Anorectal Pathophysiology and Investigations

Obstetric trauma is a major risk factor for the development of faecal incontinence (FI) in women. However, the pathoaetiology of FI encompasses numerous factors that may be contributory or additive to the development of symptoms. The pathophysiology of FI is contemporaneously recognised as multifactorial; it involves not only compromised anal sphincter and pelvic floor structure and function, but also multiple other overlapping mechanisms. In patients with FI refractory to standard conservative management, specialist diagnostic testing may be used to identify the pathophysiological basis of FI with the aim of guiding therapy. This chapter outlines pathophysiological mechanisms responsible for the development of FI and also describes the diagnostic investigations that exist to routinely evaluate pelvic floor, colonic and anorectal structure and function.