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Review
. 2014 Feb;30(1):95-106.
doi: 10.1016/j.cger.2013.10.003.

Anorectal physiology and pathophysiology in the elderly

Siegfried W B Yu  1 , Satish S C Rao
Affiliations
Review

Anorectal physiology and pathophysiology in the elderly

Siegfried W B Yu et al. Clin Geriatr Med. 2014 Feb.

Abstract

Anorectal medical disorders facing the elderly include fecal incontinence, fecal impaction with overflow fecal incontinence, chronic constipation, dyssynergic defecation, hemorrhoids, anal fissure, and pelvic floor disorders. This article discusses the latest advances in age-related changes in morphology and function of anal sphincter, changes in cellular and molecular biology, alterations in neurotransmitters and reflexes, and their impact on functional changes of the anorectum in the elderly. These biophysiologic changes have implications for the pathophysiology of anorectal disorders. A clear understanding and working knowledge of the functional anatomy and pathophysiology will enable appropriate diagnosis and treatment of these disorders.

Keywords: Age-related cellular dysfunction; Anorectal pathophysiology; Constipation; Elderly; Fecal incontinence.

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Figures

Figure 1
Figure 1. A 24-hour profile of the mean area under the curve of colonic pressure waves in healthy and constipated patients
There is significant increase in colonic motility after meals and after waking. From Rao SS, et al. Ambulatory 24-hour colonic manometry in slow-transit constipation. American journal of gastroenterology, 2004; with permission.
Figure 2
Figure 2. Normal Anatomy and Physiology of the Pelvic Floor in the Sagittal Plane at Rest, During Defecation, and the Key Pathophysiologic Changes in Subjects with Fecal Incontinence and Dyssynergic Defecation
This profile shows the arrangement of the 3 anal muscles during rest, normal defecation, and the impairment that occurs with fecal incontinence and dyssynergic defecation. From Rao SS, et al. Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Clin Gastroenterol Hepatol, 2010; with permission.
Figure 3
Figure 3. Manometric Representation of the Recto-anal Inhibitory Reflex (RAIR), Recto-anal Contractile Reflex (RACR), and the Sensorimotor Response
From Remes-Troche, J.M., et al., Rectoanal reflexes and sensorimotor response in rectal hyposensitivity. Dis Colon Rectum, 2010; with permission.
See this image and copyright information in PMC

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