DISORDERS OF FECAL CONTINENCE

Disorders of continence are disorders of the ability to perceive, reta in, or excrete faeces, or a combination of these. Disorders of percept ion are an absent or false feeling of urge. Retentional disorders are soiling, insufficiency and incontinence; disorders of excretion are co nstipation and complete rectal prolapse. Application of functional tes ts from the colorectal laboratory is helpful in diagnosing these funct ional disorders and in arriving at a strategy for treatment. Single te sts represent different aspects of anorectal function and need to be p erformed together. Abnormal results in one test must be interpreted wi th caution, especially when therapeutic surgery is considered. Contine nce disorders are difficult to deal with as the symptomatology is ofte n not specific. Most disorders can easily be diagnosed by a combinatio n of the patient's history, perineal inspection and digital rectal exa mination, but other disorders may coexist. Careful pre-operative inves tigation is of utmost importance. Functional assessment can demonstrat e unsuspected coexistent disorders and lead to a more well considered strategy for treatment, better selection of patients and improved resu lts.