Chapters authored
Applications of Anorectal Ultrasound in Anorectal Disorders
Endoanal ultrasound (EAUS) and endorectal ultrasound (ERUS) have been introduced to clinical use since the 1980s. The techniques have been used to assess various anorectal disorders and conditions, including anorectal abscess and fistula, fecal incontinence, anorectal tumor, anorectal pain and occasionally evaluation of adjacent pelvic pathology. Information acquired includes anatomical location of disease, extent of disease, involvement of anal sphincter by disease and the status of anal sphincter. This information is valuable for treatment planning, prevention of disease recurrence, prevention and/or correction of sphincter defect and follow-up evaluation. The technique is cheap, simple, well tolerated, and repeatable with acceptable accuracy. Although the interpretation is operator-dependent, technology has developed to improved image quality such as 3D-reconstruction, peroxide-enhanced technique and volume render mode. This chapter reviews the current application of anorectal ultrasound in the common anorectal disorders.
Part of the book: Proctological Diseases in Surgical Practice
Comprehensive Clinical Approach to Fecal Incontinence
Fecal incontinence is a disturbing condition, which reduces the quality of life of patients. Prevalence of this apprehensive problem is usually underestimated. However, it is more common in female, elderly, and institutionalized subjects. Factors that may be associated are urinary incontinence, diabetes mellitus, depression, diarrhea, history of anorectal surgery, anorectal trauma, pelvic organ surgery, and pelvic irradiation. To improve this condition, physicians should have insight into the individual’s pathophysiology through the process of careful history taking, severity, and quality of life assessment, thorough physical examination and comprehensive anatomic and neurophysiologic evaluation. These tests include imaging, anorectal manometry, and neural conduction tests. Finally, by these gathered information, individualized treatment for the patient is designed. Patient’s education and judicious follow-up are also parts of the plan.
Part of the book: Current Topics in Faecal Incontinence