Diagnostic Assessment

In patients submitted to RR for cancer, clinicians must dedicate attention in investigating defecation disorders. In fact, a variety of dysfunctions can occur considering the multifactorial etiology of FI in these patients, particularly when integrated therapies have been associated to surgery. Increased bowel frequency only or associated with fecal soiling or seepage should be of concern. Tenesmus is not infrequent, and incontinence to gas could coexist. In more severe cases, incontinence to liquid and/or solid feces is reported, up to many episodes per day, altering significantly daily activities and quality of life. FI severity index could be very high in these patients. Calculation of a specific score is usually useful not only to measure baseline FI severity but also to compare this to the condition reached after a given treatment. In each case, special efforts must be made to assess alteration of rectoanal sensitivity, and patients must be asked about their ability to distinguish gas from liquid and solid stools, defer defecation, and feel the bowel completely empty.

The aim of clinical examination is to investigate perianal/perineal scars, patulous anus, perineal soiling, anal ectropion, sphincter deficit, loss of perineal body, and perineal descent. During digital examination, resting and squeeze tones must be evaluated, whereas the puborectalis muscle needs to be assessed at rest, squeezing, and straining. Proctoscopy or, if necessary, colonoscopy is needed to ascertain absence of tumor recurrence or other bowel neoplasms. Physiology evaluation is of utmost importance. Anorectal manometry can offer information about alterations in resting and squeeze pressures, sphincter asymmetry by vector manometry, anomalies of rectoanal inhibitory reflex (sometimes absent, sometimes normal, sometimes not identifiable when resting pressure is very low), and rectal compliance. Assessment of rectal sensation (measuring threshold, urge, and maximum tolerated volumes) could be of help in interpreting pathophysiol-ogy in these patients. Endoanal ultrasound (or magnetic resonance, as an alternative) is mandatory to detect sphincter lesions. Electrophysiology study can investigate anal and rectal sensory and PNTML.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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