This paper introduces Professor HUANG Jinchang's experience in treating low anterior resection syndrome (LARS) of rectal cancer. Based on the clinical experience in treating fecal incontinence after rectal cancer surgery, Professor HUANG Jinchang proposes that the primary pathogenesis of LARS is spleen-kidney yang deficiency with internal obstruction of damp turbidity. The treatment approach should focus on strengthening the spleen, warming the kidney, and eliminating turbidity. The Baliao acupoints are specifically selected to eliminate turbidity, promote yang , facilitate the qi flow of the viscera, and regulate the opening and closing of the anus. Emphasis is placed on deep needling at the Baliao acupoints, with flexible acupoint selection based on accompanying symptoms. Additionally, moxibustion and bloodletting cupping are used to restore regular bowel movements and improve the quality of life for patients who have undergone anus-preserving surgery for rectal cancer.
Humans ; Rectal Neoplasms/therapy* ; Acupuncture Points ; Electroacupuncture ; Male ; Female ; Fecal Incontinence/etiology* ; Postoperative Complications/etiology* ; Middle Aged ; Yang Deficiency/therapy* ; Low Anterior Resection Syndrome

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*

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*

OBJECTIVETo observe the multiple symptom distribution, severity and quality of life of female pelvic floor dysfunction(FPFD) patients with constipation as chief complaint.

METHODSOne hundred FPFD patients with constipation as chief complaint from Speciaty Outpatient Clinic, Pelvic Floor Center of Nanjing Municipal Hospital of Traditional Chinese Medicine between September 2015 and February 2017 were retrospectively enrolled in this study. A comprehensive medical history questionnaire survey and systematical evaluation of severity and quality of life of these patients with constipation was conducted. Constipation scoring system scale (CSS) and patient-assessment of constipation quality of life questionnaire (PAC-QOL) were applied to evaluate the constipation. Other scales included: (1)pain visual analogue scale (VAS) and short form-36 questionnaire (SF-36): if combined with chronic functional anal rectal pain; (2) international consultation on incontinence questionnaire-short form (ICIQ-SF) and urinary incontinence quality of life questionnaires (I-QOL):if combined with urinary incontinence; (3) fecal incontinence severity score scale (Wexner-FIS) and fecal incontinence quality of life questionnaire (FI-QOL):if combined with fecal incontinence.

RESULTSThe mean age of 100 FPFD patients was (57.9±13.9) (24-89) years and the mean disease course was (7.0±8.2)(0.5-40.0) years. Seventy-five cases (75%) were complicated with anal pain, 70 with urinary incontinence, 37 with rectocele, 19 with nocturia, 11 with urinary frequency, 10 with defecation incontinence. Complication with only one symptom was observed in 20 cases (20%), and with two or more symptoms was observed in 80 cases (80%). Pelvic floor relaxation syndrome patients were dominant (58 cases, 58%). The severity of constipation (CSS) was 6-22 (13.89±3.79) points and the quality of life (PAC-QOL) was 45-133 (87.13±18.57) points in FPFD patients. VAS and SF-36 of patients combined with chronic functional anal rectal pain were 1-8 (3.0±1.9) points and 14.4-137.0(71.5±31.4) points respectively. ICIQ-SF and I-QOL of patients combined with urinary incontinence were 1-17 (6.1±3.6) points and 52-110 (90.0±15.8) points respectively. Wexner-FIS and FI-QOL of patients combined with fecal incontinence were 1-11 (4.4±3.0) points and 52-116 (83.4±23.3) points respectively.

CONCLUSIONSThe symptoms of FPFD patients with constipation as chief complaint are complex. They are mainly complicated with anal diseases, then urinary incontinence, and mostly with more than 2 symptoms. Their quality of life is poor.

Adult ; Aged ; Aged, 80 and over ; Constipation ; etiology ; Fecal Incontinence ; etiology ; Female ; Humans ; Middle Aged ; Pelvic Floor ; Pelvic Floor Disorders ; complications ; diagnosis ; Quality of Life ; Retrospective Studies ; Surveys and Questionnaires ; Young Adult

Adult ; Aged ; Electroacupuncture ; Fecal Incontinence ; etiology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; therapy ; Rectal Prolapse ; surgery ; Young Adult

INTRODUCTIONThe aim of the study was to determine if age at the creation of an ileal pouchanal anastomosis (IPAA) has an impact on the outcomes in patients with ulcerative colitis (UC).

MATERIALS AND METHODSA retrospective review of all patients who underwent IPAA for UC from 1999 to 2011 was performed. Long-term functional outcome was assessed using both the Cleveland Clinic and St Mark's incontinence scores.

RESULTSEighty-nine patients, with a median age of 46 (range, 16 to 71) years, formed the study group. The median duration of disease prior to their pouch surgery was 7 (0.5 to 39) years. There were 57 (64%) patients who were aged ≤50 years old and 32 (36%) who were >50 years old. Fifty-seven (64%) patients developed perioperative complications of which 51 (89.5%) were minor. High ileostomy output (n = 21, 23.6%) and urinary symptoms (n = 13, 14.6%) were the most commonly encountered complications. The older patients were more likely to have an ASA score ≥3 and a longer length of stay. Although there was a higher incidence of complications in the older group of patients, the difference was not statistically significant. There were no significant differences in the incidence of severe complications. Forty-nine (55%) patients completed our questionnaire on the evaluation of their functional outcomes. There were no significant differences in the Cleveland Clinic and St Mark's incontinence scores between the older (n = 19, 38.8%) and younger (n = 30, 61.2%) patients. There were also no significant differences in the frequency of bowel movements during the day or overnight after sleep between the 2 groups.

