INTRODUCTION: Although the association of absent or attenuated "call to stool" with constipation is well-recognized, no studies have systematically evaluated the perception of urge to defecate in a well-defined cohort of patients with chronic constipation (CC). METHODS:A prospective study of 43 healthy adult women and 140 consecutive adult women attending a tertiary center for investigation of CC. All participants completed a 5-day viscerosensory questionnaire, and all women with CC also underwent anorectal physiologic investigations. Normal urge perception and abnormal urge perception were defined using a Naive Bayes model trained in healthy women (95% having normal urge). RESULTS:In total, 181 toilet visits in healthy women and 595 in women with CC were analyzed. Abnormal urge perception occurred in 70 (50.0%) women with CC. In this group, the urge to defecate was more often experienced as abdominal sensation (69.3% vs 41.4%; P < 0.0001), and the viscerosensory referral area was 81% larger (median pixels anterior: 1,849 vs 1,022; P < 0.0001) compared to women with CC and normal urge perception. Abnormal (vs normal) urge in women with CC was associated with more severe constipation (Cleveland Clinic constipation score: 19 vs 15 P < 0.0001), irritable bowel syndrome (45.7% vs 22.9% P < 0.0001), and a functional evacuation disorder on defecography (31.3% vs 14.3% P 5 0.023). A distinct pattern of abnormal urge was found in women with CC and rectal hyposensitivity.DISCUSSION:Abnormal urge perception was observed in 50% of women with CC and was frequently described as abdominal sensation, supporting the concept that sensory dysfunction makes an important contribution to the pathophysiology of constipation.

Purpose There remains uncertainty as to which risk factors are important for the development of defaecatory problems as a result of heterogeneity of published evidence. Understanding the impact of risk factors may be important in selecting targets for disease prevention or reversal. The aim of this study was to identify and evaluate risk factors for faecal incontinence and chronic constipation. Methods Risk factors for chronic constipation and faecal incontinence were long-listed from scientific literature, then anonymously evaluated (by 50 predominantly colorectal surgical experts from the UK Pelvic Floor Society) using a Delphi technique. Each risk factor was rated as independent, a co-factor, or not a risk factor. Independent risk factors were rated between 1 (not important) and 10 (critically important) with mean (± standard deviation) calculated. Results Thirty-eight risk factors for chronic constipation were evaluated. Eighteen were classed as independent and 16 as co-factors. Opioid analgesia (7.87 ± 2.05), eating disorders (7.80 ± 1.72), and history of abuse (7.70 ± 1.89) were scored as most important independent risk factors. Female sex (6.60 ± 2.02) was considered an independent risk factor but increasing age was rated a co-factor. Thirty-three risk factors for faecal incontinence were evaluated. Twenty were classed as independent and eight as co-factors. Third- or fourth-degree tear (8.88 ± 1.57), instrumental delivery (8.47 ± 1.58), and grand multiparity (8.00 ± 1.63) were rated most important. Increasing age (7.41 ± 2.14) and female sex (7.58 ± 2.05) were both considered independent risk factors. Conclusions Several risk factors for chronic constipation and faecal incontinence were selected by Delphi approach. These factors will feed forward into Bayesian models of disease prediction that combine data and expert knowledge.

