinence severity scores and FIQL in patients with fecal incontinence: a secondary analysis from a randomized controlled trial

    Int Urogynecol J

    (2013)
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    Disclosures: none.

    L.-J. Kuo and Y.-C. Lin contributed equally to this work.

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