title: Referral for anorectal function evaluation is indicated in 65% and beneficial in 92% of patients.
abstract: OBJECTIVE
  To determine the indicated referrals to a tertiary centre for patients with anorectal symptoms, the effect of the advised treatment and the discomfort of the tests.
  
  
  METHODS
  In a retrospective study, patients referred for anorectal function evaluation (AFE) between May 2004 and October 2006 were sent a questionnaire, as were the doctors who referred them. AFE consisted of anal manometry, rectal compliance measurement and anal endosonography. An indicated referral was defined as needing AFE to establish a diagnosis with clinical consequence (fecal incontinence without diarrhea, 3rd degree anal sphincter rupture, congenital anorectal disorder, inflammatory bowel disease with anorectal complaints and preoperative in patients for re-anastomosis or enterostoma, anal fissure, fistula or constipation). Anal ultrasound is always indicated in patients with fistula, anal manometry and rectal compliance when impaired continence reserve is suspected. The therapeutic effect was noted as improvement, no improvement but reassurance, and deterioration.
  
  
  RESULTS
  From the 216 patients referred, 167 (78%) returned the questionnaire. The referrals were indicated in 65%. Of these, 80% followed the proposed advice. Improvement was achieved in 35% and a reassurance in 57% of the patients, no difference existed between patient groups. On a VAS scale (1 to 10) symptoms improved from 4.0 to 7.2. Most patients reported no or little discomfort with AFE.
  
  
  CONCLUSIONS
  Referral for AFE was indicated in 65%. Beneficial effect was seen in 92%: 35% improved and 57% was reassured. Advice was followed in 80%. Better instruction about indication for AFE referral is warranted.
authors.affiliation: Department of Gastroenterology and Hepatology, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands. m.szojda@vumc.nl
authors.forename: Maria M
authors.initials: MM
authors.lastname: Szojda
authors.forename: Erik
authors.initials: E
authors.lastname: Tanis
authors.forename: Chris J J
authors.initials: CJ
authors.lastname: Mulder
authors.forename: Richelle J F
authors.initials: RJ
authors.lastname: Felt-Bersma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012002:Rectal Diseases / Q000628:therapy*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires