In clinical guidelines issued by the American College of Gastroenterology and published in the October issue of the American Journal of Gastroenterology, recommendations are presented regarding management approaches for benign anorectal disorders.
Arnold Wald, M.D., from the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues summarized the preferred approach for evaluation and management of defecation disorders (DD), proctalgia syndromes, hemorrhoids, anal fissures, and fecal incontinence in adults.
The authors strongly recommend instrumented anorectal biofeedback therapy for the management of symptoms in DD based on a moderate quality of evidence. For proctalgia syndromes, biofeedback is strongly recommended to teach pelvic floor muscle reconditioning for levator syndrome with abnormal anorectal manometry based on a very low quality of evidence. For chronic proctalgia syndromes, no evidence is available to support use of Botox or digital massage. For chronic anal fissures, local application of a calcium channel blocker is strongly recommended for initial medical treatment based on a low quality of evidence. For chronic anal fissures that do not heal with nonsurgical measures, lateral internal sphincterotomy is strongly recommended as the surgical treatment of choice based on high-quality evidence. Additional practice recommendations for these and other disorders also were summarized.
“Health care providers should incorporate this guideline in addition to patient-specific medical comorbidities, health status, and preferences to arrive at a patient-centered care approach,” the authors write.
Several authors disclosed financial ties to the pharmaceutical and medical device industries.