*2.2.3 Data presentation and interpretation*

Total anorectal symptom scores was significantly greater in the patients compared with the control subjects (**Table 3**). Urgency of defaecation was the most frequent symptom, occurring in 10 of the 15 patients (67%). Four of these patients also had fecal incontinence [14]. Urgency of defecation in eight of the 10 patients resulted in changes in lifestyle such that the patients were either housebound or could only go out if there was a toilet nearby [14].

Basal minimum pressures just proximal to the anal canal (4 cm from the anal verge) were lower in the patients than the control subjects (p = 0.05) and there was a trend for lower basal maximum pressures at the same site (p = 0.07, **Table 4**).

Squeeze pressures measured at the sleeve sensor and at 4 cm from the anal verge were lower in the patients (p < 0.05, **Table 4**) and were below the control range in five patients [14].

In the patients, residual anorectal pressures measured at 0.5 cm from the anal verge in response to rectal distension were less (p ≤ 0.05) at volumes of 10 ml, 20 ml and 40 ml (**Table 5**). There was also a trend for lower pressures in the patients at the highest (100 ml) volume (p = 0.09).

A higher proportion of patients perceived the desire to defecate at lower rectal volumes than the controls (p < 0.05, **Figure 2**). The slope of the pressure/volume relationship associated with rectal distension volumes of 20 ml, 40 ml, 60 ml, 100 ml and overall slope was greater in the patients (p < 0.05, p < 0.01, p < 0.001, p < 0.001 and p < 0.05 respectively than the controls, suggesting that rectal compliance was reduced in the patients (**Figure 3**).

There were no differences in external anal sphincteric electrical activity between the patients and control subjects in response to voluntary squeeze and blowing up a party balloon (**Table 4**). Either basal pressures, pressures generated in response to rectal distension, voluntary squeeze and blowing up a party balloon were below the control range in 14 of the 15 patients, including all 10 patients with anorectal symptoms [14].

There was no difference in mean EAS and IAS thickness between the two groups (**Table 4**) nor difference in thicknesses of the EAS and IAS in patients with and without urgency of defaecation [14].

The data indicate that (i) urgency of defaecation, occurring in 10 out 15 (67%) of patients 10–15 years after pelvic irradiation for gynecological cancer resulted in eight of the 10 patients being either housebound or only able to go out if there was a toilet nearby, (ii) anorectal symptoms were associated with multiple parameters of anorectal dysfunction including weakness of the external anal sphincter, stiffness of the rectal wall and consequent increase in rectal sensitivity.
