Management of Benign Anorectal Disorders

Arnold Wald, MD, MACG1, Adil E. Bharucha, MBBS, MD2, Bard C. Cosman, MD, MPH, FASCRS3 and William E. Whitehead, PhD, MACG4

1Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; 2Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA; 3University of California San Diego School of Medicine, Halasz General Surgery Section, VA San Diego Healthcare System, San Diego, California, USA; 4University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill, North Carolina, USA

Am J Gastroenterol advance online publication 15 July 2014; doi: 10.1038/ajg.2014.190
Received 3 September 2013; Accepted 5 June 2014
Advance online publication 15 July 2014

Correspondence: Arnold Wald, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Suite 4000, Madison, Wisconsin 53705, USA. E-mail:


These guidelines summarize the definitions, diagnostic criteria, differential diagnoses, and treatments of a group of benign disorders of anorectal function and/or structure. Disorders of function include defecation disorders, fecal incontinence, and proctalgia syndromes, whereas disorders of structure include anal fissure and hemorrhoids. Each section reviews the definitions, epidemiology and/or pathophysiology, diagnostic assessment, and treatment recommendations of each entity. These recommendations reflect a comprehensive search of all relevant topics of pertinent English language articles in PubMed, Ovid Medline, and the National Library of Medicine from 1966 to 2013 using appropriate terms for each subject. Recommendations for anal fissure and hemorrhoids lean heavily on adaptation from the American Society of Colon and Rectal Surgeons Practice Parameters from the most recent published guidelines in 2010 and 2011 and supplemented with subsequent publications through 2013. We used systematic reviews and meta-analyses when available, and this was supplemented by review of published clinical trials.

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