Objectives Obesity is a global epidemic. Its clinical impact on symptoms of fecal incontinence (FI) and/or constipation and underlying anorectal pathophysiology remains uncertain. Methods Cross-sectional study of consecutive patients meeting Rome IV criteria for FI and/or functional constipation, with data on body mass index (BMI), attending a tertiary center for investigation between 2017-2021. Clinical history, symptoms and anorectal physiologic test results were analyzed according to BMI categories. Results 1,155 patients (84% female) were included in the analysis (33.5% normal BMI; 34.8% overweight; 31.7% obese). Obese patients had higher odds of FI to liquid stools (69.9 vs. 47.8%, OR 1.96 [CI: 1.43-2.70]), use of containment products (54.6% vs. 32.6%, OR 1.81 [1.31-2.51]), fecal urgency (74.6% vs. 60.7%, OR 1.54 [1.11-2.14]) urge FI (63.4% vs 47.3%, OR 1.68 [1.23-2.29]), and vaginal digitation (18.0% vs 9.7%, OR 2.18 [1.26-3.86]). Higher proportions of obese patients had Rome criteria-based FI or coexistent FI and functional constipation (37.3%, 50.3%) compared with overweight (33.8%, 44.8%) and normal BMI patients (28.9%, 41.1%). There was a positive linear association between BMI and anal resting pressure (β 0.45, R2 0.25, p=0.0003), though the odds of anal hypertension were not significantly higher after Benjamini-Hochberg correction. Obese patients more often had a large clinically significant rectocele (34.4% vs. 20.6%, OR 2.62 [1.51-4.55]) compared with normal BMI patients. Conclusion Obesity impacts specific defecatory (mainly FI) and prolapse symptoms and pathophysiologic findings (higher anal resting pressure, significant rectocele). Prospective studies are required to determine if obesity is a modifiable risk factor for FI and constipation.

Aims: The National Mastectomy and Breast Reconstruction Audit report (NMBRA, 2011)1 revealed that immediate implant-based breast reconstruction (IIBR) was the most common type of primary reconstruction performed in the UK (37%). The main reason given by clinicians for not offering immediate breast reconstruction was the need for adjuvant radiotherapy. Post-mastectomy radiotherapy (PMRT) decreases the rate of local recurrence as well as increase the long-term survival in patients who demonstrate intermediate to high-risk features2,3 but has been shown to increase the risk of implant complications in IIBR by up to 24% (Berry et al, 2010)4. Cordeiro et al (2004)5 showed the incidence of capsular contracture was 28% higher in the PMRT group compared with non-irradiated patients. Most patients in the UK receive hypofractionated PMRT of 40.05Gy in 15 fractions over 3 weeks based on the UK Standardisation of Breast Radiotherapy (START) trial6, which demonstrated that hypofractionated PMRT is as safe and effective as the conventional PMRT of 50Gy in 25 fractions over 5 weeks. The aim of this study was to determine whether the conventional PMRT of 50Gy in 25 fractions over 5 weeks (2Gy per fraction) was associated with a reduced risk of implant complications in patients undergoing mastectomy with IIBR compared with hypofractionated PMRT regiment of 40.05Gy in 15 fractions over 3 weeks (2.67Gy per fraction). Methods: A single centre retrospective review of data on patients who underwent IIBR followed by PMRT between September 2012 and May 2017 was conducted. Radiotherapy-related complications (surgical site infection, contracture, implant rupture or leakage, wound breakdown) were compared between the two groups of patients receiving conventional and hypofractionated PMRT. Results: Fifty-nine patients underwent IIBR followed by PMRT. Twenty-six patients received hypofractionated PMRT and thirty-three patients received conventional PMRT. Radiotherapy-related complications occurred in 62% of patients in the hypofractionated PMRT group compared with 45% in the conventional PMRT group (p = 0.30). The incidence of capsular contracture (31% in vs. 21%, p = 0.55) and wound breakdown (23% vs. 15%, p = 0.51) was higher in the hypofractionated PMRT group, but surgical site infection (SSI) was more common in the conventional group (4% vs. 6%, p = 1.00). Discussion: Possible confounding factors (BMI, smoking status, and adjuvant chemotherapy) were not analysed due to the small sample size and limitations of the retrospective nature of this study. However, our overall rate of SSI is low in comparison with national data from the NMBRA (2011), which states the SSI rate of 25% in patients who underwent breast reconstruction surgery. Conclusions: This study suggests that the rate of radiotherapy-related complications is lower in patients treated with conventional PMRT compared with hypofractionated PMRT, however the sample size is too small to demonstrate statistical significance. Further research is required to evaluate the effectiveness of conventional PMRT as an option to facilitate immediate implant-based reconstruction following mastectomy. Citation Format: Chaichanavichkij P, Arun KS, Conibear J, Ullah MZ. Post-mastectomy radiotherapy following immediate implant based reconstruction: A possible solution to a reconstructive challenge [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-10.

No abstract