Skip to main content
PMC home page
Gut logoLink to Gut
. 1998 Jul;43(1):123–127. doi: 10.1136/gut.43.1.123

Acute effects of therapeutic irradiation for prostatic carcinoma on anorectal function

E Yeoh 1, A Russo 1, R Botten 1, R Fraser 1, D Roos 1, M Penniment 1, M Borg 1, W Sun 1
PMCID: PMC1727195  PMID: 9771416

Abstract

Aim—The incidence of anorectal symptoms after radiotherapy (RTH) for localised pelvic malignant disease is unclear. In addition, the effects of pelvic irradiation on both anorectal motility and sensory function are poorly defined. A prospective study was therefore performed on 35 patients (55-82 years of age) with localised prostatic carcinoma before and four to six weeks after RTH to assess its effects on anorectal function. 
Methods—Anorectal symptoms were assessed by questionnaire. Anorectal pressures at rest and in response to voluntary squeeze, rectal distension, and increases in intra-abdominal pressure were evaluated with perfused sleeve side hole manometry. Rectal sensation was tested during graded balloon distension. Rectal compliance was calculated by the pressure-volume relation obtained during the testing of rectal sensation. Ultrasound was used to determine anal sphincter structure and integrity. 
Results—RTH had no effect on anal sphincter morphology. The frequency of defecation increased after RTH (7 (3-21) v 10 (3-56) bowel actions a week; p<0.01). After RTH, 16 patients had faecal urgency and eight faecal incontinence, compared with five and one respectively before RTH (p<0.01 for each). Basal and squeeze sleeve recorded pressures were reduced after RTH (54 (3) v 49(3) mm Hg (p<0.05) and 111 (8) v 102 (8) mm Hg (p<0.01), before and after RTH respectively; means (SEM)). Rectal compliance was reduced after RTH (1.2 v 1.4 mm Hg/ml, p<0.05). After RTH, threshold volumes for perception of rectal distension were lower in the 16 patients who either experienced faecal urgency for the first time (13 patients) or reported worsening of this symptom (three patients) compared with the remaining patients (34 (4) v 48 (5) ml respectively, p<0.05). 
Conclusion—Faecal incontinence (23%) is a common problem four to six weeks after RTH for prostatic carcinoma and is associated with minor reductions in anal sphincter pressures. The high prevalence of faecal urgency in patients after RTH may be related to alterations in rectal perception of stool. 



Keywords: anorectal function; radiotherapy; motility; manometry; incontinence

Full Text

The Full Text of this article is available as a PDF (120.1 KB).

Figure 1 .

Figure 1

Open in a new tab

Pressure along the anal canal. Changes in minimum basal (A) and squeeze plateau (B) pressure in patients before (open circles) and after (closed squares) radiotherapy. Values are mean (SEM). *p<0.05 v after radiotherapy. 


Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amdur R. J., Parsons J. T., Fitzgerald L. T., Million R. R. The effect of overall treatment time on local control in patients with adenocarcinoma of the prostate treated with radiation therapy. Int J Radiat Oncol Biol Phys. 1990 Dec;19(6):1377–1382. doi: 10.1016/0360-3016(90)90347-m. [DOI] [PubMed] [Google Scholar]
  2. Bagshaw M. A., Cox R. S., Hancock S. L. Control of prostate cancer with radiotherapy: long-term results. J Urol. 1994 Nov;152(5 Pt 2):1781–1785. doi: 10.1016/s0022-5347(17)32385-6. [DOI] [PubMed] [Google Scholar]
  3. Birnbaum E. H., Dreznik Z., Myerson R. J., Lacey D. L., Fry R. D., Kodner I. J., Fleshman J. W. Early effect of external beam radiation therapy on the anal sphincter: a study using anal manometry and transrectal ultrasound. Dis Colon Rectum. 1992 Aug;35(8):757–761. doi: 10.1007/BF02050325. [DOI] [PubMed] [Google Scholar]
  4. Carter H. B., Piantadosi S., Isaacs J. T. Clinical evidence for and implications of the multistep development of prostate cancer. J Urol. 1990 Apr;143(4):742–746. doi: 10.1016/s0022-5347(17)40078-4. [DOI] [PubMed] [Google Scholar]
  5. Fyles A., Keane T. J., Barton M., Simm J. The effect of treatment duration in the local control of cervix cancer. Radiother Oncol. 1992 Dec;25(4):273–279. doi: 10.1016/0167-8140(92)90247-r. [DOI] [PubMed] [Google Scholar]
  6. Gelfand M. D., Tepper M., Katz L. A., Binder H. J., Yesner R., Floch M. H. Acute irradiation proctitis in man: development of eosinophilic crypt abscesses. Gastroenterology. 1968 Mar;54(3):401–411. [PubMed] [Google Scholar]
  7. Hanks G. E., Leibel S. A., Krall J. M., Kramer S. Patterns of care studies: dose-response observations for local control of adenocarcinoma of the prostate. Int J Radiat Oncol Biol Phys. 1985 Jan;11(1):153–157. doi: 10.1016/0360-3016(85)90374-8. [DOI] [PubMed] [Google Scholar]
  8. Horowitz M., Harding P. E., Chatterton B. E., Collins P. J., Shearman D. J. Acute and chronic effects of domperidone on gastric emptying in diabetic autonomic neuropathy. Dig Dis Sci. 1985 Jan;30(1):1–9. doi: 10.1007/BF01318363. [DOI] [PubMed] [Google Scholar]
  9. Kearsley J. H. High-dose radiotherapy for localized prostatic cancer. An analysis of treatment results and early complications. Med J Aust. 1986 Jun 9;144(12):624–628. [PubMed] [Google Scholar]
  10. Morton R. A., Steiner M. S., Walsh P. C. Cancer control following anatomical radical prostatectomy: an interim report. J Urol. 1991 Jun;145(6):1197–1200. doi: 10.1016/s0022-5347(17)38574-9. [DOI] [PubMed] [Google Scholar]
  11. Orkin B. A., Hanson R. B., Kelly K. A., Phillips S. F., Dent J. Human anal motility while fasting, after feeding, and during sleep. Gastroenterology. 1991 Apr;100(4):1016–1023. doi: 10.1016/0016-5085(91)90277-r. [DOI] [PubMed] [Google Scholar]
  12. Pescatori M., Anastasio G., Bottini C., Mentasti A. New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum. 1992 May;35(5):482–487. doi: 10.1007/BF02049407. [DOI] [PubMed] [Google Scholar]
  13. Read M., Read N. W., Barber D. C., Duthie H. L. Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci. 1982 Sep;27(9):807–814. doi: 10.1007/BF01391374. [DOI] [PubMed] [Google Scholar]
  14. Sedgwick D. M., Howard G. C., Ferguson A. Pathogenesis of acute radiation injury to the rectum. A prospective study in patients. Int J Colorectal Dis. 1994 Apr;9(1):23–30. doi: 10.1007/BF00304295. [DOI] [PubMed] [Google Scholar]
  15. Sun W. M., Peck R. J., Shorthouse A. J., Read N. W. Haemorrhoids are associated not with hypertrophy of the internal anal sphincter, but with hypertension of the anal cushions. Br J Surg. 1992 Jun;79(6):592–594. doi: 10.1002/bjs.1800790642. [DOI] [PubMed] [Google Scholar]
  16. Sun W. M., Read N. W., Prior A., Daly J. A., Cheah S. K., Grundy D. Sensory and motor responses to rectal distention vary according to rate and pattern of balloon inflation. Gastroenterology. 1990 Oct;99(4):1008–1015. doi: 10.1016/0016-5085(90)90620-g. [DOI] [PubMed] [Google Scholar]
  17. Varma J. S., Smith A. N., Busuttil A. Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury. Br J Surg. 1985 Nov;72(11):875–878. doi: 10.1002/bjs.1800721107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Varma J. S., Smith A. N., Busuttil A. Function of the anal sphincters after chronic radiation injury. Gut. 1986 May;27(5):528–533. doi: 10.1136/gut.27.5.528. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Wasson J. H., Cushman C. C., Bruskewitz R. C., Littenberg B., Mulley A. G., Jr, Wennberg J. E. A structured literature review of treatment for localized prostate cancer. Prostate Disease Patient Outcome Research Team. Arch Fam Med. 1993 May;2(5):487–493. doi: 10.1001/archfami.2.5.487. [DOI] [PubMed] [Google Scholar]
  20. Whitmore W. F., Jr Localised prostatic cancer: management and detection issues. Lancet. 1994 May 21;343(8908):1263–1267. doi: 10.1016/s0140-6736(94)92156-3. [DOI] [PubMed] [Google Scholar]
  21. Wingo P. A., Tong T., Bolden S. Cancer statistics, 1995. CA Cancer J Clin. 1995 Jan-Feb;45(1):8–30. doi: 10.3322/canjclin.45.1.8. [DOI] [PubMed] [Google Scholar]
  22. Yeoh E. K., Horowitz M., Russo A., Muecke T., Robb T., Chatterton B. E. Gastrointestinal function in chronic radiation enteritis--effects of loperamide-N-oxide. Gut. 1993 Apr;34(4):476–482. doi: 10.1136/gut.34.4.476. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Yeoh E., Sun W. M., Russo A., Ibanez L., Horowitz M. A retrospective study of the effects of pelvic irradiation for gynecological cancer on anorectal function. Int J Radiat Oncol Biol Phys. 1996 Jul 15;35(5):1003–1010. doi: 10.1016/0360-3016(96)00147-2. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES