International Journal of Colorectal Disease

, Volume 28, Issue 4, pp 519–526

Impact of late anorectal dysfunction on quality of life after pelvic radiotherapy

  • Robin Krol
  • Robert Jan Smeenk
  • Emile N. J. T. van Lin
  • Wim P. M. Hopman
Original Article



Anorectal dysfunction is common after pelvic radiotherapy. This study aims to explore the relationship of subjective and objective anorectal function with quality of life (QoL) and their relative impact in patients irradiated for prostate cancer.


Patients underwent anal manometry, rectal barostat measurement, and completed validated questionnaires, at least 1 year after prostate radiotherapy (range 1–7 years). QoL was measured by the Fecal Incontinence Quality of Life scale (FIQL) and the Expanded Prostate Cancer Index Composite Bowel domain (EPICB)-bother subscale. Severity of symptoms was rated by the EPICB function subscale.


Anorectal function was evaluated in 85 men. Sixty-three percent suffered from one or more anorectal symptoms. Correlations of individual symptoms ranged from r = 0.23 to r = 0.53 with FIQL domains and from r = 0.36 to r = 0.73 with EPICB bother scores. They were strongest for fecal incontinence and urgency. Correlations of anal sphincter pressures, rectal capacity, and sensory thresholds ranged from r = 0.00 to r = 0.42 with FIQL domains and from r = 0.15 to r = 0.31 with EPICB bother scores. Anal resting pressure correlated most strongly. Standardized regression coefficients for QoL outcomes were largest for incontinence, urgency, and anal resting pressure. Regression models with subjective parameters explained a larger amount (range 26–92 %) of variation in QoL outcome than objective parameters (range 10–22 %).


Fecal incontinence and rectal urgency are the symptoms with the largest influence on QoL. Impaired anal resting pressure is the objective function parameter with the largest influence. Therefore, sparing the structures responsible for an adequate fecal continence is important in radiotherapy planning.


Quality of life Anorectal toxicity Anorectal function Prostate carcinoma External beam radiotherapy 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Robin Krol
    • 1
  • Robert Jan Smeenk
    • 2
  • Emile N. J. T. van Lin
    • 2
  • Wim P. M. Hopman
    • 1
  1. 1.455 Department of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenThe Netherlands
  2. 2.Department of Radiation OncologyRadboud University Medical CentreNijmegenThe Netherlands

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