Elettrostimolazione del pavimento pelvico in pazienti con incontinenza fecale dopo resezione anteriore del retto per adenocarcinoma

Aim: Faecal incontinence represents a symptom of the anterior resection syndrome that consists of frequency, urgency, fragmentation and incontinence of faeces, in patients who have received surgical resection of colorectal cancer. This syndrome is caused by a reduction of neuro-muscular activities of pelvic floor despite the safeguard of pudendal nerves. Aim of the present study was to demonstrate effectiveness and safety of electrical stimulation and bio-feedback training of pelvic floor in the treatment of faecal incontinence after rectal surgery for cancer.Methods: We filled into a rehabilitative protocol 18 patients (15 males and 3 females) underposed to Knight-Griffen anterior rectal resection, and reconstruction of bowel by ultra-low anastomosis performed by circular stapler. All of them had a temporary excluding ileal stoma and incontinence was demonstrated after closure of stoma restoring bowel continuity. Rehabilitation was performed by electrical stimulation of anal sphincter. In all patients was performed an evaluation of pelvic floor and neo-rectal capacity by manometer before and after the treatment. Because the verify of this complication, incontinence represents in these patients, a complication that deteriorate the quality of life. Advent of new techniques for the diagnosis of faecal incontinence and its applications to rehabilitative purposes, consents a conservative treatment.Results: The rehabilitative programme increased anal continence in all patients, in particular 14 of 18 patients had good continence after first and second session of therapy.Conclusions: Electrical stimulation of anal sphincter actually represents an important technique in the restore of anal sphincter function in patients with incontinence. An accurate manometric functional assessment is necessary before starting treatment. Electrical stimulation is effective, safe and low cost technique and it can be utilized successfully in patient affected by anterior resection syndrome.