AN UPDATE ON ANO-RECTAL DISORDERS FOR
ADIL E. BHARUCHA/ SATISH S. C. RAO
Kurdistan Board GEH Journal club:
Gastroenterologists frequently encounter pelvic floor disorders.
It affect 10-15% of the population.
The ano-rectum is a complex organ that collaborates with the pelvic floor
muscles to preserve fecal continence & enable defecation.
A careful clinical assessment is critical for the diagnosis& management of
defecatory disorders & fecal incontinence.
Newer diagnostic tools (eg, high-resolution manometry& MR defecography)
provide a refined understanding of anorectal dysfunctions&identify
phenotypes in defecatory disorders& fecal incontinence.
Conservative approaches, including biofeedback, are the mainstay for manage.
New minimally invasive approaches may benefit a subset of patients with fecal
incontinence, but more controlled studies are needed.
Significant advances in basic science & newer diagnostic techniques
in humans have advanced our understanding of the multifaceted pelvic
DDs are a common cause of chronic constipation.
Symptoms &careful DRE are very useful for identifying DDs, but
anorectal tests are necessary to confirm the diagnosis.
In most patients, anorectal manometry & rectal balloon expulsion test
In some patients, barium or MRI defecography is necessary to confirm
or exclude the diagnosis.
Pelvic floor retraining by biofeedback therapy represents the mainstay
FI is a common & often distressing symptom.
Bowel dysfunctions & ano-rectal sensorimotor dysfunctions are the
key pathophysiological mechanisms.
Pelvic floor retraining by biofeedback therapy in patients who do not
respond to conservative measures.
SNS or other surgical approaches for patients who are refractory to
A response to my question from the corresponding
Congratulation for your excellent review in Gastroenterology. Isn't
better to classify the defecatory disorders into the defecatory disorderinduced constipation & defecatory disorder-induced fecal incontinance
,rather than DD& FI. Thanks.
Thanks; To be honest I don't like the acronym DD for defecation
disorders and prefer to use it for dyssynergic defecation. In this article
I had to yield to my coauthor who insisted on this term. I usually prefer
to use defecation disorder for non incontinence related conditions.
Hope this helps and sets record clear. Satish Rao (Please forgive any