SummaryBackgroundAnorectal motility disorders such as dyssynergic defecation (DD), faecal incontinence (FI) and anorectal pain affect 40% of the population and are a frequent reason for gastroenterology consultation. They significantly affect the quality of life and lead to psychological distress. Lack of understanding of these problems compounded by a lack of availability and knowledge of diagnostic tools in most medical centres and/or trained physicians has significantly hampered this field.AimsTo discuss the latest advances in pathophysiology, diagnostic tests and therapeutic options for these disorders using an evidence‐based approach.MethodsWe reviewed the published literature over the past 20 years on DD, FI and anorectal pain and distilled these into a narrative review.ResultsA detailed history, prospective stool diary and digital rectal exam, together with diagnostic tests such as anorectal manometry, balloon expulsion test, translumbosacral anorectal magnetic stimulation test for assessing neuropathy, defecography and anal ultrasound, can provide detailed mechanistic and structural information. Such knowledge can pave the way for a meaningful and pathophysiologic‐based management approach. This could include biofeedback therapy for DD or FI, sensory training for rectal hyposensitivity or sensory adaptation training for rectal hypersensitivity or sphincter bulking agents or neuromodulation therapies. These treatments are effective and safe.ConclusionsAnorectal motility disorders are common, but either less well recognized or poorly managed by most gastroenterologists. Equipped with the practical and up‐to‐date knowledge provided in this review, physicians could provide improved health care for these patients.

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评论文章：肛门直肠动力障碍的诊断和治疗进展


摘要背景肛门直肠动力障碍，如排便失调 (DD)、大便失禁 (FI) 和肛门直肠疼痛，影响着 40% 的人口，也是胃肠病学咨询的常见原因。它们严重影响生活质量并导致心理困扰。对这些问题缺乏了解，加上大多数医疗中心和/或训练有素的医生缺乏诊断工具的可用性和知识，严重阻碍了这一领域的发展。方法我们回顾了过去 20 年来发表的有关 DD、FI 和肛门直肠疼痛的文献，并将其提炼成一篇叙述性综述。结果详细的病史、前瞻性粪便日记和直肠指检，以及肛门直肠测压等诊断测试、球囊排出试验、用于评估神经病变的经腰骶肛门直肠磁刺激试验、排粪造影和肛门超声，可以提供详细的机制和结构信息。这些知识可以为有意义的、基于病理生理学的管理方法铺平道路。这可能包括针对 DD 或 FI 的生物反馈疗法、针对直肠过敏的感觉训练或针对直肠过敏的感觉适应训练或括约肌填充剂或神经调节疗法。这些治疗有效且安全。 结论 肛门直肠动力障碍很常见，但大多数胃肠病学家要么不太认识，要么管理不善。凭借本次综述中提供的实用和最新知识，医生可以为这些患者提供更好的医疗保健。