Anorectal incontinence: therapeutic strategy of a complex surgical problem

The anatomophysiological integrity of the pelvic floor and anorectum contributes to the important function of continence and defecation. A variety of causes can cause damage in the anatomy and/or the innervation of the pelvic floor muscles as well as in anorectal sensitivity or stool consistency leading to anorectal continence disorder and incontinence. The most common cause of anorectal incontinence is related to injury of the sphincter muscles after delivery, or anorectal surgery. Anorectal incontinence is a complex problem, often of multifactorial origin. The exact cause of its incidence is unknown. However, the incidence is approximately 2% in the general population and 25-60% in the elderly. Although the condition is considered a problem in the elderly, it is becoming apparent that people are frequently affected from a much younger age. Anorectal incontinence is a severe disability and a major social problem as it produces a feeling of insecurity and pushes the patient towards social isolation. Management of the incontinent patient may be conservative (medicinal, biofeedback training), surgical (sphincter repair, pelvic floor repair, neosphincter formation, artificial sphincter or stoma) or use sacral nerve stimulation. The successful treatment of anorectal incontinence depends on accurate diagnosis of its cause, which is achieved by a thorough patient assessment including patient history, physical examination and selective specialized investigations. A stoma is the final resort when all other therapeutic attempts have failed.