Functional anorectal disorders
Functional anorectal disorders
复制标题
DOI：
10.1053/j.gastro.2005.11.064
复制
发表时间：
2006-04-01
期刊：
影响因子：
29.4
通讯作者：
Rao, Satish
中科院分区：
文献类型：
--
作者：
Bharucha, Adil E.;Wald, Arnold;Rao, Satish
本报告定义了功能性肛门直肠疾病（即大便失禁、肛门直肠疼痛和排便障碍）的诊断标准。功能性大便失禁被定义为在发育年龄>= 4岁的个体中反复出现>= 3个月的粪便物质不受控制的通过，其与以下相关：（1）正常受神经支配和结构完整的肌肉的功能异常，和/或（2）括约肌结构和/或神经支配没有或轻微异常，不足以解释大便失禁，和/或（3）正常或紊乱的排便习惯（即，粪便潴留或腹泻），和/或（4）心理原因。然而，结构和/或神经性异常解释了症状，或者是全身性过程的一部分（例如糖尿病神经病变）的情况不包括在功能性大便失禁中。功能性大便失禁是一种常见但未被充分认识的症状，在男性和女性中同样普遍，并且通常会引起相当大的痛苦。临床特征对指导诊断测试和治疗是有用的。功能性肛门直肠疼痛综合征包括一过性直肠痛（短暂性疼痛）和慢性直肠痛;慢性直肠痛可细分为肛提肌综合征和未指明的肛门直肠疼痛，其由任意临床标准定义。功能性排便障碍的特征是2种或2种以上的便秘症状，排便时具有以下特征中的2种以上：排便障碍、骨盆底肌肉收缩不适当和推进力不足。功能性排便障碍可以通过生物反馈治疗（如排便协同失调）进行骨盆底再训练。
This report defines criteria for diagnosing functional anorectal disorders (ie, fecal incontinence, anorectal pain, and disorders of defecation). Functional fecal incontinence is defined as the uncontrolled passage of fecal material recurring for >= 3 months in an individual with a developmental age of >= 4 years that is associated with: (1) abnormal functioning of normally innervated and structurally intact muscles, and/or (2) no or minor abnormalities of sphincter structure and/or innervation insufficient to explain fecal incontinence, and/or (3) normal or disordered bowel habits (ie, fecal retention or diarrhea), and/or (4) psychological causes. However, conditions wherein structural and/or neurogenic abnormalities explain the symptom, or are part of a generalized process (eg, diabetic neuropathy) are not included within functional fecal incontinence. Functional fecal incontinence is a common, but underrecognized symptom, which is equally prevalent in men and women, and can often cause considerable distress. The clinical features are useful for guiding diagnostic testing and therapy. Functional anorectal pain syndromes include proctalgia fugax (fleeting pain) and chronic proctalgia; chronic proctalgia may be subdivided into levator ani syndrome and unspecified anorectal pain, which are defined by arbitrary clinical criteria. Functional defecation disorders are characterized by 2 or more symptoms of constipation, with >= 2 of the following features during defecation: impaired evacuation, inappropriate contraction of the pelvic floor muscles, and inadequate propulsive forces. Functional disorders of defecation may be amenable to pelvic floor retraining by biofeedback therapy (such as dyssynergic defecation).