MANAGEMENT OF  PELVIC RADIOTHERAPY AND ANORECTAL FUNCTION – HOW TO MANAGE THE GASTRO
INTESTINAL SYMPTOMS NAMELY INCONTINENCE BASED ON STRUCTURES INVOLVED

Introduction: Prostatic, gynaecologic and anorectal cancer population have a very good chance of survival because nowadays oncologic treatments are very successful. But survivors very often have chronic
gastrointestinal side effects that greatly influence/modified their quality of life. This symptoms are often overlooked because cancer priority is the exclusion and surveillance for recurrent cancer. Pelvic radiotherapy affects anorectal function in several kinds of ways being one important factor in faecal incontinence onset. Is it possible to predict the best therapeutic approach based on the characteristics of the radiation applied and the structures mainly target after rulling out other incontinence factors?
Purpose: We decided to analyse some paradigmatic cases of our incontinence patients to delineate best approach based not only in incontinence symptoms but also manometric results (when available), after excluding others causes of chronic gastrointestinal symptoms in this population including diet and defecation habits.

Purpose: I decided to analyse some paradigmatic cases of our incontinence patients to delineate best approach based not only in incontinence symptoms but also manometric results (when available), after excluding others causes of chronic gastrointestinal symptoms in this population including diet and defecation habits.
Methods: Oncology patients submitted to pelvic radiotherapy with symptoms of incontinence have been analysed.

Results: Anal cancer is the most troublesome because there is possibility of direct surgical damage of continence structures but also because radiation have an important deleterious effect on the sphincter function so best results can be achieved with preoperative radiotherapy which permits surgical saving of sphincter structures.

Discussion: Pelvic radiotherapy affects the mechanism of continence depending on the target, dosimetry, etc. Following pelvic irradiation for malignant diseases the disorder is characterized by multiple dysfunctions including weakness of the external anal sphincter, stiffness of the rectal wall, and a consequent increase in rectal sensitivity. Literature offers some practical orientation. When the rectum is exposed, the rectal capacity is reduced and urge sensation with incontinence can be a problem but if the main target is anal sphincter soiling or incontinence are major symptoms. BFB is a good approach for both situations.

Conclusions: The traditional acceptance of inevitability of incontinence after pelvic radiotherapy needs to be reformulated because we have the possibility to ameliorate it, giving not only life but also quality of life.
Colostomy is an approach to decide only after be sure that incontinence has no other solution. The interest of BFB treatment of premorbid defecation disorders before oncologic treatments, if possible, needs to be investigated.