[Diagnostic in anorectal disorders]

Anorectal disorders which often lead to fecal incontinence are a frequent problem especially in elderly patients. Direct risk factors for fecal incontinence are higher age, female sex and co-morbidity with reduced health status. Anorectal disorders cause significant socio-economic burden. Impairment of the structural and functional integrity of the anorectum are mostly multifactorial (integrity of the muscles, sensory function, stool consistency) leading to depression and fear with reduction in quality of life. A basic diagnostic work up is sufficient to characterize the different manifestations of anorectal disorders in most of the cases. This includes patient history with daily stool protocol, clinical and endoscopic investigation. Follow-up investigations include anorectal manometry, anal sphincter-EMG, conduction velocity of the pudendal nerve, needle-EMG, barostat investigation, defecography and the dynamic MRT. Therapeutic interventions are focussed on the individual symptoms and should be provided in close cooperation with gastroenterologists, surgeons, gynecologists, urologists, physiotherapeutics and psychologists (nutritional-training, food fibre content, pharmacological treatment of diarrhea/constipation, toilet-training, pelvic floor-gymnastic, anal sphincter training, biofeedback). Indication for surgical therapy is rarely seen and should be decided only after complete diagnostic work-up and only when all conservative treatment options have failed. Surgical treatment should be provided only in experienced clinical centres.