Anorectal Disorders

This article defines the diagnostic criteria and reviews clinical evaluation and management of fecal incontinence, anorectal pain, dyssynergic defecation, and rectal hyposensitivity and hypersensitivity. Diagnostic evaluation includes anorectal manometry, balloon expulsion test, anal ultrasound, magnetic resonance imaging, defecography, and neurophysiology testing. Fecal incontinence is defined as recurrent uncontrolled passage of fecal material for 3 months. Management includes antidiarrheals, Kegel exercises, biofeedback therapy, dextranomer injection, surgery, sacral nerve stimulation, and translumbosacral neuromodulation therapy. Proctalgia fugax is defined as anorectal pain lasting seconds to minutes and levator ani syndrome is defined as pain lasting more than 30 minutes with puborectalis tenderness. Biofeedback and translumbosacral neuromodulation therapy may be useful. Dyssynergic defecation is defined by both symptoms of difficult defecation and objective evidence of dyssynergia. Biofeedback therapy is efficacious in dyssynergic defecation. Rectal sensory disorders are defined by both anorectal symptoms and increased (hyposensitivity) or decreased (hypersensitivity) sensory thresholds during rectal balloon distention; sensory biofeedback therapy is useful.