Anorectal incontinence. pathogenesis and choice of treatment.

Fecal incontinence represent a complex and multifactorial disorder. Although the condition is widely accepted as belonging to the elderly, it is now becoming apparent that younger adults are also frequently affected. Its incidence is estimated at 2% of the general population, while in the elderly it may increase up to 60%. Despite the considerable advances that have been made in the evaluation of anorectal incontinence during the past decades, the cause of this entity still remains obscure. The patient's history, the physical examination, and specialized investigations are essential for the diagnosis and the selection of the appropriate treatment. In clinical practice the most useful tests are the anorectal manometry, the anal endosonography and the pudendal nerve latency. Complete functional and anatomical assessment of the anorectum, the anal sphincters, and the pelvic floor is mandatory in all patients with fecal incontinence for the appropriate diagnosis and identification of the cause, the type of incontinence and the selection of the appropriate treatment.