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Introduction to Methods of Anorectal Physiology Evaluation

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Anorectal Physiology

Abstract

Various anorectal physiology testing and imaging methods can be utilized in evaluating, diagnosing, and managing pelvic floor disorders. Anorectal manometry systems include

perfusion systems, microtransducer systems, balloon systems, and high-resolution manometry systems, each of them confer clinical advantages and disadvantages in evaluating fecal incontinence, constipation, and anal pain. These systems provide objective measures of the sphincter complex, including resting and squeeze pressures, anal canal length, anal motility, rectal sensation and compliance, pressures during simulation of evacuation, and anorectal reflexes. Colonic transit studies may also be utilized in evaluating patients with intestinal constipation due to slow-transit or colonic inertia. Neurophysiologic examinations, including EMG and pudendal nerve terminal motor latency, may provide utility in mapping anal sphincter defects and neurogenic sphincter injuries. Additional methods, including endoanal ultrasound, cindefecography, and magnetic resonance imaging, may provide initial anatomic evaluation of the anal sphincter complex, morphologic visualization of defecatory function, and dynamic evaluation of the pelvic floor. Guidelines for utilizing these modalities in evaluating fecal incontinence and constipation are provided by the American Society of Colon and Rectal Surgeons.

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References

  1. Law PJ, Kamm MA, Bartram CI. Anal endosonography in the investigation of faecal incontinence. Br J Surg. 1991;78:312–4.

    Article  CAS  PubMed  Google Scholar 

  2. Dobben AC, Terra MP, Deutekom M, Slors JFM, Janssen LWM, Bossuyt PMM, Stoker J. The role of endoluminal imaging in clinical outcome of overlapping anterior anal sphincter repair in patients with fecal incontinence. AJR Am J Roentgenol. 2007;189:W70–7.

    Article  PubMed  Google Scholar 

  3. Parker SC, Spencer MP, Madoff RD, Jensen LL, Wong WD, Rothenberger DA. Artificial bowel sphincter: long-term experience at a single institution. Dis Colon Rectum. 2003;46:722–9.

    Article  PubMed  Google Scholar 

  4. Matzel KE, Kamm MA, Stosser M, et al. Sacral spinal nerve stimulation for faecal incontinence: multicentre study. Lancet. 2004;363:1270–6.

    Article  PubMed  Google Scholar 

  5. Maeda Y, Vaizey CJ, Kamm MA. Pilot study of two new injectable bulking agents for the treatment of faecal incontinence. Color Dis. 2008;10:268–72.

    Article  CAS  Google Scholar 

  6. Stroker K, et al. Endoanal ultrasound of the upper anal canal showing the puborectalis muscle. From: Endoanal ultrasound. Imaging pelvic floor disorders. 2nd ed. Berlin: Springer; 2008.

    Google Scholar 

  7. AGA review on anorectal testing techniques. Gastroenterology 1999;116(3):735–60.

    Google Scholar 

  8. Engin G. Endosonographic imaging of anorectal diseases. J Ultrasound Med. 2006;25:57–73.

    Article  PubMed  Google Scholar 

  9. Emblem R, Dhaenens G, Stien R, Morkrid L, Aasen AO, Bergan A. The importance of anal endosonography in the evaluation of idiopathic fecal incontinence. Dis Colon Rectum. 1994;37:42–8.

    Article  CAS  PubMed  Google Scholar 

  10. Williams AB, Malouf AJ, Bartram CI, Halligan S, Kamm MA, Kmiot WA. Assessment of external anal sphincter morphology in idiopathic fecal incontinence with endocoil magnetic resonance imaging. Dig Dis Sci. 2001;46:1466–71.

    Article  CAS  PubMed  Google Scholar 

  11. Thapar RB, Patankar RV, Kamat RD, Thapar RR, Chemburkar V. MR defecography for obstructed defecation syndrome. Indian J Radiol Imaging. 2015;25:25–30.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ekberg O, Nylander G, Fork F. Defecography. Radiology. 1985;155:45–8.

    Article  CAS  PubMed  Google Scholar 

  13. Kelvin FM, Maglinte DD, Benson T, Brubaker L, Smith C. Dynamic cystoproctography: a technique for assessing disorders of the pelvic floor in women. Am J Roentgenol. 1994;163:368–70.

