Low Rectal Cancer

The Consequences of Low Rectal Cancer Treatment

The treatment for low rectal cancer MAY affect your bowel function for the rest of your life.  The critical factor affecting the severity of these changes is the length of rectum you have left. If the anastomosis is above 6 cm, the chances are 76% you will have good functional results, between 3 and 6 cm the chances are 53% and below 3 cm the odds decrease to 35%. Other factors that will affect your bowel function include the type of surgery, surgical complications, chemotherapy and radiation burns.

The change in bowel function from the treatment of low rectal cancer can be none or all of the following conditions:

• Incontinence. Fecal incontinence is the inability to control bowel movements. This leads to stool (feces) leaking from the rectum at unexpected times.  You can be incontinent to either solid, liquid or flatus (gas) or any combination. Incontinence can be the result of damage to the anal and rectal nerves caused by surgery, chemotherapy or radiation burns.
• Clustering or incomplete evacuation.   Because you now have a limited amount of rectal reservoir, you cannot evacuate a large amount of stool at a single "sitting".  You may be able to respond to an urge and evacuate only a small amount of stool at a time.  As the peristaltic action moves stool toward the sensitive nerves surrounding the anus, you may have another "urge" within a short time.  This process can continue until the length of stool that has accumulated near the anus can be evacuated.
• Frequency.   The function of the rectum is to hold a large amount of stool until it eventfully touches the anal nerves and alert you that it is time to "go to the bathroom".  When you sit on the toilet and relax the voluntary anal muscles, all of the stool stored in the rectum is evacuated into the toilet.  Without normal rectal muscles, only a small amount of stool can be evacuated. Because stool tends to clump in the colon in defined masses, you may experience more times in the day when you feel the urge than you would if you had an entire rectum.  Some low rectal cancer survivors feel urges as many as 10-15 times a day.
• Nighttime Incontinence.  Low rectal cancer survivors learn to resist "the urge" by tightening the voluntary anal muscles to avoid soiling.  However, when you are sleeping you do not necessarily have the same amount of mental control, which can lead to soiling while sleeping.
• Urgency.  This consequence can be caused by damage that is done to your rectal nerves during the surgery.  There is a tendency to have less control over your rectal muscles.  You may experience an overwhelming "urge" to get to the toilet before you loose control and suffer from "anal leakage".

You cannot predict how many of these consequences you will experience as the result of your low rectal cancer treatment. We are all different.  Some survivors may have very few consequences while others may have some or all of the consequences.  The kind and degree of the consequences may be affected by the type, quantity and timing of your meals. The severity may decrease over time only to return even after you have had an extended "good period". Just realize that you will most likely experience some or all of these "consequences" once you have been treated for low rectal cancer. The more of your rectum that is removed, the greater are the risk that you will suffer the consequences.  If you have undergone radiation, chemotherapy or both, the chances are that your bowel functions will be permanently affected.

Educate yourself:

Factors Influencing bowel function.   An abstract on the consequences.

Surgical techniques influence on bowel function.   An abstract on how surgery affect function

LAR and Bowel Functions.    Summary of bowel function problems.

Surgical approaches to obtaining optimal bowel function.   Abstract on affects.

Rectal resection with low anastomosis: functional outcome  Summary of Effects

Sexual Dysfunction after LAR    Summary of how LAR affects sexuality

Quality of Life of J-Pouch vs. Straight     A review of how the two options affect quality of life.

Long term effects of J-Pouch vs. Straight.   A review of how both types of treatment affect life

Anorectal function following LAR.  A complete study on bowel functions after LAR

Ultra low Reconstruction  A comparison between a LAR and J-Pouch

Function of J-Pouch v Straight Connection   Study that compared long term differences

J-Pouch vs straight over time.   Functional comparison between two options over time

Long Term Functional between J-Pouch and Straight  Comparison between two options

Quality of Life between J-Pouch and Straight    Comparison of QOL between two options

Functional outcome between J-Pouch and Straight  Comparison finds J-pouch best for first year

Comparison of long term results J-pouch vs Straight.   Comparison finds J-Pouch superior

J-Pouch function at 6 months vs Straight   A comparison between the J-Pouch and Straight

Straight and colonic pouch after LAR   Comparison between two options.

Randomized Comparison between J-Pouch and Straight   Comparison between options.

Colostomies may influence patients QOL more than Poor Function.  Finding QOF Poor

Morbidity and financial impact of colostomy closure   Cost of closure after J-Pouch

Morbidity of Ostomy takedown   Discussion of morbidity of takedowns

Explore on Goggle with these key words:

Colorectal Cancer, Bowel Function, Quality of Life, Anorectal function, J-Pouch, Anastomosis, Functional Outcome

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