Anorectal and pelvic floor disorders: putting physiology into practice.

The pathophysiology of the pelvic floor syndromes is complex and confusing. Childbirth is the only aetiological agent to have been clearly identified, but its role is not universal. Learned or psychogenic pelvic floor incoordination is likely to play a part. The conditions are so intertwined that an increasingly comprehensive battery of tests has become necessary to try to unravel the component disorders; anorectal physiology testing has therefore assumed an important position in the evaluation of these patients. It is only by careful application of physiological studies in clinical practice that further advances can be made. The investigations currently available can contribute significantly to determining the optimum management of these difficult patients. Surgical indications continue to be refined. The results of careful clinical and laboratory follow-up studies have led to changes in practice. The pelvic floor syndromes have only recently been defined; there is still much work to be done.