Anorectal Physiology and Pathophysiology in the Elderly

Abstract

The U.S. elderly population (≥85 years old) is estimated to increase from 5 to 20 million people between the years 2000 to 2050. Among the medical disorders facing the elderly, anorectal problems are not only highly prevalent, but cause significant morbidity and mortality, and have deleterious effects on health care burden and quality of life. These include disorders such as fecal incontinence, fecal impaction with overflow fecal incontinence, chronic constipation, dyssynergic defecation, hemorrhoids, anal fissure, and pelvic floor disorders. Here, we discuss the latest advances in age-related changes in anal sphincter morphology and function, changes in cellular and molecular biology, alterations in neurotransmitters and reflexes, and their impact on functional changes of the anorectum in the elderly. These biophysiologic changes have implications for the pathophysiology of anorectal disorders. A clear understanding and working knowledge of the functional anatomy and pathophysiology will enable appropriate diagnosis and treatment of these disorders.

Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score

“…We believe this reflects case selection with some elderly patients, in whom there is underlying sphincter dysfunction or frailty, proceeding to an abdominoperineal excision (APE). It is also plausible that colonic dysmotility, which is associated with ageing,39 reduces the degree of urgency and bowel frequency resulting in a lower LARS score. This relationship requires further investigation and future studies should also consider patient medication.…”

The ageing gastrointestinal tract

“…Although considered a benign condition, constipation affects 30-50% of the elderly population and more than 50-70% of residents of elderly care institutions, and can markedly impair quality of life and be associated with potentially serious complications [38]. 'Constipation' may refer to straining or incomplete evacuation, hard stool, or diminished stool frequency.…”

The Diagnostic Value of a Digital Rectal Examination Compared With High-Resolution Anorectal Manometry in Patients With Chronic Constipation and Fecal Incontinence

“…Th ese disorders are more common among older people ( 1,2 ), and the number of patients with anorectal disorders is increasing because of an aging population. Anorectal manometry (ARM) is a fi rst-line diagnostic tool for dyssynergic defecation and fecal incontinence, and is used to determine anorectal pressure and sensory function ( 3 ).…”