Fecha de publicación: 23 Agosto 2010
M.J. Soria-de la Cruz
Servicio de Aparato Digestivo. Hospital Universitario Puerta del Mar de Cádiz.
This review refers to the multiple diagnostic tests available in coloproctology for the assessment of functional anorectal problems, mainly fecal incontinence and constipation.
The debate today revolves around the real need to perform diagnostic tests on patients with functional anorectal disorders. Expert authors on anorectal functional disorders discuss the need to perform basic techniques such as anorectal manometry. Some authors defend the routine performance of manometry, rectal balloon expulsion tests and anorectal ultrasonographies, leaving the rest of explorations for selected patients. In fact, anorectal tests provide important additional diagnostic information on clinical evaluation in 19-98% of the studies, they influence treatment in 75-84% of cases, and they help changing the therapeutic approach in 10-19% of cases. However, other authors consider that the most frequent causes of fecal incontinence can be identified by a physical examination and a perianal inspection, by a digital rectal examination and by a neurological assessment of the perineum, lower limbs and back. Processes such as fecal impaction in children and the elderly, reduced storage capacity in colon and rectum due to inflammatory bowel disease, radiotherapy or proctectomy, do not require special research and they benefit from conservative medical treatment. Lastly, other authors note that biofeedback is being questioned compared to conventional medical treatment, although new studies emphasize the effectiveness of biofeedback compared to general measures or simple pelvic exercises without manometry.
Therefore, not all patients may require anorectal diagnostic tests and thus it is necessary to standardize and interpret them correctly. Anorectal manometry, assessment of rectal sensation and endoanal images obtained by ultrasound or MRI are used as initial tests in most ambulatory patients with significant symptoms. The other techniques are used only in selected patients or in research patients. It is important that doctors know about the management of fecal incontinence and its causes, that they conduct a proper examination and provide effective support and care to their patients.
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