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Robert E. Gutman Geoffrey W. Cundiff
Defecatory dysfunction and fecal incontinence are common conditions for women that have tremendous psychosocial and economic implications.
The differential diagnosis for anorectal dysfunction is broad and can be classified into systemic factors, anatomic and structural abnormalities, and functional disorders.
A thorough history and physical examination are critical for the evaluation of fecal incontinence and defecatory dysfunction, as well as appropriate ancillary testing.
Treatment of anorectal dysfunction should focus on treatment of the underlying condition, with nonsurgical management attempted before surgery.
Overlapping sphincteroplasty is the procedure of choice for fecal incontinence caused by a disrupted anal sphincter.
Anorectal dysfunction encompasses a variety of conditions that disrupt normal anorectal function. Such conditions can be subdivided as those that cause defecatory dysfunction and fecal incontinence. Although anorectal dysfunction transcends any individual medical specialty, the pathophysiology, evaluation, and management of conditions relevant to obstetricians/gynecologists are presented in this chapter.
Anal continence and defecation are complex physiologic processes that require intact and coordinated neurologic and anatomic function, including colonic absorption and motility, rectal compliance, anorectal sensation, and the multifaceted continence mechanism. An understanding of normal physiology and pathophysiology is essential to the treatment of women with anorectal dysfunction.
Stool Formation and The colon plays an important role in absorption and regulation of water and electrolytes. As much