Skip to main content
SpringerLink
Log in

Level of highest mean resting pressure segment in the anal canal

A quantitative assessment of anal sphincter function

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Even with development of new technologies, the mechanism of fecal continence is still not completely understood. This study evaluates the relative position of the highest mean resting pressure segment (HMRP) in the anal canal and its correlation with function in incontinent patients and in controls. METHODS: Sixteen incontinent patients (mean age, 47.1±13.9 (range, 18–63) years; 12 female) and 16 controls (mean age, 35.4±8.7 (range, 24–58) years; 12 female) were studied using a water-perfused eight-port radial catheter computer-assisted vectormanometry. Position of the HMRP was analyzed in relation to the anal verge (D 1 ) and to the proximal functional border of the anal canal (D 2 ). RESULTS: Controls had HMRP located more distally in the anal canal, because D 2 was significantly higher than D 1 (mean, 3.45±0.75 vs. 1.81±0.63 cm;P = 0.001). For incontinent patients, D 1 and D 2 were similar (mean, 1.86±0.75 vs.2.08±1.11 cm; not significant). Comparison of the relative position of the HMRP between patients and controls showed a more proximal location for incontinent patients than controls (mean, 49.1±12.1 percent vs.35.4±10.2 percent;P =0.002). CONCLUSIONS: Position of the HMRP is significantly more proximal for incontinent patients than for controls, and measurement of the distance from the anal verge to the HMRP in relation to the full length of the anal canal may represent another way to quantitatively assess anal sphincter function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lunniss PJ, Kamm MA, Phillips RK. Factors affecting continence after surgery for anal fistula. Br J Surg 1994;81:1382–5.

    PubMed  CAS  Google Scholar 

  2. Grotz RL, Pemberton JH, Ferrara A, Hanson RB. Heal pouch pressures after defecation in continent and incontinent patients. Dis Colon Rectum 1994;37:1073–7.

    PubMed  CAS  Google Scholar 

  3. Farouk R, Duthie GS, Bartolo DC. Recovery of the internal anal sphincter and continence after restorative proctocolectomy. Br J Surg 1994;81:1065–8.

    PubMed  CAS  Google Scholar 

  4. Cullen JJ, Kelly KA. Prospectively evaluating anal sphincter function after ileal pouch-anal canal anastomosis. Am J Surg 1994;167:558–61.

    Article  PubMed  CAS  Google Scholar 

  5. Gantke B, Schäfer A, Enck P, Lübke HJ. Sonographic, manometric, and myographic evaluation of the anal sphincters morphology and function. Dis Colon Rectum 1993;36:1037–41.

    PubMed  CAS  Google Scholar 

  6. Nielsen MB, Hauge C, Rasmussen OØ, Svensen M, Pedersen JF, Christiansen J. Anal sphincter size measured by endosonography in healthy volunteers: effect of age, sex, and parity. Acta Radiol 1992;33:453–6.

    Article  PubMed  CAS  Google Scholar 

  7. Papachrysostomou M, Pye SD, Wild SR, Smith AN. Significance of the thickness of the sphincters with age and its relevance in fecal incontinence. Scand J Gastroenterol 1994;29:710–4.

    PubMed  CAS  Google Scholar 

  8. Sultan AH, Kamm MA, Hudson CN, Nicholls JR, Bartram CI. Endosonography of the anal sphincters: normal anatomy and comparison with manometry. Clin Radiol 1994;49:368–74.

    PubMed  CAS  Google Scholar 

  9. Eckardt VF, Jung B, Fisher B, Lierse W. Anal endosonography in healthy subjects and patients with idiopathic incontinence. Dis Colon Rectum 1994;37:235–42.

    Article  PubMed  CAS  Google Scholar 

  10. Yang YK, Wexner SD. Anal pressure rectography is of no benefit for sphincter evaluation. Int J Colorectal Dis 1994;9:92–5.

    Article  PubMed  CAS  Google Scholar 

  11. Rasmussen OØ. Anorectal function. Dis Colon Rectum 1994;37:386–403.

    PubMed  CAS  Google Scholar 

  12. Lestar B, Penninckx F, Kerrmans R. The composition of anal pressure: anin vivo andin vitro study in man. Int J Colorectal Dis 1989;4:118–22.

    Article  PubMed  CAS  Google Scholar 

  13. Collins CD, Brown BH, Whittaker GE, Duthie PE. New method of measuring forces in the anal canal. Gut 1969;10:160–3.

    PubMed  CAS  Google Scholar 

  14. Taylor BM, Beart RW Jr, Phillips SF. Longitudinal and radial variations of pressure in the human anal sphincter. Gastroenterology 1984;86:693–7.

    PubMed  CAS  Google Scholar 

  15. Williamson JL, Nelson RL, Orsay C, Pearl RK, Abcarian H. A comparison of simultaneous longitudinal and radial recordings of anal pressures. Dis Colon Rectum 1990;33:201–6.

