XXXX in @entity29 .

@entity1 @entity322 @entity3087 @entity2371 @entity29 @entity1241
UNASSIGNED: Advances in tailored medical therapy and introduction of biologic agents for @entity29 ( @entity29 ) treatment have increased lasting of disease remission. Some @entity1 , however, still complain defecatory symptoms. @entity1 present with a wide spectrum of conditions, the most frequent anal @entity322 , @entity2371 , that have a great impact on Quality of Life. Due to @entity29 diagnosis, little relevance is given to this type of symptoms and their epidemiologic distribution is unknown. Pathogenetic hypotheses are under investigation. Routinely diagnostic workflow and therapeutic options in pelvic floor service are often underused. The evaluation of these disorders starts with the exclusion of the presence of active disease by endoscopy; the further diagnostic workflow is the same as in @entity1 without @entity29 . For @entity1241 and obstructed defecation, simple conservative therapy with habits modification, dietary and fluid advices is effective in most cases. In non-responders @entity1 , ano- rectal physiology tests and imaging are required to select @entity1 for pelvic floor muscle training and Bio-Feed-Back. These treatments have been proven effective in @entity29 @entity1 . Some new minimally invasive alternative strategies are available for @entity29 @entity1 , as sacral nerve and posterior tibial nerve stimulation; for other ones (e.g.: bulking agents implantation) @entity29 still remain an exclusion criterion. Surgical options to cure @entity3087 are indicated in a small group of @entity29 @entity1 , due to the high risk of failure in wound healing and to the possible side effects of surgery, that can lead to anal @entity322 or to an eventual proctectomy, and in order to preserve anatomical areas that could be useful for future reconstructive techniques. A particular issue within defecatory symptoms in @entity1 with @entity29 is paradox after restorative proctocolectomy that can be related to a paradoxical pubo-rectalis contraction: if properly diagnosed, a conservative treatment is indicated, avoiding unnecessary laparotomy for small bowel occlusion. @entity2371 management, coordinated by a specialist with expertise in @entity3087 , includes many options, that vary from oral or local therapies to pelvic floor rehabilitation and sacral nerve stimulation. Surgical procedures have often non satisfactory results. Recognition and investigation of ano-rectal functional disorders in @entity1 with @entity29 is important to address correct diagnostic and therapeutic strategies, in order to avoid unnecessary and potentially detrimental medical and surgical therapies, with the aim of improving @entity1 ' Quality of Life.