    Article  CAS  Google Scholar 

  14. Kumar S, Sharma P, Andreisek G. Does conventional defecography has a role to play in evaluation of evacuatory disorders in Indian population? Indian J Radiol Imaging. 2013;23:92–6.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Jorge JMN, et al. How reliable are currently available methods of measuring the anorectal angle? Dis Colon Rectum. 1992;25:332–8.

    Article  Google Scholar 

  16. Halligan S, Bartram CI, Park H, Kamm M. Proctographic features of anismus. Radiology. 1995;197:679–82.

    Article  CAS  PubMed  Google Scholar 

  17. Shorvon PJ, et al. Defecography in normal volunteers: results and implications. Gut. 1989;30:1737–49.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Sboarina A, et al. Shape and volume of internal anal sphincter showed by three-dimensional anorectal ultrasonography. Eur J Radiol. 2012;81(7):1479–82.

    Article  CAS  PubMed  Google Scholar 

  19. Arndorfer RC, et al. Improved infusion system of intraluminal esophageal manometry. Gastroenterology. 1977;73(1):23–7.

    Article  CAS  PubMed  Google Scholar 

  20. Schuster MM, et al. Simultaneous manometric recording of internal and external anal sphincter reflexes. Bull Johns Hopkins Hosp. 1965;166:79–88.

    Google Scholar 

  21. Rao SS, Azpiroz F, Diamant N, et al. Minimum standards of anorectal manometry. Neurogastroenterol Motil. 2002;14:553–9.

    Article  CAS  PubMed  Google Scholar 

  22. Kang HR, Lee JE, Lee JS, et al. Comparison of high-resolution anorectal manometry with water-perfused anorectal manometry. J Neurogastroenterol Motil. 2015;21:126–32.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sauter M, Heinrich H, Fox M. Toward more accurate measurements of anorectal motor and sensory function in routine clinical practice: validation of high-resolution anorectal manometry and Rapid Barostat Bag measurements of rectal function. Neurogastroenterol Motil. 2014;26:685–95.

    Article  CAS  PubMed  Google Scholar 

  24. Babaei A, Lin EC, Szabo A, Massey BT. Determinants of pressure drift in Manoscan™ esophageal high-resolution manometry system. Neurogastroenterol Motil. 2015;27:277–84.

    Article  CAS  PubMed  Google Scholar 

  25. Lee TH, Bharucha AE. How to perform and interpret a high-resolution anorectal manometry test. J Neurogastroenterol Motil. 2016;22(1):46–59.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Clouse RE, Staiano A, Alrakawi A, Haroian L. Application of topographical methods to clinical esophageal manometry. Am J Gastroenterol. 2000;95:2720–30.

    Article  CAS  PubMed  Google Scholar 

  27. Vitton V, Ben Hadj Amor W, Baumstarck K, et al. Water perfused manometry vs three-dimensional high-resolution manometry: a comparative study on a large patient population with anorectal disorders. Color Dis. 2013;15:726–31.

    Article  Google Scholar 

  28. Jorge JM, Wexner SD. Anorectal manometry: techniques and clinical applications. South Med J. 1993;86:924–31.

    Article  CAS  PubMed  Google Scholar 

  29. Coller JA. Clinical application of anorectal manometry. Gastro Clin N Amer. 1987;16:17–34.

    Article  CAS  Google Scholar 

  30. Kaur G. Rectoanal reflex parameters in incontinence and constipation. Dis Colon Rectum. 2002;45:928–33.

    Article  PubMed  Google Scholar 

  31. Parkman HP, McCallum RW, Rao SSC. GI motility testing: laboratory and office handbook. Thorofare: SLACK; 2011.

    Google Scholar 

  32. Gowers WR. The automatic action of the sphincter ani. Proc R Soc Lond B Biol Sci. 1877;26:77–84.

    Google Scholar 

  33. Miller R, Bartolo DC, Cervero F, et al. Anorectal sampling: a comparison of normal and incontinent patients. Br J Surg. 1988;75:44–7.

    Article  CAS  PubMed  Google Scholar 

  34. Kaur G, Gardiner A, Duthie GS. Rectoanal reflex parameters in incontinence and constipation. Dis Colon Rectum. 2002;45:928–33.

