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Gastroenterology. 2014 Jan;146(1):37-45.e2. doi: 10.1053/j.gastro.2013.10.062. Epub 2013 Nov 6.

An update on anorectal disorders for gastroenterologists.

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Clinical Enteric Neuroscience Translational and Epidemiological Research Program, Division of Gastroenterology and Hepatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
Section of Gastroenterology/Hepatology, Department of Internal Medicine, Medical College of Georgia, Georgia Regents University, Augusta, Georgia. Electronic address:


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.


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

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