Anorectal Manometry and Sensory Testing

Anorectal manometry with rectal sensory testing is the preferred method of defining functional weakness of the external and internal anal sphincters and for detecting abnormal rectal sensation [49]. Anorectal manometry not only provides an objective assessment of anal sphincter pressures but also assesses rectal sensation, rectoanal reflexes, and rectal compliance [49]. Currently, several types of probes and pressure-recording devices are available, and each system has distinct advantages and drawbacks. A water-perfused probe with multiple closed spaced sensors is a commonly used device. Alternatively, a solid-state probe with microtransducers may be used [53, 57]. This equipment, although more fragile and expensive, is easier to calibrate and more accurate [53, 58]. Anal sphincter pressure can be measured by stationary pull through, but a rapid pull-through technique should be abandoned, as this can give falsely high sphincter pressure readings [53, 59]. Resting anal sphincter pressure predominantly represents internal anal sphincter function, and voluntary-squeeze anal sphincter pressure predominantly measures external anal sphincter function.

Patients with incontinence have low resting and low squeeze sphincter pressures [54, 59-61]. The duration of the sustained squeeze pressure provides an index of sphincter muscle fatigue. The ability of the external anal sphincter to contract in a reflex manner can also be assessed during the abrupt increases of intra-abdominal pressure, such as when coughing [13, 53, 57, 58]. This reflex response causes the anal sphincter pressure to rise above that of the rectal pressure in order to preserve continence. The response may be triggered by receptors in the pelvic floor and mediated through a spinal reflex arc. In patients with spinal cord lesions above the conus medullaris, this reflex response is present but the voluntary squeeze may be absent, whereas in patients with lesions of the cauda equina or sacral plexus, both the reflex response and the voluntary squeeze response are absent [53,62,63]. The response may be triggered by receptors on the pelvic floor and mediated through a spinal reflex arc.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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