Igualada-Martinez P et all
Clinical Paper Review by Michelle Henderson
The physiotherapy team at Guy’s and St Thomas’ Hospitals have added a valuable paper to the current literature about management of anorectal dysfunction.
This review offers a thorough description of what and how to assess (history taking, physical exam, investigations etc) along with the ensuing management of anal (faecal) incontinence and anorectal pain.
We like that the importance of patient education, and agreeing treatment goals at the start, is recognised, we know that getting the patient on board with their treatment plan can increase adherence and therefore success. For each aspect of assessment there is an explanation of both what is normal and abnormal and offers the evidence base for each of the intervention strategies. This will be especially useful for those new to assessing and managing anorectal dysfunction. Having the latest evidence base offers an excellent update for those with experience.
A point of particular interest to note – rectal (or transanal) irrigation is recommended as an early intervention (as an alternative to suppositories), before pelvic floor muscle training, potentially giving symptom relief whilst strengthening these muscles.
This is an excellent summary of holistic assessment and conservative treatments with explanations for each strategy. Whilst this paper is written for the physiotherapist, the information is readily applied to all pelvic floor specialists, regardless of discipline. It will be an interesting and useful read for all who treat patients with anorectal dysfunction.
Limited access (abstract and summary of each section) available at: https://www.sciencedirect.com/science/article/abs/pii/S104314892200077X
Igualada-Martinez P et al (2022): Physiotherapy Management of Anorectal Dysfunction. Seminars in Colon & Rectal Surgery (2022), doi: https://doi.org/10.1016/j.scrs.2022.100936