Causes of rectal incontinence after sphincter-preserving operations for rectal cancer

Diseases of the Colon and Rectum
I C OttoH Takagi

Abstract

Low anterior resection (LAR) is the treatment of choice for middle and high rectal tumors. Even though the rectal sphincter is preserved, some patients show a postoperative loss of rectal continence that may be recovered during follow-up. The purpose of this study was to collect clinical and manometric data before and after LAR to find possible explanations for incontinence. Seventeen continent patients with rectal tumors located 10 cm above the anal verge were selected. Manometry was performed before and three months after surgery and when stable frequency of bowel movement was achieved (mean, 7 months). Immediately after the operations, 14 of 17 patients showed a certain degree of incontinence but recovered during follow-up; at the end of the study, only two patients reported minor soiling. Resting and squeeze pressures were moderately reduced after surgery and increased during the following six months without regaining preoperative levels. Rectoanal inhibitory reflex was present in 94.4 percent of patients before the operations and in 25 percent of them after surgery, but it was not associated with incontinence. Rectal sensation was significantly reduced, and its recovery was well correlated with decrease in the frequency of...Continue Reading

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Nov 23, 2000·Diseases of the Colon and Rectum·S D Wexner, N A Rotholtz
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