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Effectiveness of Pelvic Floor Rehabilitation for Bowel Dysfunction After Intersphincteric Resection for Lower Rectal
Hideaki Nishigori1, Masayuki Ishii2, Yujiro Kokado2
1Colorectal and Pelvic Surgery Division, Shinko Hospital, Wakihamacho 1-4-47, Chuo Ward, Kobe City, Hyogo, 651-0072, Japan. nishigori.hideaki@shinkohp.or.jp.
Background:
The aim of this study was to evaluate the effectiveness of pelvic floor rehabilitation (PFR) for patients with bowel dysfunction after intersphincteric resection (ISR) and to compare the treatment response to that of patients after low anterior resection (LAR).
Methods:
Thirty patients with postoperative bowel dysfunction for more than 6 months were enrolled and treated with PFR for 6 months.
Results:
In the ISR group, significant improvements in the number of bowel movements and the use of antidiarrheal medications were observed, but no significant improvement was observed in the Wexner score (WS) and the fecal incontinence severity index (FISI). Meanwhile, in the LAR group, WS and FISI were better post-treatment than pre-treatment (WS: 10.7-5.7; p = 0.01, FISI: 28-11; p = 0.01). In the assessment of fecal incontinence quality of life (FIQL), only the Coping/Behavior category was improved in the ISR group (1.56 before, 2.16 after PFR; p = 0.01), while all four categories were improved significantly in the LAR group. The anorectal manometric examination showed no significant increase in sphincter pressure and the tolerable volume in patients after ISR.
Conclusions:
PFR improved several clinical symptoms of patients after ISR. Compared with patients after LAR, patients after ISR showed an insufficient response to PFR in improving fecal incontinence. Considering the result of the generalized assessment of the quality of life scale, PFR may offer a therapeutic effect for several symptoms of patients after ISR.
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