Disorders of the Anorectum and Pelvic Floor

We are delighted to present you with this issue of Gastroenterology Clinics of North America . The issue is focused on diseases of the anorectum and pelvic floor and provides a thorough, comprehensive overview of the disorders, diagnoses, and applicable investigations for these areas. We have tried to select the topics that would be seen in a gastroenterologic practice. Some of these problems may be able to be treated medically, while others may need to be referred to a surgeon. The authorship of the articles has been undertaken by numerous highly expert colorectal surgeons. We have deliberately selected the “rising stars” within colorectal surgery, rather than relying on more senior authorship. All of the authors produced very high-quality insightful and clinically relevant articles.

A detailed knowledge of the anatomy and physiology of the pelvic floor is integral in understanding the pathophysiology of symptoms affecting the pelvic floor. The issue therefore begins with an excellent review of anorectal anatomy with an emphasis on imaging techniques, followed by an article detailing the sensorimotor and neurophysiologic function and assessment of disorders of the pelvic floor. Anorectal pain is a common presenting complaint, and it is necessary for the practicing physician to be able to accurately diagnose and treat conditions of the anus and rectum that result in pain. Included in this issue are detailed reviews of the literature regarding the medical and surgical treatment of anal fissure, as well as a discussion on the treatment of anal stenosis. Nonoperative and operative therapy of hemorrhoidal disease is presented, including newer techniques such as Doppler-guided hemorrhoidal artery ligation. Chronic pelvic pain can affect up to 15% of women and be particularly difficult to diagnose and treat, as causes, evaluation, and treatments may traverse multiple specialties.

Fecal incontinence is an embarrassing and socially paralyzing condition that affects up to 18% of the population and as many as half of all nursing home residents. Multiple treatment options are available, including newer modalities such as the use of radiofrequency energy and neuromodulation of the sacral nerve plexus and the tibial nerve. This issue also contains a comprehensive discussion of the cause and management of constipation, with an emphasis on the diagnosis and treatment of pelvic outlet obstruction. A superb review of rectal prolapse and intussusception includes a discussion of newer minimally invasive techniques for the treatment of these disorders.

Finally, as the practice of anoreceptive intercourse increases, it is important for the gastroenterologist to be able to recognize the presenting symptoms of sexually transmitted diseases of the anorectum and to be familiar with their treatments. Anal intraepithelial neoplasia (AIN) is a particularly worrisome sexually transmitted disease resulting from infection with the human papillomavirus, as there may be a relationship between AIN and the development of anal cancer. A comprehensive review of the literature including controversies regarding the diagnosis and treatment of AIN is included as well.

We wish to extend our appreciation to each and every one of our authors for their respective individual time and expertise, which have insured the production of a superlative educational volume. We are confident that you will find the information in these pages to be current, comprehensive, and highly clinically relevant.

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