Skip to main content

Abstract

Physiologic testing has been used to assess pelvic floor and anorectal disorders for the past 35 years, but only in the past two decades has this testing become of value for clinical use. These physiologic tests are performed in conjunction with a history, diary of the disorder, physical examination, endoscopy, and often imaging studies. Physiologic tests have provided or confirmed a diagnosis in 75% of patients with constipation, 66% of patients with incontinence, and 42% of patients with chronic anorectal pain according to one study.

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

Access this chapter

Institutional subscriptions

References

  1. Wexner SD, Jorge JMN. Colorectal physiological tests: use or abuse of technology? Eur J Surg 1994;160:167–174.

    CAS  PubMed  Google Scholar 

  2. Lowry AC, Simmang CL, Boulos P, et al. Report of the tripartite consensus conference on definitions for anorectal physiology and rectal cancer, Washington, D.C., May 1, 1999. Dis Colon Rectum 2001;44(7):915–919.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  4. Loening‐ Baucke V, Anuras S. Effects of age and sex on anorectal manometry. Am J Gastroenterol 1991;80:50–53.

    Google Scholar 

  5. Hallan RI, Marzouk DEMM, Waldron DJ, et al. Comparison of digital and manometric assessment of anal sphincter function. Br J Surg 1989;76:973–975.

    Article  CAS  PubMed  Google Scholar 

  6. Felt Bersma RJF, Klinkenberg‐Knol, Meuwissen SGM. Anorectal function investigations in incontinent and continent patients. Dis Colon Rectum 1990;33:479–486.

    Article  CAS  PubMed  Google Scholar 

  7. Duthie HL, Watts JM. Contribution of the external anal sphincter to the pressure zone in the anal canal. Gut 1965;17:64–68.

    Article  Google Scholar 

  8. 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;32:726–736.

    Article  CAS  PubMed  Google Scholar 

  9. Rattan S, Chakder S. Role of nitric oxide as a mediator of internal anal sphincter relaxation. Am J Physiol 1992;262:G107–112.

    CAS  PubMed  Google Scholar 

  10. Perry RE, Blatchford GJ, Christensen MA, et al. Manometric diagnosis of anal sphincter injuries. Am J Surg 1990;159: 112–117.

    Article  CAS  PubMed  Google Scholar 

  11. Tjandra JJ, Sharma BRK, McKirdy HC, et al. Anorectal physiological testing in defecatory disorders: a prospective study. Aust N Z J Surg 1994;64:322–326.

    Article  CAS  PubMed  Google Scholar 

  12. Bouchoucha M, Faye A, Arsac M, Rocaries F. Anal sphincter response to distension. Int J Colorectal Dis 2001;16:119–125.

    Article  CAS  PubMed  Google Scholar 

  13. Tobon F, Reid NCRW, Talbert JL, et al. Nonsurgical test for the diagnosis of Hirschsprung's disease. N Engl J Med 1968;278: 188–194.

    Article  CAS  PubMed  Google Scholar 

  14. Preston DM, Lennard‐Jones JE. Anismus in chronic constipation. Dig Dis Sci 1985;30:413–418.

    Article  CAS  PubMed  Google Scholar 

  15. Bremmer S. Peritoneocele: a radiological study with defaeco‐peritoneography. Acta Radiol Suppl 1998;413:1–33.

    CAS  PubMed  Google Scholar 

  16. Maglinte DD, Kelvin FM, Hale DS. Dynamic cystoproctography: a unifying diagnostic approach to pelvic floor and anorectal dysfunction. AJR Am J Roentgenol 1999;169:759–767.

    Google Scholar 

  17. Jorge JMN, Habr‐Gama A, Wexner S. Clinical applications and techniques of cinedefecography. Am J Surg 2001;182:93–101.

    Article  CAS  PubMed  Google Scholar 

  18. Wiersma T, Mulder CJJ, Reeders WAJ. Dynamic rectal examination: its significant clinical value. Endoscopy 1997;29: 462–471.

    Article  CAS  PubMed  Google Scholar 

  19. Jones HJS, Blake H, Swift RI. A prospective audit of the usefulness of evacuating proctography. Ann R Coll Surg Engl 1998;80:40–45.

    CAS  PubMed  Google Scholar 

  20. Halligan S, Bartram C, Hall C, et al. Enterocele revealed by simultaneous evacuation proctography and peritoneography: does “defecation block” exist? AJR Am J Roentgenol 1996;167: 461–466.

    CAS  PubMed  Google Scholar 

  21. Sentovich SM, Rivela LJ, Thorson AG, et al. Simultaneous dynamic proctography and peritoneography for pelvic floor disorders. Dis Colon Rectum 1995;38:912–915.

    Article  CAS  PubMed  Google Scholar 

  22. Halligan S, Malouf A, Bartram C, et al. Predictive value of impaired evacuation at proctography in diagnosing anismus. AJR Am J Roentgenol 2001;177:633–637.

    CAS  PubMed  Google Scholar 

  23. Pomerri F, Zuliani M, Mazza C, et al. Defecographic measurements of rectal intussusception and prolapse in patients and in asymptomatic subjects. AJR Am J Roentgenol 2001;176:641–645.

    CAS  PubMed  Google Scholar 

  24. Rao SS, Hatfield R, Soffer E. Manometric tests of anorectal function in healthy adults. Am J Gastroenterol 1999;94:773–783.

    Article  CAS  PubMed  Google Scholar 

  25. Sentovich SM, Blatchford GJ, Rivela LJ, et al. Diagnosing anal sphincter injury with transanal ultrasound and manometry. Dis Colon Rectum 1997;40:1430–1434.

