Electrophysiological Basis of Fecal Incontinence and Its Implications for Treatment

The majority of patients with neuropathic incontinence and other pelvic floor conditions associated with straining at stool have damage to the pudendal nerves distal to the ischial spine. Sacral nerve stimulation appears to be a promising innovation and has been widely adopted and currently considered the standard of care for adults with moderate to severe fecal incontinence and following failed sphincter repair. From a decision-to-treat perspective, the short-term efficacy is good (70%–80%), but the long-term efficacy of sacral nerve stimulation is around 50%. Newer electrophysiological tests and improved anal endosonography would more effectively guide clinical decision making.

Human immunodeficiency virus and the anorectum

An understanding of HIV/AIDS is important to the practice of colon and rectal surgery as these patients frequently present with proctological diseases. Operations for anorectal pathology represent one of the most common indications for surgery in HIV-positive patients. It appears that anorectal pathology in HIV/AIDS infected patients has not been impacted by highly active anti retroviral therapy. The general approach to the HIV- infected patient and management of the anorectal diseases are discussed. Surgical procedures can be safe and effective therapeutic modalities. Symptomatic improvement of the underlying anorectal pathology may make delayed wound healing an acceptable complication in many AIDS patients. Part of the complete treatment includes education, treatment and counselling of sexual partners