Section 1 Coloproctology and Flow Equation

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  • According to the flow equation constipation can be defined as a low flow state during defecation while Anal Incontinence can be defined as abnormal flow of bowel contents through the anal canal during rest or squeeze.

Flow = Pressure/Resistance.

  • According the rectoanal interaction is a pressure -resistance interaction rather than Pressure – pressure interaction.
  • The anal canal resistance is directly proportionate to Dynamic viscosity (consistency) of stools and A.C. length and inversely proportionate to (anal canal resistance) 4.
  • Accordingly normal flow during defecation and abnormal flow during incontinence increases as the intra-rectal pressure and anal canal diameter increase and as the dynamic viscosity (consistency) of the stools and anal canal length decreases. Being modified by sensory and reflex factors.
  • Sensory factors principally affects Intrarectal pressure due to delayed sensations.
  • Reflex factors works mainly by determining which anal canal dimensions (and hence resistance) challenged by intra rectal pressure during rest or squeeze for incontinent patients or during defecation for constipated patients.
  • The mathematically calculated flow was taken as a flow index rather than an accurate measurement of flow in order to avoid too- much corrections on the native equation.
  • Norm grams representing the flow equation during defecation and continence had been plotted in order to facilitate understanding the flow equation and allocation of individual patients as a rough though rapid substitute for suggested mathematical calculations.
  • Click here for Flow index calculator

Section 2: How to use the integrated approach?

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  • The integrated Coloproctology can give a frame work to the puzzle made of hundreds of scattered pieces of the puzzle called the functional Coloproctology by providing the final imagination on how this puzzle will look like when those pieces are fitted together.
  • It can be used equally for incontinence and constipation
  • it can be used to understand normal anorectal physiology and accordingly explains the controversies experienced due conflicting research data.
  • it determines mechanical factors marinating continence and defecation and can quantities the roles played by each mechanical factor as well as sensory and reflex components in each individual patient.
  • It helps in better planning of treatment and expecting outcome based on the above- mentioned data.
  • Helps in objective evaluation of different modalities of treatment in comparison to each other e.g. the effect of biofeedback training vs. different types of surgery by mathematically calculating anal canal resistance before and after treatment.



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