Anorectal manometry

Anorectal manometry is a diagnostic procedure that allows you to determine the pressure in the rectum and colon and its exit zone (anus). In other words, during the diagnostic period, a study of the tone of the anal sphincters, the motor ability of the rectum and colon is carried out. Assigns anorectal manometry in cases where the patient complains of dysmotility of the colon, diarrhea or persistent constipation. The study will help determine the cause of these symptoms.

Indications and preparation for the examination

Anorectal manometry is prescribed to patients as a postoperative control, especially after surgery for the diagnosis of Hirschsprung’s disease (agangliosis), as well as after operations for anus atresia. Intervention occurs if there is a lack of relaxation of the internal anal sphincter, an undetermined etiology, impaired motility of the colon, and fecal incontinence.

Manometry is carried out to evaluate the results of medical intervention, differential diagnosis of the type of chronic intestinal pseudo-obstruction, pain with localization in the lower abdomen, chronic constipation that is not amenable to drug treatment.

A few hours before the scheduled examination, the patient is cleansed of the intestines with several enemas. It is important not to eat anything for at least six hours before the procedure. Before the manometry, at least two hours, you need to give up any drugs. During the period of taking medications, you should try to drink as little water as possible on the last day.

Procedure Algorithm

There are a lot of reasons that can provoke the appearance of chronic constipation. It should be noted that according to statistics, twenty percent of constipation appears due to the psychological problems of the patient.

The duration of the procedure can vary within three hours, everything directly depends on the complexity of the situation. Before proceeding with manometry, the doctor or nurse asks the patient a standard list of questions in order to avoid unpleasant complications after the procedure. The patient is moved to the couch in this position: on the left side, legs bent at the knees.

A sterile disposable catheter (a flexible tube with a balloon at the end) is inserted into the rectum. On the other hand, the catheter tube is connected to a device that registers the pressure level. To determine the reflex activity of the rectum, air is supplied with a balloon catheter. In this case, the patient is asked to relax the sphincter as much as possible, then squeeze it and perform standard emptying movements.

In addition to anorectal manometry, other methods are also used.

Anal sphincter electromyography is a diagnostic method used to study the electrical potential of the sphincter muscles. Registration of impulses is performed by special electrodes, which are installed in the patient’s anal cavity. Electromyography demonstrates the degree of coordination of relaxation and contraction of the muscles of the pelvic floor and anus.

Rectal balloon expulsion test – this type of study allows you to determine the time period during which the rectum will push the balloon out. A special balloon is inserted into the anus of the patient, after which it is filled with water through the tubes. The patient moves to the bathroom and performs a defecation procedure. The total exit time of the cartridge is recorded. If the time period is too long, this is a direct indicator of the presence of impaired functionality of the intestines and anorectal region.

Possible risks and contraindications

Anorectal manometry is essentially a harmless and completely safe procedure, as it has a minimal amount of risks. The procedure is painless with little discomfort. Sometimes during the procedure, bleeding or ruptures of the intestinal walls can be observed – extremely rare phenomena. Also, complications can occur if there is an allergic reaction to latex.

In order to avoid possible side effects, the doctor prescribes the patient to undergo a whole range of examinations and tests before the procedure, including:

• Ultrasound of the abdominal cavity and the pelvic area;
• determination of the blood group, complete blood count and general urinalysis (OAM);
• blood test for sexually transmitted diseases;
• allergy tests.

To date, there are no direct contraindications to anorectal manometry, since the procedure is safe, with a low level of discomfort and pain. With caution, it is necessary to carry out this procedure for patients with diabetes mellitus, with the presence of blood diseases, with the presence of sexually transmitted diseases. Also at risk are patients with impaired functionality of the central nervous system.

Before the procedure, such patients are given sedative drugs without fail in order not to provoke panic attacks, etc.

Due to the fact that the procedure is as safe as possible, it does not have age restrictions, therefore, it can be prescribed both to small children (only if there are indications) and to elderly patients (a cardiogram is mandatory before the procedure).

Diagnostic results

Normally, the depth of the anal sphincter should be within three centimeters, the threshold of minimum sensitivity within ten to fifteen milliliters. During the procedure, the vector volume of the intestine, the pressure in the rectum and the rectonal reflex are assessed.

If all indicators are normal, and there is a problem with the intestines, then other diagnostic methods are prescribed. Elevated sphincter pressures may be a possible cause of constipation, while low pressures may be the cause of fecal incontinence. Abnormal manifestations of reflexes in the rectum also signal the presence of a problem. The presence of Hirschsprung’s disease may be indicated by the inability of the intestines to relax. For any problems with the intestines, it is important to consult a doctor and not self-medicate.

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