CONCLUSIONIPAA procedure for patients with UC can be safely performed. Long-term functional outcome is not significantly influenced by the age at which the IPAA was created.

Adolescent ; Adult ; Age Factors ; Aged ; Colitis, Ulcerative ; surgery ; Colonic Pouches ; Fecal Incontinence ; diagnosis ; epidemiology ; etiology ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications ; diagnosis ; epidemiology ; Proctocolectomy, Restorative ; Retrospective Studies ; Treatment Outcome ; Young Adult

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

OBJECTIVETo investigate the efficacy of biofeedback therapy for fecal incontinence in patients with mid or low rectal cancer.

METHODSTwenty-four patients with mid or low rectal cancer received biofeedback treatments after restorative resection and therapeutic efficacy was evaluated using anorectal manometry and Vaizey and Wexner scoring systems. Eighteen inpatients without defecating difficulties were selected as control group.

RESULTSThe parameters of anorectal manometry in patients with rectal cancer were significantly lower than those in the control group (P<0.01). After biofeedback therapy, the maximum squeeze pressure, resting pressure and maximum tolerated volume were significantly increased, from (118.3+/-42.9) mm Hg to (193.2+/-38.2) mm Hg, (27.8+/-9.0) mm Hg to (47.9+/-9.3) mm Hg,(97.5+/-52.8) ml to (189.1+/-39.0) ml, respectively (all P<0.01), while no significant difference in sensory threshold was observed (P=0.101). Post-treatment Vaizey (10.5+/-2.3 vs 12.9+/-2.8) and Wexner (7.5+/-2.5 vs 10.1+/-2.6) scores were significantly decreased compared with those before biofeedback (P<0.01).

CONCLUSIONBiofeedback therapy can improve the anal function in patients with rectal cancer after restorative resection.

Aged ; Anal Canal ; surgery ; Biofeedback, Psychology ; Fecal Incontinence ; etiology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Pressure ; Rectal Neoplasms ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo investigate the anorectal status in patients with lumbosacral spinal cord injury (SCI).

METHODSTwenty six patients (23 males, 3 females) with lumbosacral SCI and 13 normal volunteers were enrolled into this study as controls. The median age was 43.7 years (ranging 17-68 years) and the median time of patients since injury was 59.1 months (ranging 8 months-15 years). They were diagnosed as complete lumbosacral SCI (n =2, American Spinal Injury Association (ASIA) score A), or incomplete lumbosacral SCI (n=24, ASIA score B-D) with mixed symptoms of constipation and/or fecal incontinence, and were studied by anorectal manometry. None of the patients had any medical treatments for neurogenic bowel prior to this study.

RESULTSThe maximum anal resting pressure in lumbosacral SCI patients group was slightly lower than that in control group (One-way ANOVA: P=0.939). During defecatory maneuvers, 23 of 26 (88.5%) patients with lumbosacral SCI and 1 of 13 (7.7%) in the control group showed pelvic floor dysfunction (PFD) (Fisher's exact test: P<0.0001). Rectoanal inhibitory reflex (RAIR) was identified in both patients with lumbosacral SCI and the controls. The rectal volume for sustained relaxation of the anal sphincter tone in lumbosacral SCI patients group was significantly higher than that in the control group (Independent-Samples t test: P<0.0001). The mean rectal volume to generate the first sensation was 92.7 ml+/-57.1 ml in SCI patients, 41.5 ml+/-13.4 ml in the control group (Independent-Samples t test: P<0.0001).

CONCLUSIONSMost of the patients with lumbosacral SCI show PFD during defecatory maneuvers and their rectal sensation functions are severely damaged. Some patients exhibit abnormal cough reflex. Anorectal manometry may be helpful to find the unidentified supraconal lesions. RAIR may be modulated by central nervous system (CNS).

Adolescent ; Anal Canal ; physiopathology ; Constipation ; etiology ; physiopathology ; Fecal Incontinence ; etiology ; physiopathology ; Female ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Rectum ; physiopathology ; Sacrum ; injuries ; Sensation ; Spinal Cord Injuries ; complications ; physiopathology

OBJECTIVETo evaluate the bowel control of the anus-preserving operation for elderly patients over 75 years with low rectal cancer.

METHODSThirty-nine elderly patients over 75 years with low rectal carcinoma (4-7 cm from anal verge) were treated during the study period. The patients were divided into different groups according to the surgical procedures and anastomotic locations. The bowel control and patients satisfaction were compared.

RESULTSThe time of recovering normal defecation frequency was (9.8+/- 2.9) months. There were no differences in bowel control and anorectal manometric findings between the lower anastomosis group and super-lower anastomosis group, the lower anastomosis group and anorectal anastomosis group. The patients in anorectal anastomosis group displayed significantly better bowel control and anorectal manometric findings than those in the super-lower anastomosis group (P< 0.05). The time of recovering normal defecation frequency in colonic J-pouch-anal anastomosis group was (7.7+/- 1.7) months, shorter than (10.6+/- 2.8) months in direct anastomosis group (P< 0.01). The complication rate of I degree incontinence was 36.1%, but there was no difference between the two groups. The anorectal manometric findings were better in J-pouch-anal anastomosis group than those in direct anastomosis group (P< 0.05).

CONCLUSIONColonic J-pouch-anal anastomosis for lower rectal carcinoma can significantly improve the bowel control in a short term without increasing the complication rate.

Aged ; Aged, 80 and over ; Anal Canal ; surgery ; Anastomosis, Surgical ; Defecation ; Fecal Incontinence ; etiology ; Female ; Humans ; Male ; Postoperative Period ; Rectal Neoplasms ; physiopathology ; surgery