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Gastroenterology1428 papers

Anorectal disorder

Last edited: 4/23/2026

Overview

Anorectal disorders encompass a range of conditions affecting the anal canal and rectum, including hemorrhoids, anal fissures, dyssynergic defecation, and fecal incontinence. These conditions often present with symptoms such as pain, bleeding, and altered bowel habits.

Diagnosis

  • Clinical History: Detailed patient history focusing on symptoms and bowel habits 5.
  • Physical Examination: Digital rectal examination to assess for hemorrhoids, fissures, or masses 5.
  • Endoscopic Evaluation: Anoscopy or proctoscopy for visualization of the anal canal and lower rectum 5.
  • Anorectal Manometry: To evaluate sphincter function and diagnose dyssynergic defecation 6.
  • Imaging: Rarely needed but may include MRI or ultrasound for complex cases 9.
  • Management

  • Hemorrhoids:
  • - First-Line: Conservative management including dietary modifications, fiber supplements, and stool softeners 5. - Second-Line: Rubber band ligation, sclerotherapy, or infrared coagulation for symptomatic internal hemorrhoids 5. - Surgical: Hemorrhoidectomy for severe or refractory cases 5.
  • Anal Fissures:
  • - First-Line: High-fiber diet, stool softeners, topical nitroglycerin or calcium channel blockers 5. - Second-Line: Botox injection or lateral internal sphincterotomy for chronic or refractory cases 5.
  • Dyssynergic Defecation:
  • - Behavioral Therapy: Biofeedback and pelvic floor retraining 5.
  • Fecal Incontinence:
  • - Initial: Pelvic floor exercises, bowel management programs, and antidiarrheal medications 5. - Advanced: Sacral nerve stimulation or surgical interventions in severe cases 5.

    Special Populations

  • Pregnancy: Conservative management preferred; surgical interventions should be considered only if absolutely necessary due to potential risks 12.
  • Pediatrics: Focus on conservative measures and behavioral interventions; surgical options reserved for severe cases 522.
  • Elderly: Tailored conservative approaches with careful consideration of comorbidities; surgical interventions should be weighed against risks 5.
  • Comorbidities: Management should address coexisting conditions like diabetes or cardiovascular disease, which may impact treatment outcomes 5.
  • Key Recommendations

  • Primary Management of Hemorrhoids should start with conservative measures including dietary modifications and topical treatments (Evidence: Moderate 5).
  • Anal Fissures should initially be treated with conservative and pharmacological approaches before considering surgical interventions (Evidence: Moderate 5).
  • Dyssynergic Defecation benefits significantly from biofeedback therapy, which should be considered early in management (Evidence: Moderate 6).
  • Fecal Incontinence management should prioritize non-surgical options such as pelvic floor exercises and bowel management programs (Evidence: Moderate 5).
  • In POP Surgery, consider pharmacologic thromboprophylaxis to reduce VTE risk, though evidence is conflicting (Evidence: Weak 4).
  • Avoid Transvaginal Mesh for prolapse repair due to associated risks, favoring native tissue repair or sacrocolpopexy (Evidence: Moderate 230).
  • References

    Showing 100 most recent of 503 indexed papers.

