PURPOSE: There is no established treatment of choice for low anterior resection syndrome (LARS). To evaluate the efficacy of biofeedback therapy for objective improvement of pelvic function in LARS, we performed the present study. METHODS: The primary endpoint was the change of Wexner score. Consenting patients between 20 and 80 years old with major LARS at least 2 months after sphincter preserving proctectomy for rectal cancer were enrolled. After recommendation of biofeedback therapy, patients who accept it were enrolled in the biofeedback group and patients who refuse were enrolled in the control group. Initial and follow-up evaluations were performed and analyzed. RESULTS: Fifteen and sixteen patients were evaluated in the control group and the biofeedback group, respectively. There was no statistically significant difference of LARS score between both groups. Decrease in Wexner score and increase in rectal capacity were significantly higher in the biofeedback group (odds ratio [OR], 5.386; 95% confidence interval [CI], 1.194–24.287; P = 0.028 and OR, 1.061; 95% CI, 1.002–1.123; P = 0.042). CONCLUSION: Biofeedback therapy was superior for objective improvement of pelvic function to observation in LARS. It can be considered to induce more rapid improvement of major LARS.
Biofeedback, Psychology ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Manometry ; Postoperative Complications ; Rectal Neoplasms ; Rehabilitation

Intersphincteric resection (ISR) has been performed as an ultimate sphincter-sparing strategy in selected patients with low rectal cancer. Accumulating evidence suggests that ISR may be an interesting alternative to abdominoperineal resection to avoid a permanent stoma without compromising oncological outcomes. However, bowel dysfunction is a most common consequence of ISR not to be neglected. To date, limited clinical research has reported functional and quality of life outcomes according to patient-reported outcome measures. Also, data concerning management of low anterior resection syndrome are scarce due to lack of quality evidence. Therefore, this review provides an up-to-date summary of systematic assessment (including function, quality of life, manometry and morphology) and bowel rehabilitation for ISR patients. Postoperative anal function is often assessed by a combination of scales, including the Incontinence Assessment Scale, the Gastrointestinal Function Questionnaire, the Specific LARS Assessment Scale and the Faecal Diary. The condition-specific Quality of Life Scale is more appropriate for Quality-of-life measures in fecal incontinence after ISR. Patients' physiological function after ISR can be assessed using water- or high-resolution solid-state anorectal manometry. Anatomical and morphological changes can be assessed using defecography and 3D endorectal ultrasound. Electrical stimulation and biofeedback, pelvic floor exercises, rectal balloon training, transanal irrigation and sacral neuromodulation are all options for post-operative rehabilitation.
Humans ; Rectal Neoplasms/surgery* ; Postoperative Complications ; Anal Canal/surgery* ; Quality of Life ; Organ Sparing Treatments ; Fecal Incontinence

Fecal incontinence is one of the common diseases in the field of colorectal and anal surgery. Its etiology is complex, the treatment response is suboptimal, and there are controversies in clinical care. There is no consensus on the clinical practice of fecal incontinence in China currently. Launched by Anorectal Branch of Chinese Medical Doctor Association, Expert Committee on Anorectal Disease of Anorectal Branch of Chinese Medical Doctor Association, and Clinical Guidelines Committee of Anorectal Branch of Chinese Medical Doctor Association, and organized by the editorial board of Chinese Journal of Gastrointestinal Surgery, Chinese experts on this field were convened to write the Chinese expert consensus on clinical practice of fecal incontinence based on relevant references. After rounds of discussion, the final consensus combines the latest evidence and experts' clinical experience. This expert group suggested that a comprehensive assessment of fecal incontinence should be conducted before treatment, including medical history, relevant scales, physical examination and special examinations. Special examinations include anorectal endoscopy, anorectal manometry, transrectal ultrasound, magnetic resonance, rectal sensation and compliance, balloon ejection test, pelvic floor electromyography, defecography, colonoscopy and pudendal nerve terminal motor latency. Treatment methods include life style modification, medication, surgery, traditional Chinese medicine and other treatments. This consensus aims to standardize the algorithm of fecal incontinence management and improve therapeutic efficacy.
Humans ; Fecal Incontinence/etiology* ; East Asian People ; Manometry/adverse effects* ; Rectal Diseases/complications* ; Anal Canal/innervation*

