Skip to main content
PMC home page
Gut logoLink to Gut
. 1999 Sep;45(Suppl 2):II55–II59. doi: 10.1136/gut.45.2008.ii55

Functional disorders of the anus and rectum

W Whitehead, A Wald, N Diamant, P Enck, J Pemberton, S Rao
PMCID: PMC1766682  PMID: 10457046

Abstract

In this report the functional anorectal disorders, the etiology of which is currently unknown or related to the abnormal functioning of normally innervated and structurally intact muscles, are discussed. These disorders include functional fecal incontinence, functional anorectal pain, including levator ani syndrome and proctalgia fugax, and pelvic floor dyssynergia. The epidemiology of each disorder is defined and discussed, their pathophysiology is summarized and diagnostic approaches and treatment are suggested. Some suggestions for the direction of future research on these disorders are also given.


Keywords: fecal incontinence; pelvic floor dyssynergia; anismus; proctalgia fugax; levator ani syndrome; constipation; Rome II

Full Text

The Full Text of this article is available as a PDF (70.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barrett J. A., Brocklehurst J. C., Kiff E. S., Ferguson G., Faragher E. B. Anal function in geriatric patients with faecal incontinence. Gut. 1989 Sep;30(9):1244–1251. doi: 10.1136/gut.30.9.1244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bleijenberg G., Kuijpers H. C. Treatment of the spastic pelvic floor syndrome with biofeedback. Dis Colon Rectum. 1987 Feb;30(2):108–111. doi: 10.1007/BF02554946. [DOI] [PubMed] [Google Scholar]
  3. Chaussade S., Roche H., Khyari A., Couturier D., Guerre J. Mesure du temps de transit colique (TTC): description et validation d'une nouvelle technique. Gastroenterol Clin Biol. 1986 May;10(5):385–389. [PubMed] [Google Scholar]
  4. Diamant N. E., Kamm M. A., Wald A., Whitehead W. E. AGA technical review on anorectal testing techniques. Gastroenterology. 1999 Mar;116(3):735–760. doi: 10.1016/s0016-5085(99)70195-2. [DOI] [PubMed] [Google Scholar]
  5. Drossman D. A., Li Z., Andruzzi E., Temple R. D., Talley N. J., Thompson W. G., Whitehead W. E., Janssens J., Funch-Jensen P., Corazziari E. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993 Sep;38(9):1569–1580. doi: 10.1007/BF01303162. [DOI] [PubMed] [Google Scholar]
  6. Duthie G. S., Bartolo D. C. Anismus: the cause of constipation? Results of investigation and treatment. World J Surg. 1992 Sep-Oct;16(5):831–835. doi: 10.1007/BF02066978. [DOI] [PubMed] [Google Scholar]
  7. Eckardt V. F., Dodt O., Kanzler G., Bernhard G. Anorectal function and morphology in patients with sporadic proctalgia fugax. Dis Colon Rectum. 1996 Jul;39(7):755–762. doi: 10.1007/BF02054440. [DOI] [PubMed] [Google Scholar]
  8. Eckardt V. F., Dodt O., Kanzler G., Bernhard G. Treatment of proctalgia fugax with salbutamol inhalation. Am J Gastroenterol. 1996 Apr;91(4):686–689. [PubMed] [Google Scholar]
  9. Enck P. Biofeedback training in disordered defecation. A critical review. Dig Dis Sci. 1993 Nov;38(11):1953–1960. doi: 10.1007/BF01297069. [DOI] [PubMed] [Google Scholar]
  10. Gilliland R., Heymen S., Altomare D. F., Park U. C., Vickers D., Wexner S. D. Outcome and predictors of success of biofeedback for constipation. Br J Surg. 1997 Aug;84(8):1123–1126. [PubMed] [Google Scholar]
  11. Grimaud J. C., Bouvier M., Naudy B., Guien C., Salducci J. Manometric and radiologic investigations and biofeedback treatment of chronic idiopathic anal pain. Dis Colon Rectum. 1991 Aug;34(8):690–695. doi: 10.1007/BF02050352. [DOI] [PubMed] [Google Scholar]
