Search

This manuscript summarizes consensus reached by the International Anorectal Physiology Working Group (IAPWG) for the performance, terminology used, and interpretation of anorectal function testing including anorectal manometry (focused on high-resolution manometry), the rectal sensory test, and the balloon expulsion test. Based on these measurements, a classification system for disorders of anorectal function is proposed. Aim to provide information about methods of diagnosis and new classification of functional anorectal disorders to a wide range of specialists general practitioners, therapists, gastroenterologists, coloproctologists all who face the manifestations of these diseases in everyday practice and determine the diagnostic and therapeutic algorithm. Current paper provides agreed statements of IAPWG Consensus and comments (in italics) of Russian experts on real-world practice, mainly on methodology of examination. These comments in no way intended to detract from the provisions agreed by the international group of experts. We hope that these comments will help to improve the quality of examination based on the systematization of local experience with the use of the methods discussed and the results obtained. Key recommendations: the International Anorectal Physiology Working Group protocol for the performance of anorectal function testing recommends a standardized sequence of maneuvers to test rectoanal reflexes, anal tone and contractility, rectoanal coordination, and rectal sensation. Major findings not seen in healthy controls defined by the classification are as follows: rectoanal areflexia, anal hypotension and hypocontractility, rectal hyposensitivity, and hypersensitivity. Minor and inconclusive findings that can be present in health and require additional information prior to diagnosis include anal hypertension and dyssynergia.

Aim to describe the results of a multidisciplinary discussion on the terminology of anorectal sphincterometry (AS) and profilometry (AP). We performed online survey with the use of public platform Google forms to harmonize Russian terms to be used to describe the results of AP and AS and their abbreviations. The invitation to participate in the survey was sent to the authors who use the results of AP and AS in clinical practice and perform the diagnostic procedures. The obtained answers were analyzed with the use of the aggregator and Statistica 10 (StatSoft Inc, USA) software. The level of consensus was analyzed with the use of modified Delphi criteria (C1 agreement of 90% of participants, C2 agreement of 75 to 90%, C3 less than 75%). Invitations sent 76, responses obtained 63 (response rate 82.9%). Consensus level 1 was reached for all the terms of AP and for 4out of 7 terms to describe the results of AS (3 out of 7 terms were of moderate agreement, C2). The need for the use of predefined abbreviations of terms for AS and AP was of a low rate of consensus (71.4%). The agreed terms of AS and AP should be used to prepare a conclusion for the diagnostic procedures and to publish scientific reports.

Aim. To generalize and present current data on the development of approaches to hemorrhoidectomy, as well as to analyse the function of the rectal closing apparatus after surgery.Key findings. The haemorrhoid disease is one of the most common human diseases and the most common reason for visiting a coloproctologist. In Russia, the prevalence of haemorrhoids amounts to 130–145 people per 1,000 adult population, with its proportion in the structure of colon diseases varying from 34 to 41 %. Minimally invasive methods for treating such conditions have been shown to be effective in patients with 1–3 stage haemorrhoids. However, these methods have shown little value at stage 4 hemorrhoids, largely because they fail to affect all parts of the disease pathogenesis. Thus, hemorrhoidectomy remains to be the “gold standard” for stage 4 hemorrhoids treatment, which is aimed at eliminating the three main vascular collectors. Hemorrhoidectomy is accompanied by the risk of stricture and postoperative anal sphincter failure. In this regard, it is necessary to assess the functional state of the rectal closing apparatus after hemorrhoidectomy. Improving hemorrhoidectomy, for example, by the use of an ultrasonic scalpel, allows the hemorrhoidectomy to be performed without additional sewing of vessels and coagulation, and the injury of the anal sphincter to be minimized.Conclusion. The possibility of injuring the anal sphincter is a serious problem in anal surgery. Anal sphincter incontinence is a serious illness that exacerbates the patients’ social life. Unfortunately, the issue of anal sphincter incontinence after hemorrhoidectomy is under-investigated, resulting in few rehabilitation programs.

The objective was to evaluate standard neurophysiological characteristics of the external anal sphincter and pelvic floor muscles using electromyography interference pattern analysis.Materials and methods. Electromyography was performed in 33 volunteers without complaints of bowel incontinence or bowel evacuation disorders: 20 (60.6 %) men (mean age 57.3 ± 9.4 years) and 13 (39.4 %) women (mean age 55.3 ± 12.8 years). Intra-anal electrode registered cumulative values of contractile force of sphincter ani externum: background and voluntary bioelectrical activity (BEA). Integral values of mean and maximal BEA amplitude for the rectal obturator muscles at rest, for voluntary contraction, during straining, and with increased intra-abdominal pressure were calculated.Results. Standard values of BEA of the rectal obturator muscles were obtained. These values can be used for qualitative and quantitative evaluation of pelvic floor muscles function and in additional multicenter studies aimed at development of a unified algorithm of rectal obturator and pelvic floor muscles evaluation.

Aim of investigation. To investigate options of improvement of anal sphincter function of defunctioning loop by BFT and tibial nerve stimulation.Material and methods. Overall 23 patients with preventive stoma were included in original investigation. Diagnostic profilometry and sphincterometry were carried out. Treatment included BFT and tibial nerve stimulation for 10 days. Results. After treatment profilometry revealed statistically significant increase of mean resting pressure, while sphincterometry — at conation as well.Conclusions. Muscular structures of the defunctioning anal sphincter respond to BFT and tibial nerve stimulation, increasing both tension and force of voluntary contractions.

This article analyzes the actual problems of the nonprofit sector in the field of communications. It was identified criteria allow to group communication barriers to the development of NGOs. It was analyzed the relevance of this approach to the study of public organizations. The research was based on the different types of sources, including work papers of the All-Russian Civic Forum “Agenda for Russia” held in December 2013.