International Journal of Colorectal Disease

, Volume 5, Issue 3, pp 170–173 | Cite as

Anal manometry

  • R. J. F. Felt-Bersma
  • S. G. M. Meuwissen
Review
Accepted:

Conclusions and future developments

Anal manometry on its own has limited value in the diagnosis and assessment of anorectal disorders. Thus, it should be performed in combination with other tests of anorectal function including defaecography, neurophysiological techniques and endosonography to obtain a broader picture of the disorder. Patients with faecal incontinence should benefit from this approach since it may help to clarify the influence of various possible causative factors leading to the adoption of the most appropriate therapeutic approach.

Keywords

Public Health Internal Medicine Therapeutic Approach Future Development Causative Factor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gowers WR (1877) The automatic action of the sphincter ani. Proc R Soc (Lond) 26:77–84Google Scholar
  2. 2.
    Schuster MM, Hendrix TR, Mendeloff A (1963) The internal anal sphincter response: manometric studies on its normal physiology, neural pathways and alteration in bowel diseases. J Clin Invest 42:196–207Google Scholar
  3. 3.
    Duthie HL, Bennet RC (1963) The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal incontinence. Gut 4:179–182Google Scholar
  4. 4.
    Kerremans R (1969) Morphological and physiological aspects of anal continence and defaecation. Editions Arscia, BrusselsGoogle Scholar
  5. 5.
    Read NW, Bannister JJ (1985) Anorectal manometry: techniques in health and anorectal disease. In: Henry MM, Swash M (eds) Coloproctology and the pelvic floor. Butterworths, London, pp 65–103Google Scholar
  6. 6.
    Coller JA (1987) Clinical application of anorectal manometry. Gastroenterol Clin North Am 16:17–33Google Scholar
  7. 7.
    Miller R, Bartolo DCC, Roe AM, Mortensen NJMcC (1988) Assessment of microtransducers in anal manometry. Br J Surg 75:40–43Google Scholar
  8. 8.
    Taylor BM, Beart RW, Philips SF (1984) Longitudinal and radial variations of pressure in the human anal sphincter. Gastroenterology 86:693–697Google Scholar
  9. 9.
    McHugh SM, Diamant NE (1987) Anal canal pressure profile: a reappraisal as determined by rapid pullthrough technique. Gut 28:1234–1241Google Scholar
  10. 10.
    McHugh SM, Diamant NE (1987) Effect of age, gender and parity on anal canal pressures. Dig Dis Sci 32:726–736Google Scholar
  11. 11.
    Corraziari E (1989) Anorectal manometry — a round table discussion — Gastroenterol Int 2:115–117Google Scholar
  12. 12.
    Yoshioka K, Poxon V, Keighley MRB (1987) Does the position of the patient influence the results of anal manometry? Gut 28:A 1362Google Scholar
  13. 13.
    Johnson GP, Zinsmeister A, Pemberton JH (1988) Effect of body position on anal canal pressure. Gastroenterology 94:A 209Google Scholar
  14. 14.
    Felt-Bersma RJF (1989) Clinical relevance of anorectal function investigations. Thesis, Free University Press, AmsterdamGoogle Scholar
  15. 15.
    Lestar B, Penninckx F, Kerremans R (1989) The composition of anal basal pressure. An in vivo and in vitro study in man. Int J Colorect Dis 4:118–122Google Scholar
  16. 16.
    Hancock BD, Smith K (1975) The internal sphincter and Lord's procedure for haemorrhoids. Br J Surg 62:833–866Google Scholar
  17. 17.
    Haynes WG, Read NW (1982) Anorectal activity in man during rectal infusion of saline: a dynamic assessment of the anal continence mechanism. J Physiol 330:45–56Google Scholar
  18. 18.
    Meunier P, Mollard P (1977) Control of the internal anal sphincter (manometric study with human subjects). Pflügers Arch 370:233–239Google Scholar
  19. 19.
    Frenckner B, Ihre T (1976) Influence of the autonomic nerves on the internal anal sphincter in man. Gut 17:306–312Google Scholar
  20. 20.
    Bartolo DCC, Roe AM, Locke-Edmunds JC, Virjee J, Mortensen NJMcC (1986) Flap valve theory of anorectal continence. Br J Surg 73:1012–1014Google Scholar
  21. 21.
    Harris LP, Winans CS, Pope II CE (1966) Determination of yield pressures: a method for measuring anal sphincter competence. Gastroenterology 50:754–760Google Scholar
  22. 22.
    Hiltunen KH (1985) Anal manometric findings in patients with anal incontinence. Dis Colon Rectum 28:925–928Google Scholar
