Abstract

Current perspectives on the diagnosis and management of functional anorectal disorders in patients with inflammatory bowel disease

Nigam GB1, Limdi JK1, Vasant DH2. Therap Adv Gastroenterol. 2018 Dec 6;11:1756284818816956. doi: 10.1177/1756284818816956. eCollection 2018.
 
     

Author information

1 Pennine Acute Hospitals NHS Trust, Greater Manchester, UK.

2 Honorary Senior Lecturer, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester University NHS Foundation Trust, Neurogastroenterology Unit, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK.

Abstract

Despite advances in inflammatory bowel disease (IBD) therapies, a significant proportion of patients with quiescent disease experience persistent, debilitating symptoms of faecal incontinence (FI), urgency and defaecatory disorders due to anorectal dysfunction. Such symptoms are often underreported or misdiagnosed and can lead to potentially premature treatment 'escalation' and under-utilisation of pelvic floor investigations. In this review article, we consider putative pathophysiological post-inflammatory changes resulting in altered anorectal sensitivity, motility and neuromuscular coordination and how this may drive symptoms in quiescent IBD. Finally, we discuss a pragmatic approach to investigating and managing anorectal dysfunction and highlight areas for future research for this often-neglected group of patients.

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