Clinical evaluation and treatment of chronic bowel symptoms following cancer in the colon and pelvic organs

Figures & data

Table 1. Patient characteristics.

Patient characteristics
Patients, n	60
Age years, median (range)	67 (34–88)
Gender female/male	36/24
Cancer localization n (%)
Right colon	31 (52)
Sigmoid colon	1 (2)
Rectum	14 (23)
Anal canal	4 (7)
Cervix uteri	5 (8)
Corpus uteri	2 (3)
Ovary	2 (3)
Prostate	1 (2)
Time from treatment to referral years, median (range)	5.5 (1–36)
Surgery, n (%)	55 (92)
Chemotherapy, n (%)	19 (32)
Radiotherapy, n (%)	20 (33)

Table 2. Symptoms at referral to our clinic.

Symptoms at referral
	>3 bowel movements per day	Loose stools	Urgency for defecation	Fecal incontinence	Nocturnal defecation	Abdominal pain	Bloating
All cancers, n=60	39 (65% [52.9–77.1%])	52 (87% [78.1–95.3%])	34 (57% [44.1–69.2%])	30 (50% [37.3–62.7%])	8 (13% [4.7–21.9%])	15 (25% [14.0–36.0%])	14 (23% [12.6–34.0%])
Right colon, n=31	15 (48% [30.8–66.0%])	30 (97% [90.6–100%])	18 (58% [40.7–75.4%])	12 (39% [21.6–55.9%])	4 (13% [1.1–24.7%])	10 (32% [15.8–48.7%])	9 (29% [13.1–45.0%])
Sigmoid colon, n=1	1 (100%)	1 (100%)	1 (100%)	1 (100%)	–	–	–
Rectum, n=14	13 (93% [79.4–100%])	9 (64% [39.2–89.4%])	9 (64% [39.2–89.4%])	6 (43% [16.9–68.8%])	3 (21% [0–42.9%])	–	4 (29% [4.9–52.2%])
Anal canal, n=4	3 (75% [32.6–100%])	3 (75% [32.6–100%])	1 (25% [0–67.4%])	4 (100%)	–	1 (25% [0–67.4%])	–
Cervix uteri, n=5	5 (100%)	5 (100%)	3 (60% [17.1–100%])	3 (60% [17.1–100%])	–	2 (40% [0–82.9%])	–
Corpus uteri, n=2	–	2 (100%)	1 (50% [0–100%])	2 (100%)	–	1 (50% [0–100%])	1 (50% [0–100%])
Ovary, n=2	1 (50% [0–100%])	1 (50% [0–100%])	1 (50% [0–100%])	1 (50% [0–100%])	–	1 (50% [0–100%])	–
Prostate, n=1	1 (100%)	1 (100%)	–	1 (100%)	1 (100%)	–	–

Data are presented as number (% [95%-CI]). Loose stools defined by type 6 and 7 on the Bristol Stool Chart [12].

Table 3. Results of diagnostic tests.

	Breath test		SeHCAT retention
	Positive	Negative	<10%	10–15%	Normal (>15%)
All cancers, n=60	32	15	29	6	8
Right colon, n=31	20	6	14	4	3
Sigmoid colon, n = 1	–	–	1	–	–
Rectum, n=14	7	4	6	–	5
Anal canal, n=4	1	2	3	1	–
Cervix uteri, n=5	2	1	3	–	–
Corpus uteri, n=2	1	1	1	1	–
Ovary, n=2	1	–	1	–	–
Prostate, n=1	–	1	–	–	–

Data are presented as numbers. SeHCAT: Selenium-75 homocholic acid taurine.

Table 4. Treatment modalities used in our clinic.

Treatment modalities
	n (%)
Antibiotics
Ciprofloxacin	28 (47)
Rifaximin	13 (22)
Other^a	7 (12)
Bile acid sequestrants
Cholestyramine	31 (52)
Colesevelam	19 (32)
Both	14 (23)
Loperamide	21 (35)
Laxative	9 (15)
Dietary intervention^b	20 (33)
Stoma	2 (3)

^aAmoxicillin (n = 4), metronidazole (n = 3).

^bFat and/or fiber reducing regimen.

Table 5. Symptoms after treatment in our clinic.

Symptoms after treatment
	>3 bowel movements per day	Loose stools
All cancers, n=60	12	14
Right colon, n=31	3	8
Sigmoid colon, n=1	–	–
Rectum, n=14	5	3
Anal canal, n=4	1	–
Cervix uteri, n=5	1	2
Corpus uteri, n=2	1	1
Ovary, n=2	1	–
Prostate, n=1	–	–

Data are presented as numbers. Loose stools defined by type 6 and 7 on the Bristol Stool Chart [12].

Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32:920–924.

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