Skip to main content
SpringerLink
Log in

Anorectal Disorders

  • Reference work entry
  • First Online:
Geriatric Gastroenterology

  • 65 Accesses

Abstract

Aging and anorectal dysfunction often co-occur with one another, as conditions such as constipation, rectal bleeding, and stool incontinence increase in prevalence with age. However, clinicians often overlook or misdiagnose these conditions due to their similarities. There is also a dearth of formalized training on anorectal disorders across internal medicine residency and fellowship programs, which limits provider comfort in triaging and treating anorectal disorders without involvement of sub-specialists (e.g., colorectal surgeons or gastroenterologists). In older adults, it is particularly important to delineate these differences in a time-sensitive manner as prolonged discomfort has substantial clinical and societal implications. Here, we aim to highlight the most common anorectal disorders geriatricians encounter in clinical practice and provide an up-to-date review on presentation and management of anal fissures, fecal impaction, hemorrhoids, pruritis ani, rectal prolapse, and spurious diarrhea. These sections delineate evidence-based bedside and office management with supporting images that illustrate physical exam findings and concise summaries on high-yield concepts.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  • Alonso-Coello P, Guyatt GH, Heels-Ansdell D, et al. Laxatives for the treatment of hemorrhoids. Cochrane Database Syst Rev. 2005;4:1–17.

    Google Scholar 

  • Andy UU, Vaughan CP, Burgio KL, Alli FM, Goode PS, Markland AD. Shared risk factors for constipation, fecal incontinence, and combined symptoms in older U.S. adults. J Am Geriatr Soc. 2016;64:183–8.

    Article  Google Scholar 

  • Arif-Tiwari H, Twiss CO, Lin FC, et al. Improved detection of pelvic organ prolapse: comparative utility of defecography phase sequence to nondefecography valsalva maneuvers in dynamic pelvic floor magnetic resonance imaging. Curr Probl Diagn Radiol. 2019;48(4):342–7.

    Article  PubMed  Google Scholar 

  • Bhardwaj R, Vaizey CJ, Boulos PB, Hoyle CHV. Neuromyogenic properties of the internal anal sphincter: therapeutic rationale for anal fissures. Gut. 2000;46(6):861–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bharucha AE, Wald A, Enck P, Rao S. Functional anorectal disorders. Gastroenterology. 2006;130(5):1510–8.

    Article  PubMed  Google Scholar 

  • Bharucha AE, Pemberton JH, Locke GR. American gastroenterological association technical review on constipation. Gastroenterology. 2013;144(1):218–38.

    Article  PubMed  Google Scholar 

  • Blatchford GJ. The evaluation of incontinence. Semin Colon Rectal Surg. 1997;8:61–72.

    Google Scholar 

  • Burgell RE, Lelic D, Carrington EV, et al. Assessment of rectal afferent neuronal function and brain activity in patients with constipation and rectal hyposensitivity. Neurogastroenterol Motil. 2013;25(3):260–9.

    Article  CAS  PubMed  Google Scholar 

  • Chan KKW, Arthur JDR. External haemorrhoidal thrombosis: evidence for current management. Tech Coloproctol. 2013;17(1):21–5.

    Article  CAS  PubMed  Google Scholar 

  • Clark SJ. Benign anal disease. J Am Acad Physician Assist. 2016;29(11):23–9.

    Article  Google Scholar 

  • Corman ML. Anal fissure. In: Corman ML, editor. Colon and rectal surgery. 4th ed. Philadelphia: Lippincott-Raven; 1998.

    Google Scholar 

  • Danielson J, Karlbom U, Wester T, Graf W. Efficacy and quality of life 2 years after treatment for faecal incontinence with injectable bulking agents. Tech Coloproctol. 2013;17(4):389–95.

    Article  CAS  PubMed  Google Scholar 

  • Demetriou G, Nassar A, Subramonia S. The pathophysiology, presentation and management of ischaemic colitis: a systematic review. World J Surg. 2020;44(3):927–38.

    Article  PubMed  Google Scholar 

  • Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterology. 2016;150(6):1262–1279.e2.

    Article  Google Scholar 

  • Everhart JE. Hemorrhoids. In: Everhart JE, editor. The burden of digestive diseases in the United States. Bethesda: National Institute of Diabetes and Digestive and Kidney Diseases, US Department of Health and Human Services; 2004. p. 65–8.

    Google Scholar 

  • Fargo MV, Latimer KM. Evaluation and management of common anorectal conditions. Am Fam Physician. 2012;85(6):624–30.