    1 Baessler K, Christmann-Schmid C, Haya N, Mowat A, Chen Z, Wallace SA et al.. Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. The Cochrane database of systematic reviews 2026. link 2 Leung S, Chen A, Oscar-Thompson L, Hwang K, Ong M, Kobashi KC et al.. Trends in Prolapse Repair Approaches Before and After Ban of Transvaginal Mesh. Urology practice 2026. link 3 Veiga FPLF, Araujo OR, Araujo AS, Bicalho MS, Andrade MC, Silva DCB. The role of continuous renal replacement therapy in critically ill children with cancer and multiple organ dysfunction syndrome. Jornal de pediatria 2026. link 4 Bauer HH, Schlussel MA, Rhodes SP, Hijaz AK, Sheyn D. Impact of Pharmacologic Thromboprophylaxis on Venous Thromboembolism and Bleeding Complications Following Pelvic Organ Prolapse Procedures. International urogynecology journal 2026. link 5 Bharucha AE, Knowles CH, Malcolm A. An Evidence-Based Practical Review on Common Benign Anorectal Disorders: Hemorrhoids, Anal Fissure, Dyssynergic Defecation, and Fecal Incontinence. Gastroenterology 2026. link 6 Mazor Y, Mari A, Lysy J, Beer-Gabel M, Ron Y, Bar N et al.. Enhancing standardization in anorectal manometry testing: the impact of a national position paper. European journal of gastroenterology & hepatology 2025. link 7 Vyčítal O, Geiger J, Novák P, Rosendorf J, Polák R, Liška V et al.. Emergencies in proctology. Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti 2025. link 8 Vierhout M. On the Origin of Urogynecology. International urogynecology journal 2025. link 9 Lipetskaia L, Gupta A, Cheung RYK, Khullar V, Ismail S, Bradley M et al.. International Urogynecological Consultation Chapter 2.2: Imaging in the Diagnosis of Pelvic Organ Prolapse. International urogynecology journal 2025. link 10 Shah YB, Capella CE, Simhal RK, D'Amico MJ, Smith W, Murphy AM. Sacrocolpopexy in urology versus gynecology: a contemporary analysis of outcomes and patient profiles. The Canadian journal of urology 2025. link 11 Rotem R, Carey MO, McCarthy CM, O'Reilly BA, Daykan Y, O'Sullivan OE. Preserving Essential Skills: The Future of Vaginal Hysterectomy Training in Urogynaecology. BJOG : an international journal of obstetrics and gynaecology 2025. link 12 Cohen N, Rotem R, Weintraub AY, Shafir M, Barkan Y, Porat N et al.. Attitudes toward conservative management of pelvic organ prolapse and stress urinary incontinence with vaginal pessaries: A national survey among Israeli obstetricians and gynecologists. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2025. link 13 Deng W, Zhang X, Liu X, Wang Q, Liu C, Luo S et al.. Braden score for early mortality risk assessment in critically ill intensive care patients with multiple organ dysfunction syndrome. Scientific reports 2025. link 14 Chen X, Cheng JP, Xu LL, Chen JX, Zhang YC. Multiple organ dysfunction syndrome caused by fish gallbladder poisoning: A case report of delayed etiological diagnosis. Medicine 2025. link 15 Chen S, Wu GD, Li T, Jiang J, Zhong Y, Sun D et al.. Targeting GSDMD JX06 inhibits PANoptosis and multiple organ injury. Biochemical pharmacology 2025. link 16 Chu X, Xu J, Sun Y, Gong X, Chen D, Cai C. Continuous renal replacement therapy in neonates with multiple organ dysfunction syndrome: clinical utilization effects and outcomes. Italian journal of pediatrics 2025. link 17 Lu A, Wu J, Liu J, Wang S, Wang R, Yang G et al.. Association of fission 1 with multiple organ dysfunction syndrome after multiple trauma: A prospective case control study. The American journal of emergency medicine 2025. link 18 Zhang J, Wen ZY, Li YX, Sun HP, Zheng YY. Identification and validation of key genes related to apoptosis in multiple organ dysfunction syndrome. European journal of medical research 2025. link 19 Yan QI, Hong Z. Multiple Organ Dysfunction Syndrome Caused by Human Herpes Virus 6B Infection in Adults:Report of One Case. Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 2025. link 20 de Farias ECF, Carvalho PB, do Nascimento LMPP, Pinheiro AHO, Alves MCB, Machado-Ferraro KMM et al.. IL-6, IFN-γ, IL-17A elevations and glutathione depletion predict severe MODS and mortality in critically ill children with COVID-19 and bacterial sepsis: a prospective cohort study from the Brazilian Amazon. Cytokine 2025. link 21 Liang R, Li J, Yan X, Cheng Z, Fan J. Neutrophil green inclusions combined with hemophagocytosis in peripheral blood after bee sting a case report and literature review. Medicine 2025. link 22 Chang P, Li R, Wen J, Liu G, Jin F, Yu Y et al.. Early prediction and warning of MODS following major trauma via identification of cytokine storm: A prospective cohort study. Chinese journal of traumatology = Zhonghua chuang shang za zhi 2025. link 23 Humble C, Schønemann-Lund M, Bruun-Rasmussen P, Bestle MH, Johansson PI, Poulsen LM et al.. Pro- and Anti-Inflammatory Responses and Clinical Outcomes in Critically Ill Patients With Endotheliopathy: A Cohort Study. Acta anaesthesiologica Scandinavica 2025. link 24 Xue X, Zhu S, Xu S, Zhou Y, Wang Y, Lou L et al.. Persistent Lymphopenia as a Poor Prognostic Factor in Patients With Multiple Organ Dysfunction Syndrome in the Renal Intensive Care Unit: A Retrospective Single-Center Study. Immunity, inflammation and disease 2025. link 25 Wilson R, Fern C, Goodyear C, Shelley B. Epigenetic regulation of inflammation in post-operative organ dysfunction: A scoping review protocol. PloS one 2025. link 26 Wojtanowski A, Hureau M, Jeanne M, Bureau C, Recher M, De Jonckheere J. Heart rate variability as a marker of multiple organ dysfunction syndromes: a systematic review. Journal of clinical monitoring and computing 2025. link 27 Hassan SMD, Shahid AH, Ali Z, Ahmed M, Mohammad H, Fatima SF et al.. Red blood cell distribution width (RDW) as a predictor of multiple organ dysfunction in pediatric critical care: a retrospective study. BMC pediatrics 2025. link 28 Odetola FO, Lin P, Ye W, Dombkowski KJ, Linden A. Health Care Resource Use and Costs After Hospitalization With Multiple Organ Dysfunction in Children. JAMA network open 2025. link 29 Yeung E, Baessler K, Christmann-Schmid C, Haya N, Chen Z, Wallace SA et al.. Transvaginal mesh or grafts or native tissue repair for vaginal prolapse. The Cochrane database of systematic reviews 2024. link 30 Dutta R, Xu R, Wolff DT, Badlani GH, Matthews CA. Specialty-Specific Trends in Surgery for Apical Pelvic Organ Prolapse Post Vaginal Mesh. Urogynecology (Philadelphia, Pa.) 2024. link 31 Pascual MG, Novin A, Corbisiero MF, Unciano S, Hachicha Y, Shelden N et al.. Access to Urogynecologic Care in Federally Qualified Health Centers: A Mystery Caller Study. Urogynecology (Philadelphia, Pa.) 2024. link 32 Arellano M, Santis-Moya F, Maluenda A, Pattillo A, Blümel B, Pohlhammer D et al.. Prevalence of colorectal symptoms and anal incontinence in patients with pelvic organ prolapse attended at an outpatient urogynecology service. Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia 2024. link 33 Janssen H, Jhanji S, Oliver NS, Ackland GL. Ward monitoring 4.0: real-time metabolic insights from continuous glucose monitoring into perioperative organ dysfunction. British journal of anaesthesia 2024. link 34 Lee IJ, Pulido JS, Regillo CD, Leys M. MULTIPLE ORGAN DYSFUNCTION SYNDROME AND DISSEMINATED INTRAVASCULAR COAGULATION CAUSING EXTENSIVE MULTIPLE AMALRIC TRIANGULAR CHOROIDAL INFARCTIONS. Retinal cases & brief reports 2024. link 35 Werdan K, Nuding S, Kühnert D, Kolthoum R, Schott A, Quitter F et al.. Treatment of patients with multiple organ dysfunction syndrome (MODS) with an electromagnetic field coupled to biorhythmically defined impulse configuration: the MicrocircMODS study. Clinical research in cardiology : official journal of the German Cardiac Society 2024. link 36 Foglia MJ, Raval JS, Hofmann JC, Carcillo JA. Therapeutic Plasma Exchange to Reverse Plasma Failure in Multiple Organ Dysfunction Syndrome. Journal of clinical apheresis 2024. link 37 Wang H, Fan X, Han F, Hao H, Xu X, Hao Y et al.. Metabolomics study of Shenling Baizhu Powder in the treatment of multiple organ dysfunction syndrome in the elderly (MODSE) with malnutrition. Journal of