title: An update on anorectal disorders for gastroenterologists.
abstract: Gastroenterologists frequently encounter pelvic floor disorders, which affect 10% to 15% of the population. The anorectum is a complex organ that collaborates with the pelvic floor muscles to preserve fecal continence and enable defecation. A careful clinical assessment is critical for the diagnosis and management of defecatory disorders and fecal incontinence. Newer diagnostic tools (eg, high-resolution manometry and magnetic resonance defecography) provide a refined understanding of anorectal dysfunctions and identify phenotypes in defecatory disorders and fecal incontinence. Conservative approaches, including biofeedback therapy, are the mainstay for managing these disorders; new minimally invasive approaches may benefit a subset of patients with fecal incontinence, but more controlled studies are needed. This mini-review highlights advances, current concepts, and controversies in the area.
authors.affiliation: Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Division of Gastroenterology and Hepatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
authors.forename: Adil E
authors.initials: AE
authors.lastname: Bharucha
authors.affiliation: Section of Gastroenterology/Hepatology, Department of Internal Medicine, Medical College of Georgia, Georgia Regents University, Augusta, Georgia. Electronic address: srao@gru.edu.
authors.forename: Satish S C
authors.initials: SS
authors.lastname: Rao
mesh_terms: D001003:Anal Canal / Q000033:anatomy & histology / Q000502:physiology; D001004:Anus Diseases / Q000175:diagnosis / Q000628:therapy; D001676:Biofeedback, Psychology; D003248:Constipation / Q000175:diagnosis* / Q000628:therapy; D019841:Defecography; D005242:Fecal Incontinence / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008365:Manometry; D012002:Rectal Diseases / Q000175:diagnosis* / Q000628:therapy; D012007:Rectum / Q000033:anatomy & histology / Q000502:physiology
keywords: Anorectal Manometry; Biofeedback Therapy; DD; DRE; Dyssynergic Defecation; FI; Fecal Incontinence; IAS; ICC; MRI; ROCK; RhoA–RhoA kinase; SNS; defecatory disorder; digital rectal examination; fecal incontinence; internal anal sphincter; interstitial cells of Cajal; magnetic resonance imaging; sacral nerve stimulation