    Article  PubMed  Google Scholar 

  35. Rogers J. Testing for and the role of anal and rectal sensation. Baillieres Clin Gastroenterol. 1992;6:179–91.

    Article  CAS  PubMed  Google Scholar 

  36. Enck P, von Giesen H, Schafer A, et al. Comparison of anal sonography with conventional needle electromyography in the evaluation of anal sphincter defects. Am J Gastroenterol. 1996;91:2539–43.

    CAS  PubMed  Google Scholar 

  37. Podnar S, Zalewska E, Hausmanowa-Petrusewicz I. Evaluation of the complexity of motor unit potentials in anal sphincter electromyography. Clin Neurophysiol. 2005;116:948–56.

    Article  PubMed  Google Scholar 

  38. Axelson HW, Edebol Eeg-Olofsson K. Simplified evaluation of the paradoxical puborectalis contraction with surface electrodes. Dis Colon Rectum. 2010;53:928–31.

    Article  PubMed  Google Scholar 

  39. Kiff ES, Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg. 1984;71:614–6.

    Article  CAS  PubMed  Google Scholar 

  40. Ger GC, Wexner SD. Electromyography and pudendal nerve terminal motor latency. In: Wexner SD, Bartolo DC, editors. Constipation: etiology, evaluation, and management. Oxford: Butterworth-Heinemann; 1995. p. 91–102.

    Google Scholar 

  41. Thomas C, et al. Respective value of pudendal nerve terminal motor latency and anal sphincter electromyography in neurogenic fecal incontinence. Neurophysiol Clin. 2002;32:85–90.

    Article  PubMed  Google Scholar 

  42. Yip B, Barrett RC, Coller JA, et al. Pudendal nerve terminal motor latency testing: assessing the educational learning curve: can we teach our own? Dis Colon Rectum. 2002;45:184–7.

    Article  PubMed  Google Scholar 

  43. Tetzschner T, Sørensen M, Rasmussen OO, et al. Reliability of pudendal nerve terminal motor latency. Int J Color Dis. 1997;12:280–4.

    Article  CAS  Google Scholar 

  44. Hutchinson R, Kumar D. Colonic and small bowel transit studies. In: Wexner SD, Bartolo DC, editors. Constipation: etiology, evaluation, and management. Oxford: Butterworth-Heinemann; 1995. p. 52–62.

    Google Scholar 

  45. Arhan P, Devroede G, Jehannu B, et al. Segmental colonic transit time. Dis Colon Rectum. 1981;24:625–9.

    Article  CAS  PubMed  Google Scholar 

  46. Paquette I, Varma, MG, Kaiser AM, Steele SR, Rafferty, JF. The American Society of Colon and Rectal Surgeons, Clinical Practice Guideline for the Treatment of Fecal Incontinence. 2015.

    Google Scholar 

  47. Paquette I, Varma, MG, Ternet C, Melton-Meaux G, Rafferty JF, Feingold D, Steele SR. The American Society of Colon and Rectal Surgeons, Clinical Practice Guideline for the Evaluation and Management of Constipation. 2015.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Jefferson Health, Philadelphia, PA, USA

    Jason Lei

  2. New York Institute of Technology College of Osteopathic Medicine, Huntington, NY, USA

    Colleen Nofi

  3. Northwell Health, Huntington Hospital, Hofstra School of Medicine, Huntington, NY, USA

    David E. Rivadeneira

Authors
  1. Jason Lei
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  2. Colleen Nofi
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  3. David E. Rivadeneira
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Correspondence to David E. Rivadeneira .

Editor information

Editors and Affiliations

  1. Director Department of Anorectal Physiology of Rio de Janeiro and CEPEMED, Rio de Janeiro, Brazil

    Lucia Camara Castro Oliveira

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Lei, J., Nofi, C., Rivadeneira, D.E. (2020). Introduction to Methods of Anorectal Physiology Evaluation. In: Oliveira, L. (eds) Anorectal Physiology. Springer, Cham. https://doi.org/10.1007/978-3-030-43811-1_5

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  • DOI: https://doi.org/10.1007/978-3-030-43811-1_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-43810-4

  • Online ISBN: 978-3-030-43811-1

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