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2016 ; ä (ä): ä Nephropedia Template TP
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Functional Anorectal Disorders
#MMPMID27144630
Rao SS
; Bharucha AE
; Chiarioni G
; Felt-Bersma R
; Knowles C
; Malcolm A
; Wald A
Gastroenterology
2016[Mar]; ä (ä): ä PMID27144630
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This report defines criteria and reviews the epidemiology, pathophysiology, and
management of 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
three subtypes. In proctalgia fugax, the pain is typically fleeting and lasts for
seconds to minutes. In levator ani syndrome (LAS) and unspecified anorectal pain
the pain lasts more than 30 minutes, but in LAS 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 i.e., abnormal evacuation pattern on manometry, abnormal
balloon expulsion test or impaired rectal evacuation by imaging. It includes two
subtypes; dyssynergic defecation and inadequate defecatory propulsion. Pelvic
floor biofeedback therapy is effective for treating LAS and defecatory disorders.
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