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The natural history of AIN is at present unclear, although high-risk groups—with or without HIV-related disease and possibly with high-grade CIN who are oncogenic HPV-positive with high-risk HPV subtypes—should be regularly surveyed by “new” adapted cytologic and colposcopic techniques for the specific assessment of anal diseases using technology that has been translated from gynecologic practice. Such an approach requires the accrual of a multidisciplinary team experienced in anal “colposcopy” and anal cytopathological and histopathological assessment of this very specialized area.

Patients with intractable chronic constipation should be evaluated with physiological tests after structural disorders and extracolonic causes have been excluded. Conservative treatment options should be tried until they are exhausted. If surgery is indicated, STC with IRA is the treatment method of choice, although segmental resection may be a good option for isolated megasigmoid, sigmoidocele, or recurrent sigmoid volvulus. In general, patients with GID should not be offered any surgical options because of their anticipated poor results. Moreover, patients with psychiatric disorders should be actively discouraged from resection, as they tend to have a poorer prognosis. Patients must be counseled that preoperative pain and/or bloating will likely persist, even if surgery normalizes bowel frequency. Patients with associated problems may be served better by having a stoma without resection as both a therapeutic maneuver and a diagnostic trial. Colectomy is not a treatment option for pain and/or abdominal bloating.

Rather than considering it a loose association of independently functioning organs, the pelvis should be looked upon as an organ system unto itself, composed of subdivisions that rely on each other for normal function. The anterior and posterior compartments share a common nervous system and provide structural support for each other. Therefore, it is easy to see that surgical treatment of one subdivision may have functional impact on the others. In this chapter, we have discussed how radical hysterectomy has been associated with alterations in anorectal function, although an adequate and comprehensive explanation for these findings is currently lacking. Persistent evacuation symptoms may follow surgery for vaginal support defects if there was an incomplete assessment of the pelvic floor before surgery. Similarly, fecal incontinence may persist following repair of a rectovaginal fistula if one did not assess the anal sphincter preoperatively. A multidisciplinary approach to pelvic floor problems is truly required in order to optimize patient care.