Disorders of faecal continence

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Disorders of continence are disorders of the ability to perceive, retain, or excrete faeces, or a combination of these. Disorders of perception are an absent or false feeling of urge. Retentional disorders are soiling, insufficiency and incontinence; disorders of excretion are constipation and complete rectal prolapse. Application of functional tests from the colorectal laboratory is helpful in diagnosing these functional disorders and in arriving at a strategy for treatment. Single tests represent different aspects of anorectal function and need to be performed together. Abnormal results in one test must be interpreted with caution, especially when therapeutic surgery is considered. Continence disorders are difficult to deal with as the symptomatology is often not specific. Most disorders can easily be diagnosed by a combination of the patient's history, perineal inspection and digital rectal examination, but other disorders may coexist. Careful pre-operative investigation is of utmost importance. Functional assessment can demonstrate unsuspected coexistent disorders and lead to a more well considered strategy for treatment, better selection of patients and improved results.

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