The current understanding of continence and defecation

Area of Science:

• Gastroenterology and Colorectal Surgery
• Neurogastroenterology and Motility

Background:

• Continence and defecation problems are common yet poorly understood in medical practice.
• The anorectum's complex physiology has historically been a subject of misunderstanding.

Purpose of the Study:

• To present a rational approach to evaluating anorectal function based on recent research.
• To outline a logical sequence for assessing and managing continence and defecation disorders.

Main Methods:

• Utilizing manometry, electromyography, and nerve stimulation to assess anorectal motor function.
• Employing defecating proctography, scintigraphic balloon topography, scintigraphic evacuation, and colonic transit studies for complex functions.
• Integrating data from multiple diagnostic modalities for a comprehensive understanding.

Main Results:

• Delineation of anorectal motor function is now possible with specific diagnostic tests.
• Complex functions like coordinated continence and defecation can be quantitatively measured.
• A logical sequence for maintaining normal anorectal function has been established.

Conclusions:

• Current understanding of anorectal motility and physiology allows for a systematic diagnostic pathway.
• Specialized tests aid in categorizing patients with challenging diagnoses.
• This approach facilitates the development of rational management strategies for anorectal dysfunction.