Anorectal functional diagnostics. Therapy algorithm for obstruction and incontinence

The surgical therapy of pelvic floor insufficiency is mainly focused on two functional disorders, outlet obstruction and fecal incontinence. Surgery becomes of special significance after ineffectiveness of conservative treatment options. The indications for surgical interventions should be based on a precise preoperative evaluation. The dimension of functional impairment will be primarily assessed by an accurate anamnesis, application of disease-specific scoring systems and the clinical proctological basic examination that includes digital rectal examination and proctoscopy/rectoscopy. Imaging procedures (anorectal endosonography and dynamic defecography) are carried out as adjuncts and contribute to a visualization of morphological changes. Severity and manifestation of morphological symptoms are essential for the therapeutic algorithm due to increasingly differentiated surgical strategies. Only a thorough diagnostic investigation and patient selection enable a targeted therapy of obstruction and fecal incontinence.