  23. 23.
    Katz LA, Kaufmann HJ, Spiro HM (1967) Anal sphincter pressure characteristics. Gastroenterology 52:513–518Google Scholar
  24. 24.
    Keighley MRB, Shouler P (1984) Clinical and manometric features of the solitary ulcer syndrome. Dis Colon Rectum 27:507–512Google Scholar
  25. 25.
    Kuypers JHC (1984) Fecal incontinence and the anorectal angle. Neth J Surg 36:20–23Google Scholar
  26. 26.
    Rogers J, Levy DM, Henry MM, Misiewicz JJ (1988) Pelvic floor neuropathy: a comparative study of diabetes mellitus and idiopathic faecal incontinence. Gut 29:756–761Google Scholar
  27. 27.
    Varma JS, Smith AN, McInnes A (1986) Electrophysiological observations on the human pudendo-anal reflex. J Neurol Neurosurg Psychiatry 49:1411–1416Google Scholar
  28. 28.
    Bannister JJ, Abouzekry L, Read NW (1987) Effect of aging on anorectal function. Gut 28: 353–357Google Scholar
  29. 29.
    Felt-Bersma RJF, Gort G, Meuwissen SGM (1990) Normal values in anal manometry and rectal sensation: a problem of range (submitted for publication)Google Scholar
  30. 30.
    Krogh Pedersen I, Christiansen J (1989) A study of the physiological variation in anal manometry. Br J Surg 76:69–71Google Scholar
  31. 31.
    Laurberg S, Swash M (1989) Effects of aging on the anorectal sphincters and their innervation. Dis Colon Rectum 32:737–742Google Scholar
  32. 32.
    Loening-Baucke V, Anuras S (1985) Effects of age and sex on anorectal manometry. Am J Gastroenterol 80:50–53Google Scholar
  33. 33.
    Matheson DM, Keighley MRB (1981) Manometric evaluation of rectal prolapse and faecal incontinence. Gut 22:126–129Google Scholar
  34. 34.
    Poos RJ, Frank J, Bittner R, Beger HG (1986) Influence of age and sex on anal sphincters: manometric evaluation of anorectal continence. Eur Surg Res 18:343–348Google Scholar
  35. 35.
    Read NW, Harford WF, Schmulen AC, Read MG, Santa Ana C, Fordtran JS (1979) A clinical study of patients with fecal incontinence and diarrhea. Gastroenterology 76:747–756Google Scholar
  36. 36.
    Sun WM, Read NW (1989) Anorectal function in normal subjects: effect of gender. Int J Colorect Dis 4:188–196Google Scholar
  37. 37.
    Rogers J, Laurberg S, Misiewicz JJ, Henry MM, Swash M (1989) Anorectal physiology validated: a repeatable study of the motor and sensory tests of anorectal function. Br J Surg 76:667–669Google Scholar
  38. 38.
    Felt-Bersma RJF, Klinkenberg-Knol EC, Meuwissen SGM (1988) Investigation of anorectal function. Br J Surg 75:53–55Google Scholar
  39. 39.
    Hallan RI, Marzouk DEMM, Waldron DJ, Womack NR, Williams NS (1989) Comparison of digital and manometric assessment of anal sphincter function. Br J Surg 76:973–975Google Scholar
  40. 40.
    Neill ME, Parks AG, Swash M (1981) Physiological studies of the anal sphincter musculature in faecal incontinence and rectal prolapse. Br J Surg 68:531–536Google Scholar
  41. 41.
    Kuypers JHC (1982) Anal manometry, its applications and indications. Neth J Surg 34:153–158Google Scholar
  42. 42.
    Bartolo DCC, Jarrat JA, Read MG, Donnelly TC, Read NW (1983) The role of partial denervation of the puborectalis in idiopathic faecal incontinence. Br J Surg 70:664–667Google Scholar
  43. 43.
    Kiff ES, Swash M (1984) Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 71:614–616Google Scholar
  44. 44.
    Read NW, Bartolo DCC, Read MG (1984) Differences in anal function in patients with incontinence to solids and in patients with incontinence to liquids. Br J Surg 71:39–42Google Scholar
  45. 45.
    Hiltunen KH (1985) Anal manometric findings in patients with anal incontinence. Dis Colon Rectum 28:925–928Google Scholar
  46. 46.
    Womack NR, Morrison JFB, Williams NS (1986) The role of pelvic floor denervation in the aetiology of idiopathic faecal incontinence. Br J Surg 73:404–407Google Scholar
  47. 47.
    Rogers J, Henry MM, Misiewicz JJ (1988) Combined sensory and motor deficit in primary faecal incontinence. Gut 29:5–9Google Scholar
  48. 48.
    Felt-Bersma RJF, Klinkenberg-Knol EC, Meuwissen SGM (1990) Anorectal function investigations in incontinent patients: differences and discriminatory value. Dis Colon Rectum (in press)Google Scholar
  49. 49.