  12. Heymen S., Wexner S. D., Gulledge A. D. MMPI assessment of patients with functional bowel disorders. Dis Colon Rectum. 1993 Jun;36(6):593–596. doi: 10.1007/BF02049867. [DOI] [PubMed] [Google Scholar]
  13. Hoffmann B. A., Timmcke A. E., Gathright J. B., Jr, Hicks T. C., Opelka F. G., Beck D. E. Fecal seepage and soiling: a problem of rectal sensation. Dis Colon Rectum. 1995 Jul;38(7):746–748. doi: 10.1007/BF02048034. [DOI] [PubMed] [Google Scholar]
  14. Kuijpers H. C., Bleijenberg G. The spastic pelvic floor syndrome. A cause of constipation. Dis Colon Rectum. 1985 Sep;28(9):669–672. doi: 10.1007/BF02553449. [DOI] [PubMed] [Google Scholar]
  15. Leroi A. M., Berkelmans I., Denis P., Hémond M., Devroede G. Anismus as a marker of sexual abuse. Consequences of abuse on anorectal motility. Dig Dis Sci. 1995 Jul;40(7):1411–1416. doi: 10.1007/BF02285184. [DOI] [PubMed] [Google Scholar]
  16. Lowery S. P., Srour J. W., Whitehead W. E., Schuster M. M. Habit training as treatment of encopresis secondary to chronic constipation. J Pediatr Gastroenterol Nutr. 1985 Jun;4(3):397–401. doi: 10.1097/00005176-198506000-00013. [DOI] [PubMed] [Google Scholar]
  17. Metcalf A. M., Phillips S. F., Zinsmeister A. R., MacCarty R. L., Beart R. W., Wolff B. G. Simplified assessment of segmental colonic transit. Gastroenterology. 1987 Jan;92(1):40–47. doi: 10.1016/0016-5085(87)90837-7. [DOI] [PubMed] [Google Scholar]
  18. Nelson R., Norton N., Cautley E., Furner S. Community-based prevalence of anal incontinence. JAMA. 1995 Aug 16;274(7):559–561. [PubMed] [Google Scholar]
  19. Patankar S. K., Ferrara A., Levy J. R., Larach S. W., Williamson P. R., Perozo S. E. Biofeedback in colorectal practice: a multicenter, statewide, three-year experience. Dis Colon Rectum. 1997 Jul;40(7):827–831. doi: 10.1007/BF02055441. [DOI] [PubMed] [Google Scholar]
  20. Preston D. M., Lennard-Jones J. E. Anismus in chronic constipation. Dig Dis Sci. 1985 May;30(5):413–418. doi: 10.1007/BF01318172. [DOI] [PubMed] [Google Scholar]
  21. Rao S. S., Hatfield R. A. Paroxysmal anal hyperkinesis: a characteristic feature of proctalgia fugax. Gut. 1996 Oct;39(4):609–612. doi: 10.1136/gut.39.4.609. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Rao S. S., Welcher K. D., Pelsang R. E. Effects of biofeedback therapy on anorectal function in obstructive defecation. Dig Dis Sci. 1997 Nov;42(11):2197–2205. doi: 10.1023/a:1018846113210. [DOI] [PubMed] [Google Scholar]
  23. Roberts J. P., Womack N. R., Hallan R. I., Thorpe A. C., Williams N. S. Evidence from dynamic integrated proctography to redefine anismus. Br J Surg. 1992 Nov;79(11):1213–1215. doi: 10.1002/bjs.1800791140. [DOI] [PubMed] [Google Scholar]
  24. Speakman C. T., Hoyle C. H., Kamm M. M., Henry M. M., Nicholls R. J., Burnstock G. Abnormalities of innervation of internal anal sphincter in fecal incontinence. Dig Dis Sci. 1993 Nov;38(11):1961–1969. doi: 10.1007/BF01297070. [DOI] [PubMed] [Google Scholar]
  25. Thompson W. G. Proctalgia fugax. Dig Dis Sci. 1981 Dec;26(12):1121–1124. doi: 10.1007/BF01295979. [DOI] [PubMed] [Google Scholar]
  26. Tobin G. W., Brocklehurst J. C. Faecal incontinence in residential homes for the elderly: prevalence, aetiology and management. Age Ageing. 1986 Jan;15(1):41–46. doi: 10.1093/ageing/15.1.41. [DOI] [PubMed] [Google Scholar]
  27. Wald A., Caruana B. J., Freimanis M. G., Bauman D. H., Hinds J. P. Contributions of evacuation proctography and anorectal manometry to evaluation of adults with constipation and defecatory difficulty. Dig Dis Sci. 1990 Apr;35(4):481–487. doi: 10.1007/BF01536923. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES