Annals of Coloproctology

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Original Article

Complications

Prevalence and clinical significance of evacuation disorders in patients with low anterior resection syndrome: Yuko Homma, Toshiki Mimura, Koji Koinuma, Hisanaga Horie, Naohiro Sata; Ann Coloproctol. 2025;41(4):271-278. Published online August 25, 2025; DOI: https://doi.org/10.3393/ac.2024.00934.0133

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Abstract PDF: Purpose
Low anterior resection syndrome (LARS) manifests with evacuation disorder symptoms and continence problems. However, no prior study has focused on evacuation disorders in patients with LARS. This study investigated the prevalence of evacuation disorders and their association with the LARS score.
Methods
This study included patients with defecation per anus at the time of the survey, which was conducted between November 2020 and April 2021. These patients had undergone anus-preserving surgery for rectal tumors between 2014 and 2019 at a tertiary university hospital. The severity of evacuation disorders and LARS was evaluated using the Constipation Scoring System and the LARS score, respectively. The primary endpoint was the prevalence of evacuation disorders, defined as evacuation difficulty, feeling of incomplete evacuation, and abnormally long time on the toilet. The secondary endpoints were the associations between these symptoms and the LARS score.
Results
Of 332 eligible patients, 238 (71.7%) completed the questionnaire. The overall prevalence of evacuation disorders was 48.3%. The rates of feeling incomplete evacuation, evacuation difficulty, and prolonged time on the toilet were 45.6%, 15.5%, and 8.4%, respectively. Patients with minor or major LARS had a significantly higher prevalence of evacuation disorders than those with no LARS, particularly regarding feeling incomplete evacuation.
Conclusion
Evacuation disorders were present in 48.3% of patients following anus-preserving surgery. Greater severity of LARS was associated with a higher prevalence of evacuation disorders, especially a feeling of incomplete evacuation. Patients should be informed about the potential for both evacuation disorders and continence-related symptoms following anus-preserving surgery.

Review

Biofeedback Therapy in Patients with Functional Evacuation Disorders.: Park, Ung Chae; J Korean Soc Coloproctol. 2003;19(4):260-269.

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Abstract PDF: Biofeedback therapy has emerged as a useful adjunct for patients with functional evacuation disorders over the past decade. The goals of biofeedback retraining may vary and could depend on the underlying dysfunction. In patients with obstructive defecation, the goals are to relax the anal sphincter, improve rectoanal coordination, and improve sensory perception. Methods of biofeedback therapy varied widely between centers. However, no difference was described when EMG-based biofeedback was compared to manometry-based biofeedback, or when visual or auditory feedback was given. In regards to biofeedback adjuncts, including sensory retraining with either an intrarectal balloon, a portable home-training unit or both can be practicable. There are inconsistencies in the literature regarding the patient selection criteria for biofeedback treatment. The patient group is not homogeneous. Different case selection, different regimens and different methods of biofeedback may explain the variability in success rate. Quality research that would assist in predicting outcome is still lacking. Although no specific denominator could possibly be assigned to correctly predict the overall outcome of therapy, biofeedback is not successful in all patients with outlet obstructed constipation. Results with success rates is ranging from 8.3 percent to 100 percent. The treatment of constipation by biofeedback has been viewed with some skepticism as the low success rate may simply be a placebo effect. The majority of scepticism to therapeutic outcome are derived from entry criteria for treatment. Lower success rates have been described when entry criteria were broadened. Prebiofeedback clinical findings which are presupposed to prognostic relevance are age, gender, duration of symptoms and presence of rectal pain, lower motor neuron disease, and psychiatric problems. I feel strongly that informations about the predictive factors are vital to all physicians either performing or recommending biofeedback to their patients. If biofeedback could be undertaken according to specific criteria, we, colorectal surgeon will save a fruitless endeavour, one would expect more improvements in more patients. Additional well-designed controlled trials are needed to establish the clinical and physiologic factors.

Original Article

Development of Second Stage Software in the Anal Sphincter Control System Based on the Anal Electromyography, and Investigation of Therapeutic Outcome of the Patients withChronic.: Park, Ing Chae , Seong, Moo Kyung , Chung, Soon Sup , Kim, Jong Jun , Park, Seung Hun; J Korean Soc Coloproctol. 1999;15(4):281-290.

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Abstract PDF: To eliminate the inconvenient shortcomings of our formerly designed system for the biofeedback treatment, the development of second stage software was indispensable. PURPOSE: The aims of current study were to supplement the prototype software, and to improve the application software for the database management system. Moreover, we assessed the practical value and outcome of biofeedback therapy for the patients with functional evacuation disorders by using the upgraded system.
METHODS
A new system was worked out a design to be composed of Windows based GUI (graphical user interface), DB (database) management software, and networking system. Main software performs a signal processing and a protocol making mode to train pelvic sphincter. DB program administers patient profiles and the recorded signal data. Networking system was designed to execute RS-232C serial communication of signal data with use of fast ethernet LAN networking. To affirm the reproducibility of signal display for the clinical practice, system was applied to 5 healthy volunteers. To evaluate the practical appraisal, system was applied to 27 patients with functional evacuation disorders who were undertaken anorectal physiologic tests. Patient groups were categorized as nonrelaxing puborectalis group (group I, n=17), incontinencegroup (group II, n=10). Overall patients were underwent a mean 3.7 (range, 2~10) sessions of biofeedback treatment, and the outcome was analysed in the period of 5.8 (range, 3~12) months follow-up.
RESULTS
Signal data not having drift or noise were adequately processed and displayed in a real time. Specifically, data upload with use of multi-processing overay display function was appropriately embodied. Overall data and profiles of patients groups were safely saved, sorted, and reproduced by using the upgrading database management software. Regarding to the therapeutic outcomes, 63 percent of 27 overall patients (12 of 17 patients in group I, 5 of 10 patients in group II) were improved. The subjective symptoms of 2 patients in group I were recurred in a period of 3 months follow-up.
CONCLUSIONS
Hardware and software functions of upgraded system were applicable to the Windows environment of personal computer. A developed system with second stage software made it possible to perform biofeedback treatment. Specifically, current results could be useful for the improvement of the motivation and patient's willingness in the self-learning process of biofeedback treatment.

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