title: Loose stools lead to fecal incontinence among gynecological cancer survivors.
abstract: BACKGROUND
  Many patients treated with radiotherapy to the pelvic region report a change in bowel habits. Loose stools, urgency and fecal incontinence may have a significant impact on daily life and social functioning.
  
  
  METHODS
  We attempted to follow up 789 women, treated with pelvic radiotherapy for a gynecological cancer during 1991 to 2003 at two departments of gynecological oncology in Sweden. A control group of 478 women from the Swedish Population Registry was also included. As a preparatory study, we made in-depth interviews with 26 women previously treated for gynecological cancer. Based on their narratives, we constructed a study-specific questionnaire including 351 questions and validated it face-to-face. The questionnaire covered questions of physical symptoms originating in the pelvis, demographics, psychological and quality of life factors. In relation to bowel symptoms, 60 questions were asked.
  
  
  RESULTS
  Six-hundred and sixteen (78%) gynecological cancer survivors and 344 (72%) control women participated. Two-hundred and twenty-six (37%) cancer survivors reported loose stools at least once a week. Eighty-three percent of the survivors with loose stools every day reported defecation urgency with fecal leakage, compared to 20% of cancer survivors without loose stools. Cancer survivors with loose stools at least once a week were 7.7 times more likely to suffer from defecation urgency with fecal leakage (95% CI 4.4-13.3) compared to those who had loose stools once a month or less. In order to avoid loose stools affected survivors with loose stools often skipped meals (13%), made an active choice of food (47%) and preferentially used prescribed medication (36%).
  
  
  CONCLUSIONS
  There is a relation between loose stools and defecation urgency with fecal leakage among long-term gynecological cancer survivors treated with pelvic radiotherapy. Targeting loose stools can possibly help survivors to decrease frequency of fecal leakage.
authors.affiliation: Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden. gail.dunberger@ki.se
authors.forename: Gail
authors.initials: G
authors.lastname: Dunberger
authors.forename: Helena
authors.initials: H
authors.lastname: Lind
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.forename: Ann-Charlotte
authors.initials: AC
authors.lastname: Waldenström
authors.forename: Erik
authors.initials: E
authors.lastname: Onelöv
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Avall-Lundqvist
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002277:Carcinoma / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation*; D003672:Defecation / Q000502:physiology*; D003967:Diarrhea / Q000150:complications* / Q000453:epidemiology; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data; D054928:Validation Studies as Topic