Anorectal dysfunction after surgical treatment for cervical cancer.
BACKGROUND
Although bowel symptoms and complaints are common after radical hysterectomy, the effects of operation on anorectal function are incompletely understood. In this prospective pilot study we evaluated the incidence of bowel symptoms, changes in anorectal physiology, and quality of life after radical hysterectomy.


METHODS
Eleven women undergoing radical hysterectomy for early-stage cervical cancer completed bowel function symptom surveys and cancer-specific quality-of-life scales before operation and at 6 weeks and 6 months after operation. The bowel function symptom survey was also repeated at 18 months postoperation. Anorectal manometry, balloon defecation, and pudendal nerve latency tests were performed before the operation and 6 months postoperatively.


RESULTS
The mean age was 45.3 years (range 34 to 56 years), and four of the patients were postmenopausal. Resting and squeeze sphincter pressures, volume of saline infused at first leak, total volume retained, and threshold volume for maximum tolerable volume were all decreased significantly (p < 0.05) after operation. Pudendal nerve terminal motor latency increased (p < 0.05) bilaterally. There were no significant differences in sensory thresholds. At 18 months, two women reported constipation, six reported flatus incontinence, and two reported fecal incontinence. The total quality-of-life score declined at 6 weeks but then improved significantly by 6 months (p = 0.02).


CONCLUSIONS
Bowel dysfunction is common after radical hysterectomy. Many women exhibit manometric and subjective changes compatible with fecal incontinence.
Sood
Anil K
AK
Department of Obstetrics and Gynecology, and University of Iowa Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, USA.
Nygaard
Ingrid
I
Shahin
Mark S
MS
Sorosky
Joel I
JI
Lutgendorf
Susan K
SK
Rao
Satish S C
SS
D000328:Adult; D001003:Anal Canal / Q000503:physiopathology; D003248:Constipation / Q000209:etiology / Q000503:physiopathology; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008365:Manometry; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D012002:Rectal Diseases / Q000175:diagnosis / Q000209:etiology*; D012007:Rectum / Q000503:physiopathology; D002583:Uterine Cervical Neoplasms / Q000601:surgery*