Effect Of Comprehensive Pelvic Floor Muscle Training On Bowel Function And QoL Following Rectal Cancer Sphincter-preserving Surgery

Objective1.To explore the home life experience and inner feelings of patients with rectal cancer following rectal cancer sphincter-preserving surgery.2.To explore the effect of comprehensive pelvic floor muscle rehabilitation exercise on the anal dysfunction in patients with rectal cancer following sphincter-preserving surgery.3.To explore the effect of comprehensive pelvic floor muscle rehabilitation exercise on the quality of life in patients with rectal cancer following sphincter-preserving surgery.MethodsThis study consists of two parts.Part 1: A qualitative study was conducted in patients with rectal cancer following sphincter-preserving surgery from July to September 2017.A semi-structured in-depth interview was performed between patients with rectal cancer following sphincter-preserving surgery.The interview data were collated and analyzed,and the topics were summarized and refined to deeply explore the patients’ home life experience and inner feelings after rectal cancer sphincter-preserving surgery.Part 2: A quasi-experimental study to recruit patients with mid-low rectal cancer sphincter-preserving surgery in the anorectal ward of Tianjin Cancer Hospital from October to May 2018.Patients who underwent rectal cancer sphincter-preserving surgery from October 2017 to April 2018 were included in the control group.Patients who underwent rectal cancer sphincter-preserving surgery from May 2018 to October 2018 were included in the intervention group.On the basis of regular health education and nursing guidance,the patients in control group were instructed to perform the Kegel exercise,and those in experimental group were guided to perform a comprehensive pelvic floor muscle rehabilitation exercise consist of abdominal breathing,abdominal massage,Kegel exercise,Kegel exercise with legs crossed,Kegel exercise with hip lifted and leg movement.After 3 months’ intervention,Xu Zhongfa’s anorectal function evaluation scale and the European Organization for Research and Treatment for Cancer Colorectal Cancer Module QLQ-CR(colorectal)29 were used to evaluate the anal function and quality of life.Results 1.Qualitative research resultsThe home life experience of patients with rectal cancer following sphincter preservation surgery includes five themes: 1)physical discomfort: including symptoms of intestinal disorders and radiotherapy reactions and sleep discorders;2)complex emotional reactions: including anxiety,inferiority and guilty;3)role maladjustment;4)post-traumatic growth: including gratitude and life value re-recognition;5)need for self-management improvement: including the need for disease management improvement,the need for emotion management improvement and adaptation demand.2.Quasi-experimental research resultsAfter 3 months’ intervention,the anal function of the experimental group was better than that of the control group,and the difference was statistically significant(P<0.05).In the experimental group,the anxiety and female sexual desire in the functional field of patients with rectal cancer were significantly improved compared with the control group,and the difference was statistically significant(P<0.05).The urinary frequency,frequent frequency,abdominal distension,dry mouth,fecal incontinence and perianal skin pain in the symptom area of the experimental group were significantly improved compared with the control group,and the difference was statistically significant(P<0.05).Conclusion 1.The symptoms of physical discomfort,psychological negative emotion,social maladjustment and other factors in patients with rectal cancer following sphincter saving surgery reduce patient’s physical and mental health.The home experience is not good and the demand of self-management ability increased in patients with rectal cancer following sphincter-saving surgery.The intervention strategy of home life experience in patients with rectal sphincter-saving surgery is worthy of further research.2.The comprehensive pelvic floor muscle training method combined with acupressure massage designed in this study can effectively improve the bowel function and emotional state of patients with rectal cancer after sphincter-preservation surgery,and improve their quality of life from multiple directions.