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Objectives Obesity is a global epidemic. Its clinical impact on symptoms of fecal incontinence (FI) and/or constipation and underlying anorectal pathophysiology remains uncertain. Methods Cross-sectional study of consecutive patients meeting Rome IV criteria for FI and/or functional constipation, with data on body mass index (BMI), attending a tertiary center for investigation between 2017-2021. Clinical history, symptoms and anorectal physiologic test results were analyzed according to BMI categories. Results 1,155 patients (84% female) were included in the analysis (33.5% normal BMI; 34.8% overweight; 31.7% obese). Obese patients had higher odds of FI to liquid stools (69.9 vs. 47.8%, OR 1.96 [CI: 1.43-2.70]), use of containment products (54.6% vs. 32.6%, OR 1.81 [1.31-2.51]), fecal urgency (74.6% vs. 60.7%, OR 1.54 [1.11-2.14]) urge FI (63.4% vs 47.3%, OR 1.68 [1.23-2.29]), and vaginal digitation (18.0% vs 9.7%, OR 2.18 [1.26-3.86]). Higher proportions of obese patients had Rome criteria-based FI or coexistent FI and functional constipation (37.3%, 50.3%) compared with overweight (33.8%, 44.8%) and normal BMI patients (28.9%, 41.1%). There was a positive linear association between BMI and anal resting pressure (β 0.45, R2 0.25, p=0.0003), though the odds of anal hypertension were not significantly higher after Benjamini-Hochberg correction. Obese patients more often had a large clinically significant rectocele (34.4% vs. 20.6%, OR 2.62 [1.51-4.55]) compared with normal BMI patients. Conclusion Obesity impacts specific defecatory (mainly FI) and prolapse symptoms and pathophysiologic findings (higher anal resting pressure, significant rectocele). Prospective studies are required to determine if obesity is a modifiable risk factor for FI and constipation.

Introduction and Aim The evidence base supporting the management of traumatic anorectal injuries is poor. Previous case series provide some general observations on management decisions. The aim of the current study was to describe the largest UK experience of anorectal trauma management from a national major trauma centre. Methods Retrospective review of prospective data, collected systematically as part of routine trauma practice locally, was performed. Data were extracted on mechanism of trauma, immediate hospital care, diagnostics and operative management. Outcome data were extracted, where available, from follow up. Data are presented descriptively in a case series format. Results 37 patients (35 male vs 2 female) presented with traumatic anorectal injury between March 2012 and December 2021. The median age was 34 (6–93), 20 (54%) were penetrating injuries (11 stabs, 5 GSW, 5 other) vs 17 (46%) blunt (13 RTA, 4 other). Median Injury severity score was 16. Of the 37 cases treated, there were 18 intra peritoneal (8 both intra and extra) vs 16 extra peritoneal injuries. 30 patients had defunctioning stoma (DS), 8 cases had primary repair (PR) (with or without DS). Mean length of stay was 27 days. 15 out of 37 have had GI continuity restored, out of which 13 had a water-soluble contrast study and 5 anorectal physiology preoperatively. Conclusions Traumatic anorectal injuries are uncommon within UK practice, affect predominantly young men and have high morbidity. In the majority of cases defunctioning stomas are still the mainstay of treatment. Primary repair of extraperitoneal injuries is a viable procedure.

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