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Disorders Of Colonic And Anorectal Function Notes

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Lecture 20 Disorder of colonic and anorectal function

Colonic function o Absorbs water- 1L into caecum- 100ml in stool o Storage o Mass peristalsis o Nutritional role Anorectal function and anatomy o Rectal reservoir o Internal anal sphincter/External anal sphincter o Puborectalis o Pudendal nerve Constipation o General
 Range of BM 3/day- 1/3 days
 Variable- history important
 Infrequent BM
 Straining Passage of hard stool o Signs
 Examination may be unhelpful
 General signs- Myxoedema
 Loaded colon on abdo palpation
 PR presence of large amount of stool o Investigation
 Rules out organic disease (e.g. obstruction); metabolic disorders
 Colonic transit
 Anorectal physiology
 Proctography o Slow transit constipation
 Exceedingly rare
 May be associated with visceral myopathy/neuropathy
 If visceral myopathy=small bowel transit problems Evacuatory disorders o Epi
 Predominately females
 Parous (given birth) middle aged
 Young nulliparous o Types
 Outlet obstruction

• Prolonged straining at stool

• Spending hours on toilet
 Normal/slow transit constipation
 Pelvic floor dysfunction
 Obstructed defecation
 Paradoxical pelvic floor contraction
 Anismus

• Normal response to decrease activity in EAS and puborectalis

• Anismus- increased recruitment of striated muscle in pelvic floor
 Dysfunctional defecation

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