Skip to main content

Advertisement

SpringerLink
Log in

Physiologic Changes of the Anorectum After Pelvic Radiotherapy for the Treatment of Prostate and Bladder Cancer

  • Published:
Diseases of the Colon & Rectum

Abstract

INTRODUCTION: The effect of pelvic radiotherapy on anorectal function is not clearly documented and is investigated in this prospective study. METHODS: Thirty-one males (median age, 70 years) with carcinoma of the prostate (n = 28) and bladder (n = 3) completed proctitis/incontinence symptom score questionnaires and anorectal physiology studies before and six weeks after pelvic radiotherapy. At six months after completion of radiotherapy, 25 of these patients were studied again. The results were expressed as medians and ranges and compared by the Mann-Whitney U test (2-tailed). RESULTS: Six weeks and six months after treatment, respectively, the proctitis symptom scores (0 (0–4) vs. 2 (0–7) (P < 0.001) vs. 2 (0–5) (P < 0.001)) and the incontinence symptom scores (0 (0–5) vs. 4 (0–11) (P < 0.001) vs. 3 (0–14) (P < 0.001)) increased. Urgency, frequency of defecation, anorectal pain, incontinence to liquid stool and to flatus, and alteration in lifestyle were significant symptoms after treatment. The following measurements decreased: anal canal resting pressure (83 (35–137) vs. 79 (26–152) (P = NS) vs. 71 (29–97) (P < 0.01) cm H2O), the squeeze increment (152 (51–135) vs. 162 (63–321) (P = NS) vs. 108 (45–296) (P < 0.042) cm H2O), and the maximum tolerated rectal volume (245 (115–450) vs. 194 (112–344) (P < 0.05) vs. 200 (109–350) (P < 0.138) ml). The rectal electrosensory threshold increased (20 (5.4–44) vs. 22 (9–50.5) (P < 0.134) vs. 31.5 (13.6–76) (P < 0.001) mA). CONCLUSIONS: Anorectal symptoms at six weeks after pelvic radiotherapy are related to reduced rectal capacity and compounded at six months by diminished internal and external sphincter function and rectal mucosal sensitivity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. CJ Beard KJ Propert PP Rieker et al. (1997) ArticleTitleComplications after treatment with external-beam irradiation in early-stage prostate cancer patients J Clin Oncol 15 223–229

    Google Scholar 

  2. J Crook B Esche N Futter (1996) ArticleTitleEffect of pelvic radiotherapy for prostate cancer on bowel, bladder, and sexual function Urology 47 387–394

    Google Scholar 

  3. PC Koper JC Stroom WL van Putten et al. (1999) ArticleTitleAcute morbidity reduction using 3DCRT for prostate carcinoma Int J Radiat Oncol Biol Phys 43 727–734

    Google Scholar 

  4. GS Montana WC Fowler (1989) ArticleTitleCarcinoma of the cervix Int J Radiat Oncol Biol Phys 16 95–100

    Google Scholar 

  5. CA Perez PW Grigsby MA Lockett et al. (1999) ArticleTitleRadiation therapy morbidity in carcinoma of the uterine cervix Int J Radiat Oncol Biol Phys 44 855–866

    Google Scholar 

  6. DM Sedgwick GC Howard A Ferguson (1994) ArticleTitlePathogenesis of acute radiation injury to the rectum. A prospective study in patients Int J Colorectal Dis 9 23–30

    Google Scholar 

  7. RJ Amdur JT Parsons LT Fitzgerald RR Million (1990) ArticleTitleThe effect of overall treatment time on local control in patients with adenocarcinoma of the prostate treated with radiation therapy Int J Radiat Oncol Biol Phys 19 1377–1382

    Google Scholar 

  8. A Fyles TJ Keane M Barton et al. (1992) ArticleTitleThe effect of treatment duration in the local control of cervix cancer Radiother Oncol 25 273–279

    Google Scholar 

  9. SF Counter DP Froese MJ Hart (1999) ArticleTitleProspective evaluation of formalin therapy for radiation proctitis Am J Surg 177 396–398

    Google Scholar 

  10. EK Yeoh A Russo R Botten et al. (1998) ArticleTitleAcute effects of therapeutic irradiation for prostatic carcinoma on anorectal function Gut 43 123–127

    Google Scholar 

  11. JS Varma AN Smith A Busuttil (1986) ArticleTitleFunction of the anal sphincters after chronic radiation injury Gut 27 528–533

    Google Scholar 

  12. E Yeoh WM Sun A Russo L Ibanez M Horowitz (1996) ArticleTitleA retrospective study of the effects of pelvic irradiation for gynecological cancer on anorectal function Int J Radiat Oncol Biol Phys 35 1003–1010

