Fecal Incontinence Associated with Radiotherapy for other Cancers

Several studies have shown that radical radiotherapy for both prostate cancer and bladder cancer is associated with an increased risk of fecal incontinence [21-24]. After 2 years, bowel frequency, fecal urgency, and fecal incontinence were increased in 50%, 47%, and 26% of patients, respectively [24]. These functional deficits were associated with a reduction in resting anal pressures, squeeze pressure, and rectal compliance [24].

With a medium observation time of 29 months after radical radiotherapy for urinary bladder cancer, about 55% of the patients experienced impairment in bowel function, including urgency, incontinence, and use of pads [22]. These changes had a moderate or severe impact on the performance of daily activity in 29% of patients. Physiological studies suggest that the impaired function, also for bladder cancer, is due to a combination of sphincter weakness and changes in rectal function.

For patients with cervical cancer treated with surgery and external radiotherapy, overall bowel dysfunction was the most important source of distress of any degree in a Swedish study [25]. In an Australian study, ten out of 15 patients who had pelvic irradiation for a gynecological cancer had urgency of defecation, and four suffered from fecal incontinence [26]. This dysfunction was also associated with reduction in anal canal pressures and changes in rectal function. There is a relationship between late anorectal dysfunction and dose-volume parameters from the rectum and anal canal [27].

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