The current understanding of continence and defecation

Problems of continence and defecation are encountered in all facets of medical practice. Yet, the anorectum is cloaked by misunderstanding. Recent research has shed new light on this subject and newer concepts based on systematic investigations have paved the way to a rational approach. Motor function of the anorectum can now be delineated by manometry, electromyography and nerve stimulation. More complex functions like the coordination for continence and defecation are measured using other studies including defecating proctography, scintigraphic balloon topography, scintigraphic evacuation and colonic transit. The amalgamation of data from these studies have led to a logical sequence for the maintenance of normal continence and defecation that is developed in this manuscript based on our current understanding of anorectal motility and physiology. This allows patients who are resistant to straightforward diagnosis to be selected for specialised tests resulting in categorisation and a rational management strategy for their problems.