Diagnostic, pharmacological, surgical and behavioural developments in benign anorectal disease

The investigation of benign anorectal disease has been transformed by new techniques of imaging such as anal endosonography and magnetic resonance imaging. This has led to more specific surgical treatments when structural damage is identified. It has also led to the identification of newly recognised pathologies, such as primary internal sphincter degeneration which causes passive faecal incontinence. A variety of new treatment modalities is also emerging. Pharmacological therapies are assuming great importance in relation to anal disease, with topical glyceryl trinitrate now the first treatment of choice for chronic anal fissure. For patients with intractable constipation behavioural techniques to modify pelvic floor and intestinal function are now the mainstay of therapy. New approaches to the surgical therapy of incontinence include the use of an artificial bowel sphincter, and the electrical stimulation of sacral nerves to modify pelvic floor function.