<p class="first" id="P1">This report defines criteria and reviews the epidemiology,
pathophysiology, and management
of the following common anorectal disorders: fecal incontinence (FI), functional anorectal
pain, and functional defecation disorders. FI is defined as the recurrent uncontrolled
passage of fecal material for at least 3 months. The clinical features of FI are useful
for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful
for evaluating anal and pelvic floor structure and function. Education, antidiarrheals,
and biofeedback therapy are the mainstay of management; surgery may be useful in refractory
cases. Functional anorectal pain syndromes are defined by clinical features and categorized
into 3 subtypes. In proctalgia fugax, the pain is typically fleeting and lasts for
seconds to minutes. In levator ani syndrome and unspecified anorectal pain, the pain
lasts more than 30 minutes, but in levator ani syndrome there is puborectalis tenderness.
Functional defecation disorders are defined by ≥2 symptoms of chronic constipation
or irritable bowel syndrome with constipation, and with ≥2 features of impaired evacuation,
that is, abnormal evacuation pattern on manometry, abnormal balloon expulsion test,
or impaired rectal evacuation by imaging. It includes 2 subtypes: dyssynergic defecation
and inadequate defecatory propulsion. Pelvic floor biofeedback therapy is effective
for treating levator ani syndrome and defecatory disorders.
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