Anorectal Disorders

Rao, Satish S.C.; Bharucha, Adil E.; Chiarioni, Giuseppe; Felt‐Bersma, R. J. F.; Knowles, Charles H.; Malcolm, Allison; Wald, Arnold

doi:10.1053/j.gastro.2016.02.009

Cited by 405 publications

(519 citation statements)

References 182 publications

(213 reference statements)

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“…It should also be noted that anorectal disorders are prevalent in diabetics and can also contribute to constipation; as such, a careful rectal examination to screen for coexistent pelvic floor muscle dysfunction should be performed [23, 24]. Despite the evidence for altered colonic motility and potentially increased prevalence of slow transit constipation in diabetics, from a practical standpoint colonic transit testing should be reserved for those patients failing to respond to initial laxative therapies.…”

Section: Discussionmentioning

confidence: 99%

Diabetes Mellitus and the Colon

Piper

Saad

2017

Curr Treat Options Gastro

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Opinion statement Diabetes mellitus (DM) can affect the structure and function of the colon promoting commonly encountered lower gastrointestinal symptoms such as constipation, diarrhea, abdominal distention, bloating, and abdominal pain. Specific colonic disorders for which adults with DM are at greater risk include chronic constipation, enteropathic diarrhea, colorectal cancer (CRC), inflammatory bowel disease, microscopic colitis, and Clostridium difficile colitis. Smooth muscle structure and function, density of the interstitial cells of Cajal, and the health and function of the autonomic and enteric nerves of the colon are all potential affected by DM. These effects can in turn lead to alterations in colon motility, visceral sensation, immune function, endothelial function, and the colonic microbiome. The evaluation and treatment for slow transit constipation as well as pelvic floor dysfunction should be considered when constipation symptoms are refractory to initial treatment measures. DM-related medications and small bowel conditions such as celiac disease and small intestinal bowel overgrowth should be considered and excluded before a diagnosis of enteropathic diarrhea is made. Given the higher risk of CRC, adults with DM should be appropriately screened and may require a longer bowel preparation to ensure an adequate evaluation.

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Section: Discussionmentioning

confidence: 99%

Diabetes Mellitus and the Colon

Piper

Saad

2017

Curr Treat Options Gastro

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“…1 In the United States, manometry and a BET are initially recommended, followed by barium or MR defecography if necessary. 2, 3 …”

Section: Introductionmentioning

confidence: 99%

High-resolution Anorectal Manometry for Identifying Defecatory Disorders and Rectal Structural Abnormalities in Women

Prichard

Lee

Parthasarathy

et al. 2017

Clinical Gastroenterology and Hepatology

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Background & Aims Contrary to conventional wisdom, the rectoanal gradient during evacuation is negative in many healthy people, undermining the utility of anorectal high resolution manometry (HRM) for diagnosing defecatory disorders. We aimed to compare HRM and magnetic resonance imaging (MRI) for assessing rectal evacuation and structural abnormalities. Methods We performed a retrospective analysis of 118 patients (all female; 51 with constipation, 48 with fecal incontinence, and 19 with rectal prolapse; age, 53±1 years) assessed by HRM, the rectal balloon expulsion test (BET), and MRI at Mayo Clinic, Rochester, Minnesota, from February 2011 through March 2013. Thirty healthy asymptomatic women (age, 37±2 years) served as controls. We used principal components analysis of HRM variables to identify rectoanal pressure patterns associated with rectal prolapse and phenotypes of patients with prolapse. Results Compared to patients with normal findings from the rectal BET, patients with an abnormal BET had lower median rectal pressure (36 vs 22 mmHg, P=.002), a more negative median rectoanal gradient (−6 vs −29 mmHg, P=.006) during evacuation, and a lower proportion of evacuation, based on MRI analysis (median of 40% vs 80%, P<.0001). A score derived from rectal pressure and anorectal descent during evacuation and a patulous anal canal was associated (P=.005) with large rectoceles (3 cm or larger). A PC logistic model discriminated between patients with and without prolapse with 96% accuracy. Among patients with prolapse, there were 2 phenotypes – characterized by high (PC1) or low (PC2) anal pressures at rest and squeeze along with higher rectal and anal pressures (PC1) or a higher rectoanal gradient during evacuation (PC2). Conclusions In a retrospective analysis of patients assessed by HRM, measurements of rectal evacuation by anorectal HRM, BET, and MRI were correlated. HRM alone, and together with anorectal descent during evacuation, may identify rectal prolapse and large rectoceles, respectively, and also identify unique phenotypes of rectal prolapse.

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“…The aim of this review is to summarize the evidence on the epidemiology, natural history, pathophysiology, diagnosis, and management of these conditions. This review, which is updated from an earlier review, 3 incorporates the most recent recommendations, including the Rome Criteria on anorectal disorders published in May 2016, 4 the American Urological Association guidelines for IC/BPS from September 2014, 5 and a Prostatitis Expert Reference Group document on CP/CPPS from 2015. 6 …”

Section: Introductionmentioning

confidence: 99%

Anorectal and Pelvic Pain

Bharucha

Lee

2016

Mayo Clinic Proceedings

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Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the three most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first two conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacologic, behavioral, and physical therapy. Opioids should not be avoided, and surgery has a limited role, primarily in refractory interstitial cystitis.

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Anorectal Disorders

Cited by 405 publications

References 182 publications

Diabetes Mellitus and the Colon

Diabetes Mellitus and the Colon

High-resolution Anorectal Manometry for Identifying Defecatory Disorders and Rectal Structural Abnormalities in Women

Anorectal and Pelvic Pain

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