    PubMed  CAS  Google Scholar 

  16. Coller JA. Clinical application of anorectal manometry. Gastroenterol Clin North Am 1987;16:17–33.

    PubMed  CAS  Google Scholar 

  17. Coller JA. Computerized anal sphincter manometry performance and analysis. In: Smith LE, ed. Practical guide to anorectal testing. New York: Igaku-Shoin, 1990:65–109.

    Google Scholar 

  18. Duthie HL, Bennett RD. The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal continence. Gut 1963;4:179–82.

    CAS  PubMed  Google Scholar 

  19. Hiltunen KM. Anal manometric findings in patients with anal incontinence. Dis Colon Rectum 1985;28:925–8.

    PubMed  CAS  Google Scholar 

  20. Felt-Bersma RJ, Meuwissen SG. Anal manometry. Int J Colorectal Dis 1990;5:170–3.

    Article  PubMed  CAS  Google Scholar 

  21. Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SG. Anorectal function investigations in incontinent and continent patients: differences and discriminatory value. Dis Colon Rectum 1990;26:479–86.

    Article  Google Scholar 

  22. Read NW, Bannister JJ. Anorectal manometry: techniques in health and anorectal disease. In: Henry MM, Swash M, eds. Coloproctology and the pelvic floor: pathophysiology and management. London: Butterworths, 1985:65–87.

    Google Scholar 

  23. Rasmussen OØ, Sorensen M, Tetzscher T, Christiansen J. Anorectal pressure gradient in patients with anal incontinence. Dis Colon Rectum 1992;35:8–11.

    PubMed  CAS  Google Scholar 

  24. Perry RE, Blatchford GJ, Christensen MA, Thorson AG, Attwood SE. Manometric diagnosis of anal sphincter injuries. Am J Surg 1990;159:112–7.

    PubMed  CAS  Google Scholar 

  25. Roberts PL, Coller JA, Schoetz DJ Jr, Veidenheimer MC. Manometric assessment of patients with obstetric injuries and fecal incontinence. Dis Colon Rectum 1990;33:16020.

    Article  Google Scholar 

  26. Braun JC, Treutner KH, Dreuw B, Klimaszewski M, Schumpelick V. Vectormanometry for differential diagnosis of fecal incontinence. Dis Colon Rectum 1994;37:989–96.

    Article  PubMed  CAS  Google Scholar 

  27. Williamson ME, Lewis WG, Holdsworth PJ, Finan PJ, Johnston D. Decrease in the anorectal pressure gradient after low anterior resection of the rectum: a study using continuous ambulatory manometry. Dis Colon Rectum 1994;37:1228–31.

    PubMed  CAS  Google Scholar 

  28. Morgado PJ Jr, Wexner SD, James K, Nogueras JJ, Jagelman DG. Ileal pouch-anal anastomosis is preoperative anal manometry predictive of postoperative functional outcome? Dis Colon Rectum 1994;37:224–8.

    Article  PubMed  Google Scholar 

  29. Church JM, Saad R, Schroeder T,et al. Predicting the functional results of anastomosis to the anus: the paradox of preoperative anal resting pressure. Dis Colon Rectum 1993;36:895–900.

    Article  PubMed  CAS  Google Scholar 

  30. McHugh SM, Diamant NE. Effect of age, gender and parity on anal canal pressures: contribution of impaired anal sphincter function to fecal incontinence. Dig Dis Sci 1987;32:726–36.

    Article  PubMed  CAS  Google Scholar 

  31. Loening-Baueke V, Anuras S. Effects of age and sex on anorectal manometry. Am J Gastroenterology 1985;80:50–3.

    Google Scholar 

  32. Bannister JJ, Abouzekry L, Read NW. Effect of aging on anorectal function. Gut 1987;28:353–7.

    PubMed  CAS  Google Scholar 

  33. Laurberg S, Swash M. Effects of aging on the anorectal sphincters and their innervation. Dis Colon Rectum 1989;32:737–42.

    PubMed  CAS  Google Scholar 

  34. Pedersen IK, Christiansen J. A study of the physiological variation in anal manometry. Br J Surg 1989;76:69–71

    PubMed  CAS  Google Scholar 

  35. Enck P, Kuhlbusch R, Lübke H, Frieling T, Erckenbrecht JF. Age and sex and anorectal manometry in incontinence. Dis Colon Rectum 1989;32:1026–30.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Colon and Rectal Surgery, University of Southern California, Los Angeles, California

    Ricardo N. Goes M.D., Anthony J. Simons M.D. & Robert W. Beart Jr. M.D.

Authors
  1. Ricardo N. Goes M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony J. Simons M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert W. Beart Jr. M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Dr. Goes is supported at the University of Southern California by grants from the Fundacao de Amparo a Pesquisa do Estado de Sao Paulo-FAPESP, Brazil.

About this article

Cite this article

Goes, R.N., Simons, A.J. & Beart, R.W. Level of highest mean resting pressure segment in the anal canal. Dis Colon Rectum 39, 289–293 (1996). https://doi.org/10.1007/BF02049470

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02049470

Key words

Search

Navigation