Lan Nan, Smukalla Scot T M, Chang Shannon
Department of Gastroenterology, Columbia University Irving Medical Center, New York, New York.
Division of Gastroenterology, New York University Grossman School of Medicine, New York, New York.
Gastroenterol Hepatol (N Y). 2023 Jan;19(1):41-47.
Functional anorectal disorders are common in patients with ileal pouch-anal anastomosis (IPAA) and often have a debilitating impact on quality of life. The diagnosis of functional anorectal disorders, including fecal incontinence (FI) and defecatory disorders, requires a combination of clinical symptoms and functional testing. Symptoms are generally underdiagnosed and underreported. Commonly utilized tests include anorectal manometry, balloon expulsion test, defecography, electromyography, and pouchoscopy. The treatment for FI begins with lifestyle modifications and medications. Sacral nerve stimulation and tibial nerve stimulation have been trialed on patients with IPAA and FI, resulting in improvement in symptoms. Biofeedback therapy has also been used in patients with FI but is more commonly utilized in defecatory disorders. Early diagnosis of functional anorectal disorders is important because a response to treatment may significantly improve a patient's quality of life. To date, there is limited literature describing the diagnosis and treatment of functional anorectal disorders in patients with IPAA. This article focuses on the clinical presentation, diagnosis, and treatment of FI and defecatory disorders in patients with IPAA.
功能性肛门直肠疾病在回肠储袋肛管吻合术（IPAA）患者中很常见，并且常常对生活质量产生不利影响。功能性肛门直肠疾病的诊断，包括大便失禁（FI）和排便障碍，需要结合临床症状和功能测试。症状通常诊断不足且报告较少。常用的检查包括肛门直肠测压、气囊排出试验、排粪造影、肌电图和储袋镜检查。FI的治疗首先从生活方式改变和药物治疗开始。骶神经刺激和胫神经刺激已在IPAA和FI患者中进行试验，症状得到改善。生物反馈疗法也已用于FI患者，但更常用于排便障碍。功能性肛门直肠疾病的早期诊断很重要，因为对治疗的反应可能会显著改善患者的生活质量。迄今为止，描述IPAA患者功能性肛门直肠疾病诊断和治疗的文献有限。本文重点关注IPAA患者FI和排便障碍的临床表现、诊断和治疗。
