Anorectal manometry

P.Piramanayagam
Consultant,
Department of Medical Gastroenterology,
Apollo Hospitals, Chennai
Outline
• Rectal manometry- Equipment
• Protocol for testing
• Interpretation
• Clinical utility- Diagnostic- Constipation/ incontinence
• Biofeedback
Colonometrogram
Rectal manometry- Equipment
• Water perfusion • Solid state
Equipment
Rectal manometry
• Line tracing • Topography
Rectal examination- Subjective equivalent to
rectal manometry
• Basal anal tone
• Squeeze
• Strain
• Pelvic floor descent
Rectal manometry- Protocol for testing
• Digital rectal examination
• Insertion of rectal manometry catheter

Baseline resting anal pressure

Squeeze
Strain to defecate
RAIR
Rectal sensory perception- Sensory threshold/Desire to defecate/ Maximal
tolerated volume (Urgency)
Balloon expulsion test
Normal values
Interpretation of findings: Normal pattern on
attempted defecation
Dyssynergic defecation
Rectum Rectum
adequate Inadequate
pressure pressure
Anal canal Type 1 Type 2
Paradoxical
contraction
Anal canal Type 3 Type 4
Incomplete
relaxation
 Patients with internal Normal
hemorrhoids, fissure and
SRUS

Dyssynergic defecation 77% 46%

Abnormal balloon expulsion 66% 20%
test

Functional evacuation disorders were more common in patients with fissure and SRUS than in hemorrhoids

Indian J Gastroenterol 2019; 38 (2): 173-77

Fecal continence
Continence mechanisms
Case scenario
• Normal colonoscopy
Fecal incontinence
Fecal incontinence
Classification of anorectal motility disorders
Summary
• Reviewed equipment- water perfusion/ solid state
• Data presentation- line tracing/ colour topography
• Role in evaluation of constipation/ diarrhea- defecation disorder/
incontinence
• Working group consensus- Work in progress
• Defecation disorders common in anorectal pathology
Thank you
 Rectal manometry - caveats

Grossi U, Carrington EV, Bharucha AE, et al Diagnostic accuracy study of anorectal manometry for diagnosis of

dyssynergic defecation Gut 2016;65:447-455.