pharmaceutical and biomedical analysis 2024. link 38 Atreya MR, Banerjee S, Lautz AJ, Alder MN, Varisco BM, Wong HR et al.. Machine learning-driven identification of the gene-expression signature associated with a persistent multiple organ dysfunction trajectory in critical illness. EBioMedicine 2024. link 39 Tavares CAM, Azevedo LCP, Rea-Neto Á, Campos NS, Amendola CP, Kozesinski-Nakatani AC et al.. Dapagliflozin for Critically Ill Patients With Acute Organ Dysfunction: The DEFENDER Randomized Clinical Trial. JAMA 2024. link 40 Li Y, Liu P, Wang W, Jia H, Bai Y, Yuan Z et al.. A novel genotype-phenotype between persistent-cloaca-related VACTERL and mutations of 8p23 and 12q23.1. Pediatric research 2024. link 41 Drezdzon MK, Peterson CY. Anorectal Emergencies. The Surgical clinics of North America 2023. link 42 Fitz FF, Bortolini MAT, Pereira GMV, Salerno GRF, Castro RA. PEOPLE: Lifestyle and comorbidities as risk factors for pelvic organ prolapse-a systematic review and meta-analysis PEOPLE: PElvic Organ Prolapse Lifestyle comorbiditiEs. International urogynecology journal 2023. link 43 Karamchandani K, Dave S, Hoffmann U, Khanna AK, Saugel B. Intraoperative arterial pressure management: knowns and unknowns. British journal of anaesthesia 2023. link 44 Hahn G, Novak T, Crawford JC, Randolph AG, Lange C. Longitudinal Analysis of Contrasts in Gene Expression Data. Genes 2023. link 45 Regiroli G, Loi B, Pezza L, Sartorius V, Foti A, Barra PF et al.. Continuous Venovenous Hemofiltration Performed by Neonatologists With Cardio-Renal Pediatric Dialysis Emergency Machine to Treat Fluid Overload During Multiple Organ Dysfunction Syndrome: A Case Series. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2023. link 46 Zhang Y, Wu W, Zhang Z. The predictive value of the systemic inflammatory response index for the occurrence of multiple organ dysfunction syndrome in patients with wasp sting injury. Toxicon : official journal of the International Society on Toxinology 2023. link 47 Liu X, DuMontier C, Hu P, Liu C, Yeung W, Mao Z et al.. Clinically Interpretable Machine Learning Models for Early Prediction of Mortality in Older Patients with Multiple Organ Dysfunction Syndrome: An International Multicenter Retrospective Study. The journals of gerontology. Series A, Biological sciences and medical sciences 2023. link 48 Huang B, Yan J, Li C, Jin F, Ma R, Cao G et al.. Red blood cell distribution width is a risk factor for multiple organ dysfunction syndrome in elderly patients with infection: a case control study. Aging clinical and experimental research 2023. link 49 Benscoter AL, Alten JA, Atreya MR, Cooper DS, Byrnes JW, Nelson DP et al.. Biomarker-based risk model to predict persistent multiple organ dysfunctions after congenital heart surgery: a prospective observational cohort study. Critical care (London, England) 2023. link 50 VanBuren JM, Hall M, Zuppa AF, Mourani PM, Carcillo J, Dean JM et al.. The Design of Nested Adaptive Clinical Trials of Multiple Organ Dysfunction Syndrome Children in a Single Study. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2023. link 51 Kurniawati EM, Rahmawati NA, Widyasari A. Differences Between 25-hydroxyvitamin D Levels in Patients with Pelvic Organ Prolapse and Non-Pelvic Organ Prolapse: A Systematic Review. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2023. link 52 de Beaufort CMC, van den Akker ACM, Kuijper CF, Broers CJM, de Jong JR, de Beer SA et al.. The Importance of Screening for Additional Anomalies in Patients with Anorectal Malformations: A Retrospective Cohort Study. Journal of pediatric surgery 2023. link 53 Sandozi A, Kaplan-Marans E, Polland A. Contemporary Clinical Research in the Management of Pelvic Organ Prolapse in the United States: A Systematic Review. Urogynecology (Philadelphia, Pa.) 2022. link 54 Perez Ruiz de Garibay A, Kortgen A, Leonhardt J, Zipprich A, Bauer M. Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients. Critical care (London, England) 2022. link 55 van den Noort F, Manzini C, van der Vaart CH, van Limbeek MAJ, Slump CH, Grob ATM. Automatic identification and segmentation of slice of minimal hiatal dimensions in transperineal ultrasound volumes. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2022. link 56 Whittington JR, Shnaekel KL, Ramseyer AM, Cato M, Ounpraseuth S, Hughes DS et al.. Longitudinal assessment of obstetrics and gynecology resident perceptions and comfort following cerclage placement simulation. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2022. link 57 Leanza V, Di Stefano A, Paladino EC, Rivoli L, Distefano REC, Palumbo M. Stasis ulcer and hydronephrosis after severe genital prolapse: a case report. Journal of medical case reports 2022. link 58 Cheong I. Multiple organ dysfunction due to inferior vena cava thrombosis diagnosed by point-of-care ultrasound in the intensive care unit. Journal of clinical ultrasound : JCU 2022. link 59 Liu G, Xu J, Wang C, Yu M, Yuan J, Tian F et al.. A machine learning method for predicting the probability of MODS using only non-invasive parameters. Computer methods and programs in biomedicine 2022. link 60 Weiss SL, Carcillo JA, Leclerc F, Leteurtre S, Schlapbach LJ, Tissieres P et al.. Refining the Pediatric Multiple Organ Dysfunction Syndrome. Pediatrics 2022. link 61 Schlapbach LJ, Weiss SL, Bembea MM, Carcillo JA, Leclerc F, Leteurtre S et al.. Scoring Systems for Organ Dysfunction and Multiple Organ Dysfunction: The PODIUM Consensus Conference. Pediatrics 2022. link 62 Cui Y, Shi J, Lu G, Wang Y, Zhu X, Ren H et al.. Prognostic death factors in secondary hemophagocytic lymphohistiocytosis children with multiple organ dysfunction syndrome receiving continuous renal replacement therapy: A multicenter prospective nested case-control study. Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 2022. link 63 Ding M, Zhang Y, Xu W, Fang C, Zhang K. MicroRNA-200b-3p as a biomarker for diagnosis and survival prognosis of multiple organ dysfunction syndrome caused by acute paraquat poisoning. Human & experimental toxicology 2022. link 64 Nigam JS, Nishit, Kumar T, Singh A, Tewari P, Pandey JK. Anorectal Melanoma-Brownish Black Mass Not Always a Hemorrhoid. Journal of gastrointestinal cancer 2022. link 65 Ringel NE, Brown O, Moore KJ, Carey ET, Dieter AA. Disparities in Complications After Prolapse Repair and Sling Procedures: Trends From 2010-2018. Urology 2022. link 66 Leventoğlu S, Menteş B, Şenol E, Zimmerman D, Pellino G, Pellino G et al.. Urgent and elective proctologic/anorectal interventions in the COVID-19 pandemic: A practical guideline for treatment safety. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES 2021. link 67 Wallington DG, Holliday EB. Preparing Patients for Sexual Dysfunction After Radiation for Anorectal Cancers: A Systematic Review. 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Use of pelvic model-based simulation for sacrospinous ligament fixation education in novice learners: a single-blinded randomized controlled trial. International urogynecology journal 2021. link 73 Cohen DL, Richter V, Malikov I, Bermont A, Shirin H. The Effect of a Didactic Course on Gastroenterology Nurses' Knowledge and Interest in Anorectal Manometry. Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates 2021. link 74 Karaoğlan T, Aydin S, Bilginer U. Development of a Low-Fidelity Laparoscopic Sacrocolpopexy Simulation Model and Evaluation of Curriculum. Female pelvic medicine & reconstructive surgery 2021. link 75 Bramblet R, Altman A, Holbert M. Using Motion Tracking to Analyze Forceps Paths During Simulated Forceps-Assisted Vaginal Deliveries. Simulation in healthcare : journal of the Society for Simulation in Healthcare 2021. link 76 Song J, Pan X. 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    Original source

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      Impact of Pharmacologic Thromboprophylaxis on Venous Thromboembolism and Bleeding Complications Following Pelvic Organ Prolapse Procedures.Bauer HH, Schlussel MA, Rhodes SP, Hijaz AK, Sheyn D International urogynecology journal (2026)
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