Management of fecal incontinence after treatment for rectal cancer.

PURPOSE OF REVIEW: Anorectal dysfunction constitutes a major problem in patients surviving rectal cancer. In this review, the current options for management of fecal incontinence after treatment for rectal cancer are discussed. RECENT
FINDINGS: First line therapy should be conservative measures aimed at symptomatic control. Dietary regiments, fibers, constipating agents and enemas may be tried. Biofeedback is an option to strengthen the external anal sphincter, improve rectal sensitivity and coordinate pelvic floor muscles. Colonic irrigation has been successful to reduce symptoms and improve quality of life. Surgical interventions may be considered if conservative management fails. Sacral nerve stimulation is a successful minimal invasive procedure for the treatment of fecal incontinence; however, evidence of the method after treatment for rectal cancer is still limited. Complex surgical procedures should be limited to only highly selected patients. A stoma should be considered when other treatment modalities have failed.
SUMMARY: Systematic evaluation of the postoperative anorectal function in patients treated for rectal cancer should be a standard practice at every follow-up. An individually tailored treatment should be offered to the severely affected patients to minimize their symptoms. The evidence on the most commonly used treatments is sparse, therefore, further randomized controlled studies are needed.