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Unlabelled: The most important quality parameters of rectal cancer surgery are oncological radicality, postoperative complications, recurrence rate and survival. Rectal dysfunction following low anterior resection occurs in up to 25-50% of patients. Despite its high frequency, however, it does not receive enough attention. Rectal dysfunction after surgery includes frequent bowel movements, urgency, incomplete evacuation, incontinence or sexual and urinary dysfunctions. The complex of symptoms is collectively referred to as the low anterior resection syndrome - LARS. In this review, we discuss the alterations in anorectal physiology after low anterior resection, the etiology and risk factors of LARS, different types of neorectal reservoir construction, and various options for prevention and treatment of LARS. Furthermore, sexual and urinary dysfunction is briefly reviewed., Keywords: low anterior resection bowel dysfunction incontinence anorectal physiology.

Objective: Evaluation of the mutual relationship between delivery and late anal incontinence., Design: Review., Setting: Department of Gynaecology and Obstetrics, Charles University and University Hospital Pilsen., Summary: Anal incontinence is a symptom often referred to by women between the ages of 40 and 60. However, it seems, that only a small number of such cases might be related to obstetric perineal trauma. According to recent data, elective Caesarean section only plays a small protective role. Its effect is restricted to the first few years after delivery. With time, the function of the anal sphincter gradually deteriorates. Subsequent deliveries might contribute to this functional impairment. The long-term effect of forceps delivery is still not clear. The extent of anal sphincter trauma (particularly the defect of the internal anal sphincter) seems to have an impact on the development of anal incontinence, even years after the event. Overlooking defects of the anal sphincter is a cause of problems long after delivery. Given the unsatisfactory results of secondary overlapping, and also, relatively good preliminary effect of primary repair, careful observence of the recommended steps leading to the correct diagnostics of obstetric perineal trauma is crucial, as is adequate repair.

Objective: Summary of the impact of Caesarean section on anal incontinence., Design: Review., Setting: Department of Gynaecology and Obstetrics, Charles University and University Hospital Plzen., Summary: Review of the current international literature. Currently, Caesarean section is not considered to reduce symptoms of anal incontinence. If there is any reduction of symptoms, that remains only for a short term (40% in 3 months after the delivery in the largest trial). In a long term, virtually in no trial has been observed any difference, and others, non-obstetrical factors (particularly aging) prevail. Current knowledge does not allow to assess sufficiently pros and cons of Caesarean compared to vaginal delivery. High risk groups, that would profit from elective Ceasarean, have not been clearly identified yet.

Objective: Numerous anatomical studies over the last years resulted in a principal shift in the view of the area of female pelvic floor. These studies also deal with the area of posterior compartment, i.e. a region which used to be of little interest to urogynecologists. This article presents a brief outline of anatomical and physiological knowledge as well as a brief survey of most important methods of examination and basic clinical symptoms associated with disorders of posterior part of hiatus urogenitalis. The presently accepted concept of a complex approach to disorders of female pelvic floor will probably require increased interest in this area among urogynecologists. The article is aimed at summarizing elementary knowledge necessary for adequate clinical care of patients suffering from disorder in posterior compartment function., Subject: Review article., Setting: Department of Gynecology and Obstetric, Faculty Hospital Na Bulovce, 1st Medical Faculty, Prague, Czech Republic.

The authors present their initial experience with anal manometry using a PC Polygraph of Synectics Medical Co. They discuss the manometric examination of 14 patients with ulcerative colitis, incl. 12 who were operated. In all 12 patients an ilea-pouch-anal anastomosis was made. By manometry a postoperative drop of pressures at rest was found and partly also of pressures during muscular contraction as well as shortening of the zone of high anal pressure. The resulting values, however, did not influence continence, except for temporary soiling, the frequency of bowel movements being 2-8. Anal manometry is an important objective examination of the sphincter function as it makes it possible to compare values before and after therapy. It must be however combined with other anorectal physiological tests such as endosonography, EMG, defaecography etc.