Author:

Keywords:

Rectal surgery, faecal incontinence, anorectal dysfunction, rehabilitation, pelvic floor exercises, biofeedback, sacral nerve stimulation, Science & Technology, Life Sciences & Biomedicine, Gastroenterology & Hepatology, Surgery, SACRAL NERVE-STIMULATION, QUALITY-OF-LIFE, RETROGRADE COLONIC IRRIGATION, TOTAL MESORECTAL EXCISION, FECAL INCONTINENCE, ANTERIOR RESECTION, COLORECTAL-CANCER, BOWEL DYSFUNCTION, BIOFEEDBACK THERAPY, SURGERY, Colorectal Surgery, Fecal Incontinence, Female, Humans, Male, Postoperative Complications, Rectum, Rectal surgery fecal incontinence anorectal dysfunction rehabilitation pelvic floor exercises biofeedback sacral nerve stimulation, 1103 Clinical Sciences, 3202 Clinical sciences

Abstract:

AIM: Common problems after rectal resection are loose stools, faecal incontinence, increased frequency and evacuation difficulties, for which there are various therapeutic options. A systematic review was conducted to assess the outcome of treatment options aimed to improve anorectal function after rectal surgery. METHOD: Publications including a therapeutic approach to improve anorectal function after rectal surgery were searched using the following databases: MEDLINE, PubMed, EMBASE, Pedro, CINAHL, Web of Science, PsychInfo and the Cochrane Library. The focus was on outcome parameters of symptomatic improvement of faecal incontinence, evaluation of defaecation and quality of life. RESULTS: The degree of agreement on eligibility and methodological quality between reviewers calculated with kappa was 0.85. Fifteen studies were included. Treatment options included pelvic floor re-education (n=7), colonic irrigation (n=2) and sacral nerve stimulation (SNS) (n=6). Nine studies reported reduced incontinence scores and a decreased number of incontinent episodes. In 10 studies an improvement in resting and squeeze pressure was observed after treatment with pelvic floor re-education or SNS. Three studies reported improved quality of life after pelvic floor re-education. Significant improvement of the Fecal Incontinence Quality of Life Scale was found in three studies after SNS. CONCLUSION: Conservative therapies such as pelvic floor re-education and colonic irrigation can improve anorectal function. SNS might be an effective solution in selected patients. However, methodologically qualitative studies are limited and randomized controlled trials are needed to draw evidence-based conclusions.