Adibi P, Mazdak H, Derakhshandeh A, Toghiani A. Change in functional bowel symptoms after prostatectomy: a case-control study. J Res Med Sci. 2011 February; 16(2):130-135.

Pelvic Physiotherapy Think Tank

December 7, 2011

Michelle Spicka

Objective:  The goal of this study was to compare the relative frequency changes in IBS symptoms in the patients who underwent prostate surgery.

Subjects: 126 patients (66 in a case group and 66 in a control group) were involved.  66 patients (33 with a TURP and 33 with an open prostatectomy) were interviewed from 3-12 months postop.  66 patients (a control group who had the same prostate symptoms but were waiting for surgery in that time period) were interviewed also.  Both case and control groups were selected using convenience time-based sequential sampling from a single academic center under treatment by one urologic surgeon.

Study Design/Method:  A structured interview was designed for data gathering and patients were interviewed during follow up in the clinic.

Oxford Levels of Evidence: case-control study design - Level 4

Outcome/Results:  The main positive finding of this study is that open prostatectomy was followed by a significant increase in diarrhea and bowel habit alternation associated with onset of abdominal pain. 

Limitations: decreased sample size;

Conclusion:

1)      Prostatectomy, in both forms of open and transurethral, may cause onset of abdominal discomfort and bowel habit change that may resolve in time but significantly may induce bowel habit change in form of diarrheal symptoms.

2)      One assumption for development of post-surgical bowel functional changes is an inflammatory process in the pelvic region that involves sensory nerves of this region with activation of mast cells and consequently visceral hypersensitivity (Barbara et al 2007)

Thought Questions:

1)      How can this be applied to other abdominal surgeries? 

a.       Van Dam et al (Dis Colon Rectum 1997) reported that hysterectomy played an important role in the pathogenesis of disturbed defecation…severe deterioration in bowel function was noted in 31% of patients and an additional 11% noted a moderate change in their symptoms, all after hysterectomy

b.      Heaton et al (Gut 1993) studies over 1000 women and found that, compared with unoperated controls, 20% of  women after hysterectomy were more likely to consider themselves constipated, strained more and had feelings of incomplete emptying…in women who had a cholecystectomy, rectal irritability (urgency of defecation) was more prevalent in 44% compared with unoperated controls with nonfunctioning gallbladders

c.       Prior et al (Gut 1992) noted that 10% of women develop irritable bowel syndrome after hysterectomy (in a study group of 205 women)

2)      What role does psychology play in onset of bowel symptoms after surgery?

a.       Granot et al (Clin J Pain 2005) noted that the higher the anxiety and pain is after surgery, the more predisposed a patient would be to having functional bowel changes

3)      How  can physical therapy help? (Electrical stimulation for sacral neuromodulation)

a.       Leng et al (Urol Clin North Am 2005) determined that sacral nerve stimulation of the pudendal nerve at sacral nerve roots can “turn off” supraspinally mediated neurologic hyperactivity