    PubMed  Google Scholar 

  • Ford AC, Moayyedi P, Lacy BE, et al. American college of gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109(Suppl 1):2–26.

    Article  Google Scholar 

  • Foxx-Orenstein AE, Umar SB, Crowell MD. Common anorectal disorders. Gastroenterol Hepatol. 2014;10(5):294–301.

    Google Scholar 

  • Gallo G, Martellucci J, Pellino G, et al. Consensus Statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of complete rectal prolapse. Tech Coloproctol. 2018;22(12):919–31.

    Article  CAS  PubMed  Google Scholar 

  • Guniganti P, Lewis S, Rosen A, Connolly S, Raptis C, Mellnick V. Imaging of acute anorectal conditions with CT and MRI. Abdom Radiol. 2017;42:403–22.

    Article  Google Scholar 

  • Halland M, Talley NJ. Fecal incontinence: mechanisms and management. Curr Opin Gastroenterol. 2012;28:57–62.

    Article  PubMed  Google Scholar 

  • Hassan I, Pemberton JH, Young-Fadok TM, et al. Ileorectal anastomosis for slow transit constipation: long-term functional and quality of life results. J Gastrointest Surg. 2006;10(10):1330–7.

    Article  PubMed  Google Scholar 

  • Heffernan C, Pachter HL, Megibow AJ, Macari M. Stercoral colitis leading to fatal peritonitis: CT findings. Am J Roentgenol. 2005;184(4):1189–93.

    Article  Google Scholar 

  • Hull T, Giese C, Wexner SD, et al. Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence. Dis Colon Rectum. 2013;56(2):234–45.

    Article  PubMed  Google Scholar 

  • Jenkins JT, Urie A, Molloy RG. Anterior anal fissures are associated with occult sphincter injury and abnormal sphincter function. Color Dis. 2008;10(3):280–5.

    Article  CAS  Google Scholar 

  • Johanson JF, Rimm A. Optimal nonsurgical treatment of hemorrhoids: a comparative analysis of infrared coagulation, rubber band ligation, and injection sclerotherapy. Am J Gastroenterol. 1992;87(11):1601–6.

    Google Scholar 

  • Kilpatrick JA, Zobell S, Leeflang EJ, Cao D, Mammen L, Rollins MD. Intermediate and long-term outcomes of a bowel management program for children with severe constipation or fecal incontinence. J Pediatr Surg. 2020;55(3):545–8.

    Article  PubMed  Google Scholar 

  • Kim KO, Kozarek R, Gluck M, Ross A, Lin OS. Changes in lower gastrointestinal bleeding presentation, management, and outcomes over a 10-year span. J Clin Gastroenterol. 2019;53(10):e463–7.

    Article  PubMed  Google Scholar 

  • Lindsey I, Jones OM, Cunningham C, George BD, Mortensen NJM. Botulinum toxin as second-line therapy for chronic anal fissure failing 0.2 percent glyceryl trinitrate. Dis Colon Rectum. 2003;46(3):361–6.

    Article  PubMed  Google Scholar 

  • Loder PB, Kamm MA, Nicholls RJ, Phillips RKS. “Reversible chemical sphincterotomy” by local application of glyceryl trinitrate. Br J Surg. 1994;81(9):1386–9.

    Article  CAS  PubMed  Google Scholar 

  • Lohsiriwat V. Treatment of hemorrhoids: a coloproctologist’s view. World J Gastroenterol. 2015;21(31):9245–52.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lysy J, Sistiery-Ittah M, Israelit Y, et al. Topical capsaicin – a novel and effective treatment for idiopathic intractable Pruritus Ani: a randomised, placebo controlled, crossover study. Gut. 2003;52(9):1323–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Maccioni F. Functional disorders of the ano-rectal compartment of the pelvic floor: clinical and diagnostic value of dynamic MRI. Abdom Imaging. 2013;38(5):930–51.

    Article  PubMed  Google Scholar 

  • MacLean J, Russell D. Pruritus Ani. Aust Fam Physician. 2010;39(6):366–70.

    PubMed  Google Scholar 

  • McCallion K, Gardiner KR. Progress in the understanding and treatment of chronic anal fissure. Postgrad Med J. 2001;77(914):753–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • McCrea GL, Miaskowski C, Stotts NA, Macera L, Varma MG. Pathophysiology of constipation in the older adult. World J Gastroenterol. 2008;14(17):2631–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nelson R, Furner S, Jesudason V. Fecal incontinence in Wisconsin nursing homes prevalence and associations. Dis Colon Rectum. 1998;41:1226–9.

