title: Systematic review: anal and rectal changes after radiotherapy for prostate cancer.
abstract: OBJECTIVE
  Pelvic radiotherapy may lead to changes of anorectal function resulting in incontinence-related complaints. The aim of this study was to systematically review objective findings of late anorectal physiology and mucosal appearance after irradiation for prostate cancer.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane library were searched. Original articles in which anal function, rectal function, or rectal mucosa were examined ≥3 months after EBRT for prostate cancer were included.
  
  
  RESULTS
  Twenty-one studies were included with low to moderate quality. Anal resting pressures significantly decreased in 6 of the 9 studies including 277 patients. Changes of squeeze pressure and rectoanal inhibitory reflex were less uniform. Rectal distensibility was significantly impaired after EBRT in 7 of 9 studies (277 patients). In 4 of 9 studies on anal and in 5 of 9 on rectal function, disturbances were associated with urgency, frequent bowel movements or fecal incontinence. Mucosal changes as assessed by the Vienna Rectoscopy Score revealed telangiectasias in 73 %, congestion in 33 %, and ulceration in 4 % of patients in 8 studies including 346 patients, but no strictures or necrosis. Three studies reported mucosal improvement during follow-up. Telangiectasias, particularly multiple, were associated with rectal bleeding. Not all bowel complaints (30 %) were related to radiotherapy.
  
  
  CONCLUSIONS
  Low to moderate quality evidence indicates that EBRT reduces anal resting pressure, decreases rectal distensibility, and frequently induces telangiectasias of rectal mucosa. Objective changes may be associated with fecal incontinence, urgency, frequent bowel movements, and rectal bleeding, but these symptoms are not always related to radiation damage.
authors.affiliation: 455 Department of Gastroenterology and Hepatology, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Robin
authors.initials: R
authors.lastname: Krol
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: Smeenk
authors.forename: Emile N J T
authors.initials: EN
authors.lastname: van Lin
authors.forename: Eric E K
authors.initials: EE
authors.lastname: Yeoh
authors.forename: Wim P M
authors.initials: WP
authors.lastname: Hopman
mesh_terms: D001003:Anal Canal / Q000503:physiopathology* / Q000528:radiation effects*; D003672:Defecation / Q000528:radiation effects; D005242:Fecal Incontinence / Q000209:etiology; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000528:radiation effects; D008297:Male; D011312:Pressure; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011878:Radiotherapy / Q000009:adverse effects; D012007:Rectum / Q000503:physiopathology* / Q000528:radiation effects*; D013684:Telangiectasis / Q000209:etiology; D014456:Ulcer / Q000209:etiology