Comparison of Anorectal Manometry Testing in Left Lateral and Lithotomy Positions

Abstract

Objectives: Anorectal manometry (ARM) is typically performed in left lateral position, but many practitioners are more familiar with the lithotomy position. We aimed to evaluate agreement between anorectal manometry performed in left lateral and lithotomy positions and patient preference for testing position. Methods:We performed a prospective comparison study of left lateral versus lithotomy position for women undergoing ARM for the evaluation of fecal incontinence. Women were randomly assigned to undergo testing in either left lateral first followed by lithotomy position, or vice versa. Women then completed a survey assessing preference of position. We performed Bland-Altman analysis to measure the level of agreement between anorectal measurements obtained in the two positions.Results: Twenty-one women were enrolled (mean age 65 ± 2.2 years). We noted an acceptable level of agreement between anal pressure values obtained in left lateral vs. lithotomy positions: anal resting pressure (mean difference 0.9mmHg, 95% limits of agreement 30.2 and −28.5) and anal squeeze pressure (mean difference 1.8mmHg, 95% limits of agreement 54.3 and −50.7). The level of agreement for sensory values was outside the predetermined clinical acceptability range. Most women (17/21, 81%) reported a "good" or "very good" experience in both positions. Conclusion:ARM testing in the two positions can be used interchangeably for anal resting and squeeze pressures, but not for anorectal sensation. This modification can be introduced into

Effect of posture on anorectal manometric measurements in female patients with fecal incontinence and rectoanal intussusception

“…Studies on the effect of posture on rectal volume are limited. Halani et al [21] reported that although there was no signi cant difference in the rectal volume measured in the left-lateral position compared with the lithotomy position in female FI patients, higher values for the measurements were observed in lithotomy than in the left-lateral position. Another study of urogynecological patients reported similar results [22].…”

Effect of posture on anorectal manometric measurements in female patients with fecal incontinence and rectoanal intussusception

“…Studies on the effect of posture on rectal sensation are limited. Halani et al [ 25 ] reported that although there was no significant difference in the rectal volume measured in the left-lateral position compared with the lithotomy position in female FI patients, higher values for the measurements were observed in lithotomy than in the left-lateral position. Another study of urogynecological patients reported similar results [ 26 ].…”

“…In our study, DDV and MTV were signi cantly higher in the erect position than in the left-lateral position in the 80 FI patients. The reason is unclear however, but testing was performed in the same sequence as previous studies [21,22], rst in the left-lateral position and then in the lithotomy position, which may have blunted rectal sensation during rectal capacity examination in the erect position. The order of examination should be reversed and re-examined in the future.…”

Low anterior resection syndrome and methods of its assessment (literature review)

“…В литературе также существует мнение об эффективности определения анального давления покоя и давления сжатия в литотомическом положении. Однако данная модификация на данный момент не введена в клиническую практику, поскольку не отразила пользы для мониторинга ректальной чувствительности [50].…”