    Keighley MRB, Fielding JWL (1983) Management of faecal incontinence and results of surgical treatment. Br J Surg 70:463–468Google Scholar
  50. 50.
    Fang DT, Nivatvongs S, Vermeulen FD, Herman FN, Goldberg SM, Rothenberger DA (1984) Overlapping sphincteroplasty for acquired anal incontinence. Dis Colon Rectum 27:720–722Google Scholar
  51. 51.
    Browning GGP, Parks AG (1983) Post-anal repair for neuropathic faecal incontinence: correlation of clinical results and anal canal pressures? Br J Surg 70:101–104Google Scholar
  52. 52.
    Vroonhoven ThJMV, Schouten WR (1984) Postanal repair in the treatment of faecal incontinence. Neth J Surg 36:160–162Google Scholar
  53. 53.
    Miller R, Bartolo DCC, Locke-Edmunds JC, Mortensen NJMcC (1988) Prospective study of conservative anal operative treatment for faecal incontinence. Br J Surg 75:101–105Google Scholar
  54. 54.
    Womack NR, Morrison JFB, Williams NS (1988) Prospective study of the effects of postanal repair in neurogenic faecal incontinence. Br J Surg 75:48–52Google Scholar
  55. 55.
    Hoitsma HFW, Meyer S, Klinkenberg-Knol EC, Otter den G (1984) The treatment of complete rectal prolapse by transabdominal posterior rectopexy. Neth J Surg 36:73–76Google Scholar
  56. 56.
    Matheson DM, Keighley MRB (1981) Manometric evaluation of rectal prolapse and faecal incontinence. Gut 22:126–129Google Scholar
  57. 57.
    Yoshioka K, Hyland G, Keighley MRB (1989) Anorectal function after abdominal rectopexy: parameters of predictive value in identifying return of continence. Br J Surg 76:64–68Google Scholar
  58. 58.
    Felt-Bersma RJF, Janssen JJWM, Klinkenberg-Knol EC, Hoitsma HWF, Meuwissen SGM (1989) Soiling: anorectal function and results of treatment. Int J Colorect Dis 4:37–40Google Scholar
  59. 59.
    Lanfranchi GA, Bazzocchi G, Fedirici S, Brignola C, Campieri M, Rossi F, Domini R, Labo G (1984) Anorectal manometry in the diagnosis of Hirschsprung's disease—comparison with clinical and radiological criteria. Am J Gastroenterol 79:270–274Google Scholar
  60. 60.
    Ikawa H, Kim SM, Hendren WH, Donahae PK (1986) Acetylcholinesterase and manometry in the diagnosis of the constipated child. Arch Surg 121:435–438Google Scholar
  61. 61.
    Iway N, Yanagihara J, Tokiwa K, Degachi E, Perdrynski W, Tahahaski T (1988) Reliability of anorectal manometry in the diagnosis of Hirschsprung's disease—die Treffsicherheit der anorectalen Manometrie in der Diagnose des Morbus Hirschsprung. Z Kinderchir 43:405–407Google Scholar
  62. 62.
    Barnes PRH, Lennard-Jones JE (1988) Function of the striated anal sphincter during straining in control subjects and constipated patients with a radiologically normal rectum or idiopathic megacolon. Int J Colorect Dis 3:207–209Google Scholar
  63. 63.
    Felt-Bersma RJF, Luth WJ, Janssen JJWM, Meuwissen SGM (1990) Defecography in patients with anorectal disorders: which findigns are clinically relevant? Dis Colon Rectum (in press)Google Scholar
  64. 64.
    Hancock BD (1977) The internal anal sphincter and anal fissure. Br J Surg 64:92–95Google Scholar
  65. 65.
    Gibbons CP, Read NW (1986) Anal hypertonia in fissures: cause or effect? Br J Surg 73:443–445Google Scholar
  66. 66.
    Chowcat NL, Araujo JGC, Boulos PB (1986) Internal sphincterotomy for chronic anal fissure: long term effects on anal pressure. Br J Surg 73:915–916Google Scholar
  67. 67.
    Hancock BD (1977) Internal sphincter and the nature of haemorrhoids. Gut 18:651–655Google Scholar
  68. 68.
    Hiltunen KM, Matikanen M (1985) Anal manometric findings in symptomatic hemorrhoids. Dis Col Rectum 28:807–809Google Scholar
  69. 69.
    Gibbons CP, Bannister JJ, Read NW (1988) Role of constipation and anal hypertonia in the pathogenesis of haemorrhoids. Br J Surg 75:656–660Google Scholar
  70. 70.
    Pescatori M, Maria G, Anastasio G, Rinallo L (1989) Anal manometry improves the outcome for fistula-in ano. Dis Col Rectum 32:588–592Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • R. J. F. Felt-Bersma
    • 1
  • S. G. M. Meuwissen
    • 2
  1. 1.Department of GastroenterologyAcademical Hospital UtrechtUtrechtThe Netherlands
  2. 2.Department of GastroenterologyFree University HospitalAmsterdamThe Netherlands

Personalised recommendations