Function and dysfunction of the colon and anorectum in adults: working team report of the Swedish Motility Group (SMoG).
Symptoms of fecal incontinence and constipation are common in the general population. These can, however, be unreliably reported and are poorly discriminatory for underlying pathophysiology. Furthermore, both symptoms may coexist. In the elderly, fecal impaction always must be excluded. For patients with constipation, colon transit studies, anorectal manometry and defecography may help to identify patients with slow-transit constipation and/or pelvic floor dysfunction. The best documented medical treatments for constipation are the macrogols, lactulose and isphagula. Evolving drugs include lubiprostone, which enhances colonic secretion by activating chloride channels. Surgery is restricted for a highly selected group of patients with severe slow-transit constipation and for those with large rectoceles that demonstrably cause rectal evacuatory impairment. For patients with fecal incontinence that does not resolve on antidiarrheal treatment, functional and structural evaluation with anorectal manometry and endoanal ultrasound or magnetic resonance (MR) of the anal canal may help to guide management. Sacral nerve stimulation is a rapidly evolving alternative when other treatments such as biofeedback and direct sphincter repair have failed. Advances in understanding the pathophysiology as a guide to treatment of patients with constipation and fecal incontinence is a continuing important goal for translational research. The content of this article is a summary of presentations given by the authors at the Fourth Meeting of the Swedish Motility Group, held in Gothenburg in April 2007.
Karling
Pontus
P
Department of Internal Medicine, Umeå University Hospital, Sweden. pontus.karling@vll.se
Abrahamsson
Hasse
H
Dolk
Anders
A
Hallböök
Olof
O
Hellström
Per M
PM
Knowles
Charles H
CH
Kjellström
Lars
L
Lindberg
Greger
G
Lindfors
Per-Johan
PJ
Nyhlin
Henry
H
Ohlsson
Bodil
B
Schmidt
Peter T
PT
Sjölund
Kristina
K
Sjövall
Henrik
H
Walter
Susanne
S
D001003:Anal Canal / Q000294:innervation / Q000503:physiopathology*; D003106:Colon / Q000294:innervation / Q000503:physiopathology*; D003248:Constipation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005242:Fecal Incontinence / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D012007:Rectum / Q000294:innervation / Q000503:physiopathology*