Experience and Process of Functional Reconstruction of Defecation for Low Rectal Cancer Patient after Anal Sphincter-Saving Operation

• Main Authors: Ching-shiang Liou, 劉清香
• Other Authors: Ching-Huey Chen
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/78619161921901905264

碩士 === 國立成功大學 === 護理學系碩博士班 === 97 === Resection due to a lower rectal cancer with anal sphincter-preserving operation may affect patients’ normal function of defecation and social interaction, seriously devastating the quality of life. The treatment and rehabilitation process is long and complex, and presently, there is no standard clinical guideline in the rehabilitation process. Thus, in order to design an effective protocol to facilitate patients’ defecation capacity, it is necessary to understand patients’ experience during this process. The purpose of this study was to explore the recovering experience of patients with low rectal cancer after their anal sphincter-saving operation and to develop an instructional protocol to guide health care professions in how to reconstruct patients’ defecation function. Case study was applied and purposive sampling was used to recruit subjects who received anal sphincter-saving operation in a medical center located in Southern Taiwan. Data were collected from November, 2008 to March, 2009 through patient’s medical chart, health care documents, and face to face interview transcripts. Content analysis was used to analyze the data. Finally, four subjects (1 female) participated in this study (age ranged from 63 to 73). Study results indicated that after the first ostomy operation, subjects suffered from incontinence of mucus, incontinence of mucus due to exertion of pressure, urgency and frequent mucus, bottom ache by prolong standing, and anal tenesmus. All these symptoms were alleviated after 1 to 4 weeks of anastomosis dilation and pelvic exercise (PE) training initiated 2 to 4 weeks after the ostomy operation. After 7-21 weeks PE training, anal muscle power improved from 2 to 3 points. When performing PE and tiptoe-standing exercise, subjects usually misused their muscle parts and need to be informed. Furthermore, subjects may need to adjust psychologically to their need of relying on a family member to assist them in the anastomosis dilation training. Through the defecation exercise, all subjects were able to perform rapid contraction of the anal sphincter 5 times in order to minimize the frequency of defecation. Additionally, all subjects were able to follow the diet control of consuming no more then 80% full per meal and prohibited from eating foods with crude fiber. Subjects might self-regulate their intake of anti-diarrheal medication and laxatives accordingly to their defecation problems. Due to the importance of incontinence and effectiveness of the rehabilitation interventions, all subjects reported that they have maintained PE, diet control, and prolong defecation exercise during the sixth month follow-up after their ostomy take-down operation. Furthermore, 3 of 4 subjects were free from incontinence. The subjects reported their lives from dirty to clean after take-down of colostomy. Based on the experience of four subjects, health care educational guidelines and procedures were suggested.