    Google Scholar 

  13. GE Kim JJ Lim W Park et al. (1998) ArticleTitleSensory and motor dysfunction assessed by anorectal manometry in uterine cervical carcinoma patients with radiation-induced late rectal complication Int J Radiat Oncol Biol Phys 41 835–841

    Google Scholar 

  14. EH Birnbaum Z Dreznik RJ Myerson et al. (1992) ArticleTitleEarly effect of external beam radiation therapy on the anal sphincter Dis Colon Rectum 35 757–761

    Google Scholar 

  15. EH Birnbaum RJ Myerson RD Fry IJ Kodner JW Fleshman (1994) ArticleTitleChronic effects of pelvic radiation therapy on anorectal function Dis Colon Rectum 37 909–915

    Google Scholar 

  16. T Iwamoto S Nakahara R Mibu M Hotokezaka H Nakano M Tanaka (1997) ArticleTitleEffect of radiotherapy on anorectal function in patients with cervical cancer [published erratum appears in Dis Colon Rectum 1997;40:1298] Dis Colon Rectum 40 693–697

    Google Scholar 

  17. NA Talley F Chen D King M Jones NJ Talley (1997) ArticleTitleShort-chain fatty acids in the treatment of radiation proctitis Dis Colon Rectum 40 1046–1050

    Google Scholar 

  18. CJ Vaizey E Carapeti JA Cahill MA Kamm (1999) ArticleTitleProspective comparison of faecal incontinence grading systems Gut 44 77–80

    Google Scholar 

  19. ME Neill AG Parks M Swash (1981) ArticleTitlePhysiological studies of the anal sphincter musculature in faecal incontinence and rectal prolapse Br J Surg 68 531–536

    Google Scholar 

  20. R Miller DC Bartolo F Cervero NJ Mortensen (1988) ArticleTitleAnorectal sampling Br J Surg 75 44–47

    Google Scholar 

  21. MA Kamm JE Lennard-Jones (1990) ArticleTitleRectal mucosal electrosensory testing—evidence for a rectal sensory neuropathy in idiopathic constipation Dis Colon Rectum 33 419–423

    Google Scholar 

  22. EE Yeoh R Botten A Russo et al. (2000) ArticleTitleChronic effects of therapeutic irradiation for localized prostatic carcinoma on anorectal function Int J Radiat Oncol Biol Phys 47 915–924

    Google Scholar 

  23. GM da Silva M Berho J Efron et al. (2001) ArticleTitleHistological analysis of the anal sphincter after radiotherapy Colorectal Dis 3 56–924

    Google Scholar 

  24. T Lembo J Munakata H Mertz et al. (1994) ArticleTitleEvidence for the hypersensitivity of lumbar splanchnic afferents in irritable bowel syndrome Gastroenterology 107 1686–1696

    Google Scholar 

  25. NY Haboubi PF Schofield PL Rowland (1988) ArticleTitleThe light and electron microscopic features of early and late phase radiation-induced proctitis Am J Gastroenterol 83 1140–1144

    Google Scholar 

  27. AF Engel MA Kamm CI Bartram RJ Nicholls (1995) ArticleTitleRelationship of symptoms in faecal incontinence to specific sphincter abnormalities Int J Colorectal Dis 10 152–155

    Google Scholar 

  28. MG Read NW Read (1982) ArticleTitleRole of anorectal sensation in preserving continence Gut 23 345–347

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Royal Free and University College Medical School, and Meyerstein Institute of Oncology, The Middlesex Hospital, London, United Kingdom

    Rajeev S. Kushwaha M.A., M.R.C.S., Dickon Hayne F.R.C.S., Carolynne J. Vaizey M.D., F.R.C.S., Elisa Wrightham B.Sc.(Hons), Heather Payne M.R.C.P., F.R.C.R. & Paul B. Boulos M.S., F.R.C.S.

Authors
  1. Rajeev S. Kushwaha M.A., M.R.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dickon Hayne F.R.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carolynne J. Vaizey M.D., F.R.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elisa Wrightham B.Sc.(Hons)
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Heather Payne M.R.C.P., F.R.C.R.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul B. Boulos M.S., F.R.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Kushwaha, R.S., Hayne, D., Vaizey, C.J. et al. Physiologic Changes of the Anorectum After Pelvic Radiotherapy for the Treatment of Prostate and Bladder Cancer. Dis Colon Rectum 46, 1182–1188 (2003). https://doi.org/10.1007/s10350-004-6712-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-004-6712-0

Keywords

Search

Navigation