Advances in the evaluation of anorectal function

Abstract

Faecal incontinence and evacuation disorders are common, impair quality of life and incur substantial economic costs worldwide. As symptoms alone are poor predictors of underlying pathophysiology and aetiology, diagnostic tests of anorectal function could facilitate patient management in those cases that are refractory to conservative therapies. In the past decade, several major technological advances have improved our understanding of anorectal structure, coordination and sensorimotor function. This Consensus Statement provides the reader with an appraisal of the current indications, study performance characteristics, clinical utility, strengths and limitations of the most widely available tests of anorectal structure (ultrasonography and MRI) and function (anorectal manometry, neurophysiological investigations, rectal distension techniques and tests of evacuation, including defecography). Additionally, this article provides our consensus on the clinical relevance of these tests.

Normative values for region‐specific colonic and gastrointestinal transit times in 111 healthy volunteers using the 3D‐Transit electromagnet tracking system: Influence of age, gender, and body mass index

“…[1][2][3] Localization of region-specific transit abnormalities may complement recognized tests of colonic and anorectal function 4 and facilitate an effective diagnosis and management of such conditions. This may aid in advancing our understanding of GI motility disorders, particularly those of the lower GI tract such as the irritable bowel syndrome and chronic constipation, which present a substantial healthcare and socioeconomic burden.…”

“…This may aid in advancing our understanding of GI motility disorders, particularly those of the lower GI tract such as the irritable bowel syndrome and chronic constipation, which present a substantial healthcare and socioeconomic burden. [1][2][3] Localization of region-specific transit abnormalities may complement recognized tests of colonic and anorectal function 4 and facilitate an effective diagnosis and management of such conditions. 5 Recommended methods 6 to clinically assess colonic motility include the use of radio-opaque markers (ROM) 7 and colonic scintigraphy.…”

Anorectal physiology in health: A randomized trial to determine the optimum catheter for the balloon expulsion test

“…Historical testing protocols focused more on anal resting and squeeze pressures, and less on parameters such as anal pressure on cough, duration of anal squeeze and the push maneuver . Therefore, as recently highlighted in a consensus statement, studies using current setups and comprehensive testing protocols for defining normal reference range are warranted. Lastly, the effect of age and parity on normal range ARM parameters in females is uncertain, and available data are controversial .…”

Functional anal canal length measurement using high‐resolution anorectal manometry to investigate anal sphincter dysfunction in patients with fecal incontinence or constipation

“…In patients with refractory symptoms of fecal incontinence (FI) or chronic constipation (CC), comprehensive diagnostic evaluation is advocated to determine pathophysiology, 1,2 with several tests routinely available. 3 Anorectal manometry (ARM) is the most established tool to investigate sphincteric function and rectoanal co-ordination. 4 Measurements in patients with FI include anal resting and squeeze pressures, which primarily act as surrogate markers of internal and external sphincter (dys)function, respectively.…”