Recent Advances in Functional Anorectal Disorders

Abstract

Defecatory disorders are a common cause of chronic constipation and should be managed by biofeedback-guided pelvic floor retraining. While anorectal tests are necessary to diagnose defecatory disorders, recent studies highlight the utility of a careful digital rectal examination. While obstetric anal injury can cause fecal incontinence (FI), diarrhea is a more important risk factor for FI among women in the community, who typically develop FI after age 40. Initial management of fecal incontinence should focus on bowel disturbances. Pelvic floor retraining with biofeedback therapy is beneficial for patients who do not respond to bowel management. Sacral nerve stimulation should be considered in patients who do not respond to conservative therapy.

Bear‐Down Maneuver Is a Useful Adjunct in the Evaluation of Children With Chronic Constipation

“…Average age was 13.7 AE 3.1 years (range [8][9][10][11][12][13][14][15][16][17][18][19] and 55% were girls. Average age was 13.7 AE 3.1 years (range [8][9][10][11][12][13][14][15][16][17][18][19] and 55% were girls.…”

“…BET has previously been used in children with constipation, but the results could not reliably predict clinical outcome, although constipated children who were able to defecate the rectal balloon showed a trend toward improvement (7). Although it is a useful screening test, the BET cannot distinguish among the different types of pelvic outlet dysfunction (10). The inability to expel the balloon within 1 minute is suggestive of pelvic floor dysfunction (8).…”

Brain responses to mechanical rectal stimulation in patients with faecal incontinence: an fMRI study

“…Notably, abnormalities of the rectal reservoir leading to problems with the storage and/or evacuation of faeces may result in FI. The maintenance of continence is dependent on a complex interaction between somatic, enteric and autonomic nervous systems and smooth and striated muscles under higher cerebral control , although these areas have not received equal attention by researchers. Abnormal communication between the rectum and the brain (i.e.…”

Anal Manometry in the Investigation of Fecal Incontinence: totum pro parte, not pars pro toto

“…However, in the absence of overt ‘organic disease’ these investigations provide little insight into the cause of symptoms and no guide to therapy. In this situation, assessment of anorectal function is indicated [2,3]. Conventional anorectal manometry (ARM) acquires measurements of resting tone using a ‘pull-through’ technique and measurements of voluntary squeeze pressure and rectoanal coordination during simulated defecation.…”

“…Although widely applied, this technique has important limitations. First, conventional ARM with 4–8 water-perfused measuring ports has relatively low resolution and is susceptible to measurement artifacts caused by sphincter asymmetry and catheter movement relative to the anal sphincter due to patient behavior or pelvic floor descent [2,3]. Second, measurement of rectal capacity, compliance and sensitivity by elastic balloon are affected by the properties of the balloon as well as the rectum [4,5].…”