This issue of the Surgical Clinics of North America covers a broad spectrum of anorectal disease such as basic anatomy, physiology, and testing of the anorectal region, as well as the most current diagnostic and management strategies for many of the common anorectal conditions encountered by surgeons including hemorrhoids, anal fissures, abscess and fistula. Also presented here are new techniques in the management of pilonidal disease, perianal infections including HIV and condyloma, pruritis ani, and anal stenosis - difficult conditions that often are frustrating for patient and surgeon alike. Two articles are dedicated to the current management of anorectal Crohn's disease and rectovaginal fistulas, including the evolving multidisciplinary approach. In addition, advances in the evaluation and current management of retrorectal tumors and anal neoplasms including the role of local excision and transanal endoscopic microsurgery for selected rectal tumors are covered. Rounding out this issue are approaches to the difficult situation of anorectal trauma including foreign body management, as well as two articles dedicated to the evaluation of pelvic floor disorders and fecal incontinence.