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Faecal Incontinence
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
P. Ronan O’Connell, Thomas Dudding
Pelvic radiotherapy can cause damage to the anal sphincters if they are included in the field of irradiation. Although the sphincters may be structurally intact, there will often be a functional deficit following the use of radiotherapy for rectal cancer, prostate cancer and for anal carcinoma. The development of radiation proctitis can lead to diarrhoea, mucous production and reduced rectal compliance, which may precipitate or exacerbate incontinence in those with co-existing anal sphincter disruption.
Complications of External-Beam Radiation Therapy
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
Acute radiation proctopathy, by definition, occurs during and up to six weeks after completion of radiation therapy. Patients may experience urgency, tenesmus, increased frequency of bowel movements, occasional diarrhea, or hemorrhoidal bleeding (22). Chronic radiation proctitis is defined when clinical symptoms persist or appear 6 to 12 months after the conclusion of radiation therapy. Symptoms of chronic radiation proctitis are the result of the pathophysiologic changes occurring in the rectum. Hematochezia or rectal bleeding is the most common symptom and occurs as a result of rupture of the fragile radiation-induced telangiectasias, as well as oozing from friable ischemic mucosa, as shown in Figure 3B. This can be particularly serious for patients on warfarin or other anticoagulants, and rectal bleeding can be severe enough to result in significant anemia and the necessity of transfusions. In a recent study, only patients on anticoagulants developed chronic rectal bleeding, (Anthony V. D’Amico, personal communication) as shown in Figure 4.
Colon, rectum and anus
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Take a general colorectal history and anorectal history. Determine the type of bleeding, the timing and the amount. Determine whether the blood is separate from the stool or mixed in. Is the blood bright red or dark? Is there pain associated with the passage of blood? Haemorrhoids are associated with bright red rectal bleeding separate from the stool or coating it, on the paper or dripping into the toilet. Bleeding is usually painless and may be associated with prolapsing haemorrhoids.Anal fissure is associated with a smear of bright red blood on the paper and pain on defaecation.Rectal prolapse is associated with a serosanguinous discharge and the prolapse.Inflammatory bowel disease is usually associated with blood mixed in with stool, which may be loose or diarrhoea. It is associated with frequent, loose, bloody stools and the presence of mucopus in more severe cases. Systemic disturbance, abdominal pain, malaise and weight loss may also be features.Tumours vary in their presentation, depending on the site of the tumour and the rate of bleeding. Tumours near the anus tend to present with bright red bleeding similar to haemorrhoids. More proximal tumours may present with dark red bleeding, while caecal tumours may be insidious and only present with iron-deficiency anaemia.Diverticular disease or angiodysplasia may present with a history or episodes of brisk rectal bleeding of large amounts or with the passage of a large dark red stool. This bleeding usually stops and stools return to normal before the next episode.Ischaemic colitis is associated with left-sided abdominal pain and blood-stained diarrhoea in elderly patients with evidence of atherosclerosis or previous aortic aneurysm repair.Radiation proctitis patients have a history of radiotherapy, possibly following resection of a rectal carcinoma.
Potential applications of drug delivery technologies against radiation enteritis
Published in Expert Opinion on Drug Delivery, 2023
Dongdong Liu, Meng Wei, Wenrui Yan, Hua Xie, Yingbao Sun, Bochuan Yuan, Yiguang Jin
Radiation proctitis is the most common clinical adverse reaction for patients receiving radiotherapy as part of the standard course of treatment for ovarian, prostate, and colon cancers. Preventive treatment protects the gastrointestinal tract from the deleterious effects of radiation therapy, improving the quality of patient life. Rectal administration is preferred due to the direct drug delivery to the lesion site of the rectum, increasing the concentration of drugs to alleviate the symptoms of radiation proctitis. Glycosaminoglycan (GAG), a highly anionic polysaccharide prepared by chemical sulfation of HA, has anti-inflammatory properties but a short retention time in the gut. Silk elastin-like protein polymers (SELPs) and semi-synthetic GAG composite rectal in situ injectable gels were prepared, which were temperature sensitive with liquid injection and converted to a solid hydrogel at the rectum. The residence time of GAG increased at the rectum, facilitating its diffusion into the rectal lumen. The hydrogel remarkably alleviated the radiation-induced abdominal pain of mice. It is a promising prevention and treatment of radiation proctitis (Figure 3) [119].
Completion surgery after chemoradiotherapy for cervical cancer – is there a role? UK Cancer Centre experience of hysterectomy post chemo-radiotherapy treatment for cervical cancer
Published in Journal of Obstetrics and Gynaecology, 2019
Sarah L. Platt, Amit Patel, Pauline J. Humphrey, Hoda Al-Booz, Jo Bailey
Clinical notes were reviewed to assess for the medium and long-term post-treatment complications. Most of the patient-reported symptoms and side-effects were bowel and urinary problems. Of the 7/15 patients with bowel symptoms: three had chronic diarrhoea necessitating a regular anti-diarrhoeal medication, one had normal investigations following an episode of rectal bleeding, two had a radiation proctitis diagnosed at colonoscopy, and one had an entero-vesical fistula requiring a defunctioning ileostomy. This last patient also had a vesico-vaginal fistula requiring an ileal conduit at the same surgical intervention. Five other patients had urinary complications: one had a resolving urinary incontinence, two had a urinary urgency and a haematuria confirmed as radiation cystitis at cystoscopy, and two had a urological intervention for a ureteric fibrosis with retrograde stents in one case and nephrostomy in the other case. Three patients reported chronic pelvic and back pain symptoms, one secondary to a sacral fracture. Additionally, two patients reported anxiety and depression symptoms, whilst one patient reported an ongoing fatigue.
Mechanisms of inflammatory responses to radiation and normal tissues toxicity: clinical implications
Published in International Journal of Radiation Biology, 2018
Masoud Najafi, Elahe Motevaseli, Alireza Shirazi, Ghazale Geraily, Abolhasan Rezaeyan, Farzad Norouzi, Saeed Rezapoor, Hamid Abdollahi
Proctitis refers to inflammation of the lower parts of the colon including primarily, the sigmoid colon and the rectum. Acute radiation proctitis most commonly occurs in the first few weeks and chronic proctitis begin several months to years after radiation therapy such as external radiotherapy and brachytherapy for pelvic cancers such as prostate, cervical, and colon cancers. Acute radiation proctitis results from direct damage of the epithelium but chronic proctitis occurs because of damage to the blood vessels, especially the small vessels which supply the cells of the sigmoid colon and the rectum. The most important mechanisms involved in the development of chronic radiation proctitis are long term inflammation and free radical production (Do et al. 2011). Indaram et al. indicated that the mucosal levels of IL-2, IL-6, and IL-8 are abnormally high in patients with proctitis that have undergone radiation therapy (Indaram et al. 2000). Although, early changes may not lead to obvious symptoms but If inflammation progresses, it may evolve to mucosal ulceration, ischemia, ulceration, telangiectasia, and bleeding, which can extend decreasing blood cells in patients that underwent radiotherapy (Grover and Johnson 1997).