Recent Advances in Functional Anorectal Disorders
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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.
KeywordsFunctional anorectal disorders Constipation Irritable Bowel Syndrome (IBS) Defecatory disorders Pelvic floor retraining Digital rectal examination Balloon expulsion test Fecal incontinence Obstetric Anal sphincter injury Primiparous Anal incontinence Rectal sensation Biofeedback Risk factors Community Cholecystectomy Bariatric surgery Gastric bypass Electrical therapy Sacral nerve stimulation Radio frequency Bulking-agent NASHA Dx
This study was supported in part by RO1 DK 78924 from the National Institutes of Health.
A. Bharucha: Consultancy and patents for Medspira, Inc.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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