FUNCTIONAL COLONIC AND ANORECTAL DISORDERS - DETECTING AND OVERCOMINGCAUSES OF CONSTIPATION AND FECAL INCONTINENCE

Evaluation of constipation and fecal incontinence begins with comprehe nsive history taking, which may include overcoming a significant psych osocial barrier, Before functional anorectal diseases can be controlle d, the fundamental cause must be determined and any underlying disorde r corrected. In constipation, a colonic or anorectal motility disorder is often the cause; about half of refractory cases are the result of obstructive defecation. In fecal incontinence, dysfunction of several anatomic or physiologic mechanisms may be the cause. Anorectal manomet ry is useful in assessment in both disorders. Other helpful tests are colonic transit measurement in constipation and electrophysiologic tes ts and defecography in fecal incontinence, Treatment of constipation o ften includes dietary measures and use of laxatives or prokinetic agen ts; fecal incontinence may respond to bulking or antidiarrheal agents. In both disorders, some patients have responded to the recently descr ibed technique of neuromuscular conditioning with biofeedback. In some cases, surgical repair must be considered.