Pelvic floor muscle training for bowel dysfunction following colorectal cancer surgery: A systematic review

Lin, Kun-You; Granger, Catherine L; Denehy, Linda; Frawley, Helena

doi:10.1002/nau.22654

Cited by 39 publications

(31 citation statements)

References 49 publications

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“…Dietary restrictions, high fibre consumption, and probiotics are advised, although no data support the benefit of those agents. For major LARS patients, additional procedures such as pelvic floor rehabilitation (in the form of biofeedback, electrostimulation, pelvic floor muscle training, and volumetric training) and transanal irrigation are available and of some benefit [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Can the POLARS tool accurately predict low anterior resection syndrome in rectal cancer patients undergoing laparoscopic resection?

et al. 2019

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Introduction: Radical rectal cancer resection can lead to a long-term bowel function impairment known as low anterior resection syndrome (LARS). It remains unclear how to determine which patients are at a higher risk of developing LARS post-surgery. The POLARS tool was designed to predict the onset and severity of LARS in rectal cancer patients after surgery. The study aimed to assess the accuracy of POLARS in predicting the onset of LARS. Material and methods: A total of 66 rectal cancer patients treated laparoscopically between January 2016 and December 2017 were included in this retrospective study. Using POLARS, the predictive value for the occurrence of LARS was documented. During an average 17-month follow-up period, the bowel function of the patients was assessed using the dedicated LARS questionnaire. The predicted and actual scores were then compared. Results: Study participants included 36 women (54.5%) and 30 men (45.5%), with a mean age of 62.55 years (SD 10.2; range 37-81). The mean predicted score according to POLARS was 24.5 (i.e. category "minor LARS"), and the mean actual score in the follow-up period was 16.42 ("no LARS" category). In only 39% of patients, the predicted LARS category was the same as the actual LARS category assessed by the questionnaire. Worse bowel function than reported at follow-up was predicted in 75% of all mispredictions. Conclusions: POLARS did not prove to be accurate in predicting the risk and severity of LARS in these patients, although the average numbers appear promising. Further evaluation of the POLARS tool using a larger cohort is needed.

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Section: Discussionmentioning

confidence: 99%

Can the POLARS tool accurately predict low anterior resection syndrome in rectal cancer patients undergoing laparoscopic resection?

et al. 2019

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“…the majority of studies reported significant improvements in stool frequency, incontinence episodes, severity of fecal incontinence, and health-related quality of life after pelvic floor muscle training and biofeedback. 15 however, a multimodal approach, performed managing with some rehabilitative techniques such as biofeedback, pelvic floor muscle training, electrostimulation, and volumetric/rectal balloon training according to the individual needs of the patient, could significantly improve symptoms 16 more than individual techniques alone. moreover, irradiated patients show short-and long-term training effects comparable to those of nonirradiated patients despite the higher degree of incontinence at baseline.…”

Section: Treatment Algorithmmentioning

confidence: 97%

Low Anterior Resection Syndrome

Martellucci

2016

Diseases of the Colon &Amp; Rectum

130

112

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f or almost 100 years abdominoperineal excision has been the standard treatment of choice for rectal cancer. however, as miles said, "the operation is a severe one. i do not think that it should be performed on those over 60 years of age; of 10 such cases all died. With regard to the remainder, of whom there were 36, 8 died from the effects of the operation, 4 have had recurrence, 2 died of intercurrent disease, while 22 are alive and well after periods varying from six months to six years." 1 the conviction that the quality of life for patients with a colostomy after abdominoperineal excision was poorer than for patients undergoing an operation with a sphincterpreserving technique has meant that, over the past 20 years, the anterior resection with preservation of the sphincter function has become the preferred treatment for rectal cancers, with the exception of those cancers very close to the anal sphincter.to date, also thanks to the multimodal treatment of rectal cancer, sphincter-preserving surgery with the restoration of bowel continuity to avoid a permanent colostomy is feasible in up to 80% of these patients. however, patients having sphincter-preserving operations may experience symptoms affecting their quality of life that are different from stoma patients and the question of whether the quality of life of people after anterior resection is superior to that of people after abdominoperineal excision/hartmann operation has yet to be answered.in fact, up to 80% of patients undergoing a low or very low anterior resection will experience postoperatively a constellation of symptoms including fecal urgency, frequent bowel movements, bowel fragmentation, emptying difficulties and incontinence, increased gas, collectively referred to as the low anterior resection syndrome (laRs).even if most of the functional impairments are clinically recovered by 6 to 12 months after the operation, longterm studies are now reporting the presence of adverse symptoms up to 15 years after resection. these long-term results suggest that after about 12 months, the symptoms of anterior resection syndrome are the result of permanent changes rather than short-lived neorectal irritability in the postoperative period. 2 Bowel dysfunction is a major problem with an immense impact on quality of life following sphincter-preserving resection, and the quality of life of patients who have had rectal cancer is closely associated with the severity of the laRs. 3 impaired bowel function is usually provoked by the variable association of colonic dysmotility, neorectal reservoir dysfunction, and anal sphincter or pelvic nerves damage.there are currently no specific treatments for anterior resection syndrome. management is empirical and symptom based, using existing therapies for fecal incontinence, fecal urgency, and rectal evacuatory disorders. moreover, rectal cancer specialists do not have a very thorough understanding of which bowel dysfunction symptoms truly matter to the patient after sphincter-preserving treatment, or how these symptoms affe...

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“…The immunohistochemical study of pelvic floor muscles had shown that female patients with POP or SUI have muscle fiber damage [10]. Changes in the pelvic floor muscles cause changes in their dominating muscles, which provides a morphological basis for nerve damage that can cause damage to the pelvic floor muscles [3,11,12]. Therefore, the damage of nerves of the female genitourinary tract was an important reason for POP and SUI in females.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of neuropeptide Y expression in pelvic tissue in patients with pelvic floor dysfunction

Zhang

Luo

2019

Open Life Sciences

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ObjectivesTo investigate the neuropeptide Y (NPY) expression in the tissue of pelvic floor ligament and anterior vaginal wall in female patients with pelvic organ prolapse (POP) and stress urinary incontinence (SUI).MethodSeventeen patients with POP, 6 with SUI, 13 with POP and SUI (POP&SUI), and 10 controls were included in this study from First Affiliated Hospital of JiNan University. Immunohistochemical assay was used to examine NPY expression in the tissue of round ligament, cardinal ligament of uterus, uterosacral ligament, and anterior vaginal wall. NPY expression were compared between POP, SUI, POP&SUI and controls.ResultsNPY was positive expressed in the round ligament, cardinal ligament of uterus, uterosacral ligament, and anterior vaginal subepithelial connective tissue. Compared with the control group, NPY expression in the round, cardinal, and uterosacral ligaments in patients with POP&SUI group was decreased with significant statistical difference (p<0.05). NPY expression in anterior vaginal wall was significantly decreased in POP, SUI, and POP&SUI groups compared to normal group (p<0.05). Compared to POP group, NPY expression in SUI and POP&SUI groups were significantly decreased (p<0.05), however the difference was not statistical different between SUI and POP&SUI groups (p>0.05). In POP and POP&SUI groups, the NPY expression in the cardinal ligament of uterus, uterosacral ligament, and anterior vaginal wall were negatively correlated with age (p<0.05), however, was not correlated with number of pregnancy, number of delivery, and BMI (p>0.05).ConclusionsNPY expression was reduced in the round ligament, cardinal ligament of uterus, Uterosacral ligament, and vaginal anterior wall of the patients with POP and SUI. The decreased NPY expression may play an important role in the development of pelvic floordysfunction.

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Pelvic floor muscle training for bowel dysfunction following colorectal cancer surgery: A systematic review

Cited by 39 publications

References 49 publications

Can the POLARS tool accurately predict low anterior resection syndrome in rectal cancer patients undergoing laparoscopic resection?

Can the POLARS tool accurately predict low anterior resection syndrome in rectal cancer patients undergoing laparoscopic resection?

Low Anterior Resection Syndrome

Clinical significance of neuropeptide Y expression in pelvic tissue in patients with pelvic floor dysfunction

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