**1. Introduction**

Variety causes of neuromuscular disorders of the pelvic floor muscles may affect the functional integrity of the pelvic floor and anorectum leading to the different pathological conditions such as anorectal incontinence, urinary incontinence and constipation of obstructed defecation, sexual dysfunction, and perineal pain syndromes.

Anorectal incontinence is considered a severe condition that influences the patient's life causing mainly unsafety as well anxiety and fear to social contact. The exact incidence of anorectal incontinence is unknown but in a few epidemiological studies it has been reported 2.2–8.3% in the population. It is more frequent in women and particularly in the elderly. However, some studies reported an incidence >50% [1–3].

Constipation can significantly affect the quality of patient' life and its diagnosis may be done at every age but usually in the elderly and in women. The incidence of chronic constipation has been calculated in epidemiological studies 2–27% [4, 5]. The Rome III diagnostic criteria have been helped to constipation definition (**Table 1**) [6]. However, constipation is assumed a subjective symptom of varied pathological

conditions (**Table 2**) [7]. Furthermore, constipation can be distinguished in normal constipation, slow transit constipation, and constipation of pelvic outlet obstruction or obstructed defecation [8]. Constipated patients with obstructed defecation usually have a normal colonic transit time, but delayed transit in the rectosigmoid part [9]. Some of these patients are presented with a megarectum, large rectocele, enterocele, rectal prolapse, or perineal descent, while others maintain a spasm of the pelvic floor muscles leading to difficult evacuation [10].

Perineal pain syndromes are characterized by chronic perineal pain (anorectum and perineum) without anorectal or endopelvic organic disease [11]. These syndromes constitute an idiopathic multifactorial complex interaction between neurological, musculoskeletal, and endocrine systems that is more influenced by psychological and behavioral factors [12]. The lack of understanding of the etiology of perineal pain is evident in its many names (chronic perineal, pain chronic idiopathic anal pain,


#### **Table 1.**

*Rome III criteria to diagnosis of chronic constipation.*


#### **Table 2.**

*Causes of constipation of obstructed defecation.*
