Papel de las pruebas funcionales anorrectales en la enfermedad perianal: implicaciones para la práctica clínica

Patients with inflammatory bowel disease and concomitant perianal disease may present with urgency and/or faecal incontinence due to both the underlying inflammatory process and possible abnormalities in anorectal function, or by affecting rectal compliance. Anorectal function studies show that in Crohn's disease anal resting pressure and squeeze pressure are decreased in patients with previous surgery on the perianal region. In ulcerative colitis there is no published data on the capacity of the anal sphincter in patients with ulcerative colitis and perianal disease. Anal pressures are normal in patients with ulcerative colitis even during flare-ups with a dramatic decrease in rectal compliance contributing to urgency and incontinence in these patients. Likewise, increased fatigability of the striated sphincter muscle, observed in both patients with Crohn's disease and with ulcerative colitis, is associated with faecal urgency or incontinence. In conclusion, it might be useful to evaluate anorectal function in those patients who will be operated on due to injury in the perianal region and prior to bowel transit restorative surgery.