Anorectal manometry, rectal sensation, defaecography, Sitz mark testing, pudental nerve testing and anorectal ultrasound
Anal manometry, rectal sensation, defaecography, pudental nerve testing and anorectal ultrasound are tests to utilize the study of a number different conditions, including constipation and faecal incontinence. They are also used to study more severe problems such as anal sphincter disruption and tumours of the anorectum.
Of all gastro-intestinal complaints amongst older adults, constipation is the most common. 60% of elderly out patients report frequent laxative use. Constipation is medically defined as a decrease in stool frequency less than three bowel movements per week.
Symptoms of constipation include;
Incontinence is less prevalent than constipation, affecting roughly 10% of the general population and is most common in patients over the age of 65. Incontinence occurs when there is uncontrollable evacuation of rectal contents.
The leading causes of faecal incontinence amongst the elderly patients include;
This procedure is the recommended form of evaluation for patients suffering from anorectal problems. In particular, constipation, faecal incontinence and particularly injuries to the anal sphincters or a combination of any of these. During this procedure we will test both the strength of your resting pressure, i.e evaluation of the internal sphincter and test your squeeze, i.e contracting pressure of your external sphincters/levator ani.
The sphincters are a set of two muscles, the internal sphincter and the external anal sphincter. They help regulate the timing of the acceptable and proper passage of bowel movements. If the anal sphincter muscles tightens or relaxes at the wrong time, i.e incontinence of constipation may occur.
Anorectal manometry is painless. A small flexible tube about the size of thermometer is inserted within the anorectum and measures the pressures of the anal sphincter, the length of the anal sphincter as the patient squeezes, relaxes and then pushes.
A slightly larger balloon will then be inserted into your rectum to test whether you evacuatory sensation is normal.
Defaecography and Sitz mark testing
Defaecography is generally used to examine patients who experience chronic constipation to identify any possible structural or functional abnormalities of the rectum. This is an x-ray examination inducted to watch the movement of barium in the rectum.
During the x-ray the patient will be instructed to rest, hold and finally push to evacuate the barium from the rectum.
The results are useful in determining whether or not the patient has a remediable form of constipation.
Treatment can either be in the form of medications alternatively surgical intervention depending on the patient's findings and diagnosis.
When there is a question of how fast or how completely food is progressing through the gastrointestinal tract, a Sitz mark test is performed.
The patient is asked to swallow a small capsule with metal rings that can be seen under x-ray control. Over the course of five days x-rays are taken to assess the rate of which the rings pass through the bowel. During this test the patient will be told not to take any laxatives. Depending on the results treatment may be offered for patients with delayed transit time.
Pudental nerve testing
The pudental nerve elevates the external genitalae of both sexes as well as the sphincters for the bladder and the rectum. During this examination we will measure the amount of time it takes for the stimulation of the pudental nerves to reach the external anal sphincter. Patients with abnormalities of the pudental nerve may have symptoms of either rectal or urinary incontinence. Alternatively severe constipation, or an inability to empty their bladder.
Ultrasound imaging of the anorectal sphincter provides complimentary structural information to the functional information that can be obtained with anorectal manometry and should be performed in combination with this test.
Anorectal ultrasound is very useful;
For more information on Anorectal Studies please contact Dr Michael Elliot.