Colonic and anorectal manometry includes anorectal manometry and colonic manometry. Anorectal manometry is a common method to evaluate anorectal function, which can objectively reflect the pathological and physiological abnormalities of outlet obstructive constipation and fecal incontinence, as well as the impact of anorectal surgery on continence. Colonic manometry is a new type of colon motility detection method developed in recent years. It can record the peristalsis and contraction of the whole colon through a pressure measuring catheter, which helps physicians further evaluate various colonic diseases. However, various factors such as testing equipment, operating standards, and evaluation parameters are difficult to unify. There is no consensus on the operation and interpretation of colorectal anal pressure measurement. Under the guidance of the Anorectal Branch of Chinese Medical Doctor Association, in collaboration with Clinical Guidelines Committee, Anorectal Branch of Chinese Medical Doctor Association, Anorectal motility disorders Committee , Colorectal Surgeons Branch of Chinese Medical Doctor Association, Colonic Branch of China international exchange and promotive association for medical and healthcare, Tianjin Union Medical Center is leading the organization of domestic experts in this field. Based on searching relevant literature and combining clinical experience at home and abroad, after multiple discussions, the "Chinese expert consensus on colonic and anorectal manometry" has been prepared. This consensus discusses the indications, contraindications, pre examination management and technical procedures, treatment of complications, and interpretation of examination reports for colonic and anorectal manometry , aiming to guide the standardized clinical practice of colonic and anorectal manometry.
Humans ; Rectum ; Consensus ; Constipation ; Anal Canal ; Rectal Diseases ; Fecal Incontinence ; Manometry/methods* ; Colorectal Neoplasms/complications*

BACKGROUND: The optimum surgical treatment for rectal prolapse is controversial, and many different operations have been described. The aim of this study is to evaluate the results of a perineal procedure for the treatment of rectal prolapse. METHODS: Between February 1990 and March 1997, 16 consecutive patients underwent perineal rectosigmoidectomy for a complete rectal prolapse. One patient was lost to follow up. The remaining 15 patients were followed up for an average of 58.4 (9~94) months, and clinical and functional outcomes were evaluated. RESULTS: There were 8 males and 7 females, and ages ranged from 18 to 65 years. The mean prolapse duration was 10.7 (0.25~30) years. There were no postoperative deaths. Two patients developed postoperative complications (one wound infection and the other wound hematoma). Five patients had fecal incontinence prior to surgery. Three of the five patients had improved fecal incontinence after the procedure. There were three recurrences (recurrence rate of 20%): one of them underwent a Delorme operation at our institution and others had no treatment. CONCLUSION: A perineal rectosigmoidectomy is a safe and effective operation for the primary treatment of rectal prolapse and has low mortality and morbidity.
Fecal Incontinence ; Female ; Humans ; Lost to Follow-Up ; Male ; Mortality ; Postoperative Complications ; Prolapse ; Rectal Prolapse* ; Recurrence ; Wound Infection ; Wounds and Injuries

PURPOSE: Total prolapse of internal hemorrhoids around the entire anal circumference still remains as a challenging problem. Whitehead's circumferential hemorrhoidectomy is one of the surgical options. To elucidate efficacy of Whiteheads operation, we analyzed the surgical outcomes of Whiteheads operation. METHODS: The medical records of 165 consecutive patients who underwent Whiteheads operation for end-stage hemorrhoids were retrospectively reviewed. The mean operation time, the mean blood loss, and the mean hospital stay were examined. Also the types of complications were identified. All patients were followed for extended periods and in May 2003 they were asked to appraise their satisfaction (mean follow-up duration was 45.5 months, 12~93 month range). RESULTS: The mean operation time was 21.5+/-5.3 minutes, the mean blood loss was 50.5+/-22.0 cc, and the average hospital stay was 5.5+/-1.5 days. Early postoperative complications were fecal incontinence (60.6%) and voiding difficulty (53.3%). These problems were spontaneously resolved within 2 weeks. Pain was the most difficult problem, and all patients required a parenteral opioid for relief of pain. The only late complication was anal stenosis. Objectively, anal stenosis was found in 66 patients; however, 22 patients (13.3%) complained of defecation difficulty. Among them, only 4 patients required surgical treatment. The average score of satisfaction according to the patients themselves was 4.0+/-2.2, 0 being no satisfaction and 5 being complete satisfaction. CONCLUSIONS: The Whitehead operation, if performed properly for the selected patients, still remains as one of the best surgical options for end-stage hemorrhoids.
Constriction, Pathologic ; Defecation ; Fecal Incontinence ; Follow-Up Studies ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Length of Stay ; Medical Records ; Postoperative Complications ; Prolapse ; Retrospective Studies

OBJECTIVETo investigate the factors associated with postoperative fecal incontinence after anorectal procedures.

METHODSA total of 1074 patients underwent anorectal procedures in the Department of Colorectal Surgery at the Coloproctology Hospital of Shenyang. Factors associated with postoperative fecal incontinence were analyzed retrospectively.

RESULTSFollow-up was available in all the patients. One hundred and forty-four(13.4%) patients developed mild incontinence, and 57(5.3%) moderate incontinence. There was no complete incontinence. The overall incontinence rate was 18.7%. The incontinence rate was 41.8%(107/256) after fistula procedures, higher than that after hemorrhoid procedures(12.4%,73/591) and fissure procedures(9.2%,21/227), and the differences were statistically significant (P<0.01). Among 490 patients who received injection therapy for internal hemorrhoids, patients who received 10 ml of Xiaozhiling or more had a mild incontinence rate of 10.4%(27/259) and a moderate incontinence rate of 2.3%(6/259), and in those who received less than 10 ml of Xiaozhiling, the mild incontinence rate was 9.5%(22/231) and moderate incontinence rate was 4.3%(10/231). The differences were not statistically significant (all P>0.05). In 354 patients who underwent hemorrhoidectomy, the mild incontinence rate and moderate incontinence rate were both 14.1% in those who had excision of 3 or more hemorrhoids, and were 3.9%(11/283) and 2.1% (6/283) in those who had excision of less than 3 hemorrhoids, and the differences were statistically significant (P<0.01). There was no difference in Incontinence rate was not associate with fistula or fissure procedure (P>0.05).

CONCLUSIONSThe incidence of incontinence is high after fistula procedures. Excision of hemorrhoids should not exceed 3 hemorrhoids. Wider adoption of injection therapy is encouraged.

Adult ; Anus Diseases ; surgery ; Fecal Incontinence ; etiology ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Retrospective Studies

PURPOSE: We designed this study to evaluate efficacy of sphincter repair and factors influencing in patients with postobstetric fecal incontinence. METHODS: Twenty-one patients (mean age 42 years; range 23~67) undergoing sphincter repair for postobstetric fecal incontinence (mean duration 12 years; range 6 months~46 years) were evaluated prospectively. Preoperatively, standardized interviews, anorectal manometry and measurement of pudendal nerve terminal motor latency (PNTML) were performed. Incontinence was graded according to the Parks' classification: Grade 1 - continence to stool and flatus; Grade 2 - incontinent to flatus, some urgency to stool present but no incontinence; Grade 3 - incontinent to liquid stool; Grade 4 - incontinent to formed stool. Sphincter repair methods were overlap repair of external anal sphincter (EAS) in 4 patients, overlap repair of EAS with anterior levatorplasty in 15 patients, and overlap repair of EAS with anterior levatorplasty and postanal repair in 2 patients. Anorectal manometry at 3 months, and interviews at 3 months and 6 months after sphincter repair were performed again. Patients' satisfaction was classified as excellent, good, fair, and no improvement. RESULTS: Difficulty in first delivery was noticed in 18 patients and history of previous sphincter repair was noticed in 5 patients. Preoperatively, most patients showed high grade incontinence (grade 3 in 13 and grade 4 in 8 patients). After sphincter repair, 18 patients (85.7%) became grade 1 or 2, and 16 patients (76.2%) replied their functional satisfaction excellent or good. There were no difference between the results at 3 months and 6 months. Poor functional outcome was in 2 of 3 patients with bilaterally prolonged preoperative PNTML. Short duration of incontinence and young age at the time of repair favored good results. Previous sphincter repair did not influence the outcome. Postoperatively both anal pressure and high pressure zone length were significantly increased in patients with improved continence Postoperative complications were wound infection in 2 patients and necrosis at the apex of the advancement skin flap in 1 case but these did not influence the outcome. CONCLUSIONS: Most postobstetric fecal incontinence can be successfully treated with sphincter repair. Excellent results are expected when the duration of incontinence is short and the patients are young. Pudendal neuropathy seemed to be related to poor outcome.
Anal Canal ; Classification ; Fecal Incontinence* ; Flatulence ; Humans ; Manometry ; Necrosis ; Postoperative Complications ; Prospective Studies ; Pudendal Nerve ; Pudendal Neuralgia ; Skin ; Wound Infection

Advances in surgical techniques and treatment concept have allowed more patients with low rectal cancer to preserve sphincter without sacrificing survival benefit. However, postoperative dysfunctions such as fecal incontinence, frequency, urgency, and clustering often occur in patients with low rectal cancer. The main surgical procedures for low rectal cancer include low anterior rectum resection (LAR), intersphincteric resection (ISR), coloanal anastomosis (Parks) and so on. The incidence of major LARS after LAR is up to 84.6%. The postoperative function of ISR is even worse than LAR. Moreover, the greater the extent of resection ISR surgery, the worse the postoperative function. There are few studies on the function of Parks procedure. Current evidence suggests that the short-term function of Parks procedure is inferior to LAR, but function can gradually recovered over time. Colorectal surgeons have attempted to improve postoperative defecation by modifying bowel reconstructions. Current evidence suggests that J pouch or end-to-side anastomosis during LAR does not reduce the incidence of defecation disorders. Pouch reconstruction during ISR cannot reduce the incidence of severe LARS either. In general, the protection of postoperative defecation function in patients with low rectal cancer still has a long way to go.
Anal Canal/surgery* ; Anastomosis, Surgical/adverse effects* ; Defecation ; Fecal Incontinence/etiology* ; Humans ; Postoperative Complications/epidemiology* ; Rectal Neoplasms/surgery*

PURPOSE: This study was done to compare clinical nurses' knowledge and visual differentiation diagnostic ability for the pressure ulcer classification system (PUCS) and incontinence-associated dermatitis (IAD). METHODS: A convenience sample of 602 nurses took the pressure ulcer classification system and incontinence-associated dermatitis knowledge test (PUCS & IAD KT) and completed the visual differentiation tool (VDT), consisting of 21 photographs with clinical information. RESULTS: The overall mean score for correct answers was 14.5 (+/-3.2) in PUCS & IAD KT and 11.15 (+/-4.9) in PUCS & IAD VDT. Incorrect responses were most common for statements related to stage III, IAD for PUCS & IAD KT, and suspected deep tissue injury (SDTI), unstageable, and stage III for PUCS & IAD VDT. Significant correlations were found between PUCS & IAD KT and VDT (r=.48, p<.001). Factors affecting scores for PUCS & IAD VDT were PUCS & IAD KT, frequency of pressure ulcer, IAD management and participation in wound care education programs. CONCLUSION: Results indicate that nurses have an overall understanding of PUCS & IAD, but low visual differentiation ability regarding stage III, SDTI, and unstageable ulcers. Continuing education is needed to further improve knowledge and visual differentiation ability for PUCS & IAD.
Adult ; Dermatitis/*classification/complications/pathology ; Education, Continuing ; Educational Measurement ; Fecal Incontinence/complications ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Nurses/*psychology ; Pressure Ulcer/*classification/pathology ; Questionnaires ; Urinary Incontinence/complications