    Article  CAS  PubMed  Google Scholar 

  26. Bartram CI, Burnett SJD. Atlas of Anal Endosonography. Oxford: Butterworth‐Heinemann; 1991.

    Google Scholar 

  27. Bartram C. Radiologic evaluation of anorectal disorders. Gastroenterol Clin North Am 2001;30:55–75.

    Article  CAS  PubMed  Google Scholar 

  28. Sultan AH, Kamm MA, Talbot IC, et al. Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg 1994;81(3):463–465.

    Article  CAS  PubMed  Google Scholar 

  29. Barker PG, Lunniss PJ, Armstrong P, et al. Magnetic resonance imaging of fistula‐in‐ano: technique, interpretation and accuracy. Clin Radiol 1994;49:7–13.

    Article  CAS  PubMed  Google Scholar 

  30. Fletcher JG, Busse RF, Reiderer SJ, et al. Magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders. Am J Gastroenterol 2003;98:399–411.

    Article  CAS  PubMed  Google Scholar 

  31. Briel JW, Stoker J, Rociu E, et al. External anal sphincter atrophy on endoanal magnetic resonance imaging adversely affects continence after sphincteroplasty. Br J Surg 1999;86:1322–1327.

    Article  CAS  PubMed  Google Scholar 

  32. William AB, Bartram CI, Modhwadia D, et al. Endocoil magnetic resonance imaging quantification of external anal sphincter atrophy. Br J Surg 2001;88:853–859.

    Article  Google Scholar 

  33. Sato T, Konishi F, Kanazawa K. Variations in motor evoked potential latencies in the anal sphincter system with sacral magnetic stimulation. Dis Colon Rectum 2000;43:966–970.

    Article  CAS  PubMed  Google Scholar 

  34. deSouza NM, Hall AS, Puni R, et al. High resolution magnetic resonance imaging of the anal sphincter using a dedicated endoanal coil. Dis Colon Rectum 1996;39:926–934.

    Article  CAS  PubMed  Google Scholar 

  35. Fletcher JG, Busse RF, Riederer SJ, et al. Magnetic resonance imaging of anatomic and dynamic defects of the pelvic floor in defecatory disorders. Am J Gastroenterol 2003;98:399–411.

    Article  CAS  PubMed  Google Scholar 

  36. Del Rey AP, Entrena BF. Reference values of motor unit potentials (MUPs) of the external anal sphincter muscle. Clin Neurophysiol 2002;113:1832–1839.

    Article  PubMed  Google Scholar 

  37. Ferrara A, Lujan JH, Cebrian J, et al. Clinical, manometric, and EMG characteristics of patients with fecal incontinence. Tech Coloproctol 2001;5:13–18.

    Article  CAS  PubMed  Google Scholar 

  38. Osterberg A, Graf W, Eeg‐Olofsson KE, et al. Results of neurophysiologic evaluation in fecal incontinence. Dis Colon Rectum 2000;43(9):1256–1261.

    Article  CAS  PubMed  Google Scholar 

  39. Jacobs PPM, Scheuer M, Kuijpers JHC, et al. Obstetric fecal incontinence: role of pelvic floor denervation and results of delayed sphincter repair. Dis Colon Rectum 1990;33(6):494–497.

    Article  CAS  PubMed  Google Scholar 

  40. Yeh CY, Pikarsky A, Wexner SD, et al. Electromyographic findings of paradoxical puborectalis contraction correlate poorly with cinedefecography. Tech Coloproctol 2003;7:77–81.

    Article  CAS  PubMed  Google Scholar 

  41. Lopez A, Nilsson BY, Mellgren A, et al. Electromyography of the external anal sphincter: comparison between needle and surface electrodes. Dis Colon Rectum 1999;42:482–485.

    Article  CAS  PubMed  Google Scholar 

  42. Laurberg S, Swash M, Henry MM. Delayed external sphincter repair for obstetric tear. Br J Surg 1998;75:786–788.

    Article  Google Scholar 

  43. Wexner SD, Marchetti F, Jagelmen DG. The role of sphincteroplasty for fecal incontinence reevaluated: a prospective physiologic and functional review. Dis Colon Rectum 1991;34:22–30.

    Article  CAS  PubMed  Google Scholar 

  44. Ashraf W, Park F, Lof J, et al. An examination of the reliability of reported stool frequency in the diagnosis of idiopathic constipation. Am J Gastroenterol 1996;91:26–32.

    CAS  PubMed  Google Scholar 

  45. Metcalf AM, Phillips SF, Zinsmeister AR, et al. Simplified assessment of segmental colonic transit. Gastroenterology 1987; 92:40–47.

    CAS  PubMed  Google Scholar 

  46. Charles F, Camilleri M, Phillips SF, Thomforde GM, Forstrom LA. Scintigraphy of the whole gut: clinical evaluation of transit disorders. Mayo Clin Proc 1995;70(2):113–118.

    Article  CAS  PubMed  Google Scholar 

  47. Caride VJ, Prokop EK, Troncale FJ, et al. Scintigraphic determination of small intestinal transit time: comparison with the hydrogen breath technique. Gastroenterology 1984;86: 714–720.

    CAS  PubMed  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer Science+Business Media, LLC

About this entry

Cite this entry

Smith, L.E., Blatchford, G.J. (2007). Physiologic Testing. In: Wolff, B.G., et al. The ASCRS Textbook of Colon and Rectal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-36374-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-36374-5_4

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-24846-2

  • Online ISBN: 978-0-387-36374-5

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics