Anorectal disorders

Satish Sanku Chander Rao, Adil E. Bharucha, Giuseppe Chiarioni, Richelle Felt-Bersma, Charles Knowles, Allison Malcolm, Arnold Wald

Research output: Contribution to journalArticle

114 Scopus citations

Abstract

This report defines criteria and reviews the epidemiology, pathophysiology, and management of the following common anorectal disorders: fecal incontinence (FI), functional anorectal pain, and functional defecation disorders. FI is defined as the recurrent uncontrolled passage of fecal material for at least 3 months. The clinical features of FI are useful for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful for evaluating anal and pelvic floor structure and function. Education, antidiarrheals, and biofeedback therapy are the mainstay of management; surgery may be useful in refractory cases. Functional anorectal pain syndromes are defined by clinical features and categorized into 3 subtypes. In proctalgia fugax, the pain is typically fleeting and lasts for seconds to minutes. In levator ani syndrome and unspecified anorectal pain, the pain lasts more than 30 minutes, but in levator ani syndrome there is puborectalis tenderness. Functional defecation disorders are defined by ≥2 symptoms of chronic constipation or irritable bowel syndrome with constipation, and with ≥2 features of impaired evacuation, that is, abnormal evacuation pattern on manometry, abnormal balloon expulsion test, or impaired rectal evacuation by imaging. It includes 2 subtypes: dyssynergic defecation and inadequate defecatory propulsion. Pelvic floor biofeedback therapy is effective for treating levator ani syndrome and defecatory disorders.

Original languageEnglish (US)
Pages (from-to)1430-1442.e4
JournalGastroenterology
Volume150
Issue number6
DOIs
StatePublished - May 1 2016

Keywords

  • Anorectal Disorders
  • Anorectal Pain
  • Biofeedback Therapy
  • Constipation
  • Dyssynergic Defecation
  • Fecal Incontinence
  • Levator Ani Syndrome

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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  • Cite this

    Rao, S. S. C., Bharucha, A. E., Chiarioni, G., Felt-Bersma, R., Knowles, C., Malcolm, A., & Wald, A. (2016). Anorectal disorders. Gastroenterology, 150(6), 1430-1442.e4. https://doi.org/10.1053/j.gastro.2016.02.009