    Article  CAS  PubMed  Google Scholar 

  • Pfenninger JL, Zainea GG. Common anorectal conditions: Part I. Symptoms and complaints. Am Fam Physician. 2001;63(12):2391–8.

    CAS  PubMed  Google Scholar 

  • Qureshi W. How i approach it: anal fissures. Am J Gastroenterol. 2020;115(3):315–6.

    Article  PubMed  Google Scholar 

  • Ramage L, Simillis C, Yen C, et al. Magnetic resonance defecography versus clinical examination and fluoroscopy: a systematic review and meta-analysis. Tech Coloproctol. 2017;21(12):915–27.

    Article  CAS  PubMed  Google Scholar 

  • Rao SSC, Go JT. Update on the management of constipation in the elderly: new treatment options. Clin Interv Aging. 2010;5:163–71.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rao SSC, Rattanakovit K, Patcharatrakul T. Diagnosis and management of chronic constipation in adults. Nat Rev Gastroenterol Hepatol. 2016;13(5):295–305.

    Article  CAS  PubMed  Google Scholar 

  • Rentsch M, Paetzel C, Lenhart M, Feuerbach S, Jauch KW, Fürst A. Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology. Dis Colon Rectum. 2001;44(7):999–1007.

    Article  CAS  PubMed  Google Scholar 

  • Ruhl CE, Sayer B, Byrd-Holt DD, Brown DM. Costs of digestive diseases. In: Everhart JE, editor. The Burden of digestive diseases in the United States. Bethesda: National Institute of Diabetes and Digestive and Kidney Diseases, US Department of Health and Human Services; 2004. p. 137–48.

    Google Scholar 

  • Schultz I, Miellgren A, Öberg M, Dolk A, Holmström B. Whole gut transit is prolonged after Ripstein rectopexy. Eur J Surg. 1999;165(3):242–7.

    Article  CAS  PubMed  Google Scholar 

  • Suares NC, Ford AC. Systematic review: the effects of fibre in the management of chronic idiopathic constipation. Aliment Pharmacol Ther. 2011;33(8):895–901.

    Article  CAS  PubMed  Google Scholar 

  • Sun WM, Read NW, Donnelly TC, Bannister JJ, Shorthouse AJ. A common pathophysiology for full thickness rectal prolapse, anterior mucosal prolapse and solitary rectal ulcer. Br J Surg. 1989;76:290–5.

    Article  CAS  PubMed  Google Scholar 

  • Szumulowicz UM. Pruritis Ani. In: Zutshi M, editor. Anorectal disease. Cham: Springer; 2016.

    Google Scholar 

  • Tran V, Limketkai BN, Sauk JS. IBD in the elderly: management challenges and therapeutic considerations. Curr Gastroenterol Rep. 2019;21(11):60.

    Google Scholar 

  • Tranqui P, Trottier DC, Victor C, Freeman JB. Nonsurgical treatment of chronic anal fissure: Nitroglycerin and dilatation versus nifedipine and botulinum toxin. Can J Surg. 2006;49(1):41–5.

    PubMed  PubMed Central  Google Scholar 

  • Varma MG, Brown JS, Creasman JM, et al. Fecal incontinence in females older than aged 40 years: who is at risk? Dis Colon Rectum. 2006;49(6):841–51.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wallenhorst T, Bouguen G, Brochard C, et al. Long-term impact of full-thickness rectal prolapse treatment on fecal incontinence. Surgery. 2015;158(1):104–11.

    Article  PubMed  Google Scholar 

  • Wexner SD, Jorge JMN. Anatomy and embryology of the anus, rectum and colon. In: Corman ML, editor. Colon and rectal surgery. 4th ed. Philadelphia: Lippincott-Raven; 1998. p. 1–26.

    Google Scholar 

  • Zaghiyan KN, Fleshner P. Anal fissure. Clin Colon Rectal Surg. 2011;24(1):22–30.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Frederick B. Peng

  2. Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Waqar Qureshi

Authors
  1. Frederick B. Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Waqar Qureshi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Waqar Qureshi .

Editor information

Editors and Affiliations

  1. Department of Medicine, Robert Wood Johnson School of Medicine, Rutgers University, New Brunswick, NJ, USA

    C. S. Pitchumoni

  2. Department of Medicine, Division of Geriatrics, Montefiore Medical Center, Wakefield Campus, Bronx, NY, USA

    T.S. Dharmarajan

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Peng, F.B., Qureshi, W. (2021). Anorectal Disorders. In: Pitchumoni, C.S., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-030-30192-7_97

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-30192-7_97

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-30191-0

  • Online ISBN: 978-3-030-30192-7

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation