Comparison of digital and manometric assessment of anal sphincter function

Hallan, R. I.; Marzouk, D. E. M. M.; Waldron, David; Womack, N. R.; Williams, Norman S.

doi:10.1002/bjs.1800760934

Cited by 125 publications

(40 citation statements)

References 14 publications

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“…However, only Thekkinkattil et al [7] had a comparable high number of controls and FI patients, which seems mandatory due to the known influence of sex and age on the ARM parameter [5]. Notwithstanding, we can confirm that MRP and MSP are significantly lower in FI than in continent people [3,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34]. Thus, the ARM pressure parameters seem to be appropriate to quantify the sphincter function in FI patients.…”

Section: Discussionsupporting

confidence: 65%

Accuracy of Anorectal Manometry in Patients with Fecal Incontinence

et al. 2012

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Background/Aim: Patients with fecal incontinence (FI) have lower anal resting (MRP) and squeeze (MSP) pressure and an impaired sensitivity compared to healthy people. However, whether anorectal manometry (ARM) can separate precisely between health and disease is discussed controversially. The aim was to evaluate the accuracy of ARM in a huge cohort of patients and controls. Methods: ARM was obtained in 144 controls and in 559 FI patients. MRP, MSP, and balloon volume at first perception (BVP) and urge sensation (BVU) were determined. Receiver operating curve analysis was used to determine optimal cut-offs and sensitivity, specificity and accuracy calculated. Results: FI patients showed lower MRP, MSP, BVU (p < 0.001) and a higher BVP (p = 0.007). Deterioration of the ARM parameter increased with FI severity. ARM demonstrated an excellent sensitivity (91.4%) and accuracy (85.8%), but only a moderate specificity (62.5%). The sensitivity of ARM rose with FI severity. The pressure data showed higher sensitivity and accuracy than the sensory data despite comparable specificity. Conclusions: Sensitivity and accuracy of single ARM parameters is only moderate for the pressure data and poor for the sensory data. In contrast, ARM demonstrated an excellent sensitivity, a moderate specificity, and a convincing accuracy justifying its use in clinical routine.

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Section: Discussionsupporting

confidence: 65%

Accuracy of Anorectal Manometry in Patients with Fecal Incontinence

et al. 2012

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“…In one study of 66 patients, digital examination by an experienced surgeon was somewhat correlated with resting sphincter pressure (r = 0.56; p < 0.001) or maximum squeeze pressure (r = 0.72: p < 0.001) (64). In another study of 280 patients with several anorectal disorders, a reasonable correlation was reported between digital palpation and manometry (65).…”

Section: Digital Rectal Examinationmentioning

confidence: 92%

“…Although there are insufficient data regarding normal values, overlap among healthy subjects and patients with incontinence (65,67), and large confidence intervals in studies that have examined test reproducibility (64,83), for the individual patient with incontinence, manometry testing can be very useful. Manometric tests of anorectal function may also be useful in assessing objective improvement following drug therapy (84), biofeedback therapy (85), or surgery (86).…”

Section: Sensory Testingmentioning

confidence: 99%

Diagnosis and Management of Fecal Incontinence

Rao

2004

Am J Gastroenterology

284

295

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DEFINITIONFecal incontinence is defined as either the involuntary passage or the inability to control the discharge of fecal matter through the anus. Clinically there are three subtypes (a) passive incontinence-the involuntary discharge of stool or gas without awareness; (b) urge incontinence-the discharge of fecal matter in spite of active attempts to retain bowel contents, and (c) fecal seepage-the leakage of stool following otherwise normal evacuation. The severity of incontinence can range from the unintentional elimination of flatus to the seepage of liquid fecal matter or sometimes the complete evacuation of bowel contents. Not surprisingly, these events cause considerable embarrassment, which in turn can lead to a loss of self-esteem, social isolation, and a diminished quality of life (1). EPIDEMIOLOGYAlthough fecal incontinence affects people of all ages, its prevalence is disproportionally higher in women, in the elderly, and in nursing home residents. Estimates of its prevalence vary greatly and depend on the clinical setting, the influence of social stigma, the definition of incontinence, and the frequency of occurrence.In the U.S. householder survey, frequent leakage of stool or fecal staining for more than 1 month was reported by 7.1% and 0.7% of the population, respectively (2). In contrast, two or more episodes of fecal incontinence per month were reported by 0.8% of patients presenting to primary care clinics in the UK (3). In an elderly (>65 yr) self-caring population, fecal incontinence occurred at least once a week in 3.7% of subjects and in more men than women (men:women = 1.5:1) (4). In contrast, 25-35% of institutionalized patients (5) and 10-25% of hospitalized geriatric patients (6) suffer from fecal incontinence. In the United States, fecal incontinence is the second leading cause for placement in nursing homes (6).In a survey of 2,570 households, comprising 6,959 individuals, the prevalence of at least one episode of incontinence during the previous year was 2.2%; among these 63% were women, 30% were >65 yr of age, 36% were incontinent of solid stool, 54% of liquid stool, and 60% of flatus (7). Furthermore, in another prospective survey of patients attending either a gastroenterology or a primary care clinic, over 18% reported fecal incontinence at least once a week (8). Only one third had ever discussed the problem with a physician (8). When stratified for the frequency of episodes, 2.7% of patients reported daily incontinence, 4.5% weekly, and 7.1% once per month (8). In another survey, fecal incontinence was associated with urinary incontinence in 26% of women attending a Uro/Gyn Clinic (9). A higher incidence of mixed fecal and urinary incontinence was also reported in nursing home residents (10, 11).The cost of health care related to fecal incontinence includes items that can be measured such as the evaluation, diagnosis and treatment of incontinence, medications, the use of disposable pads and other ancillary devices, skin care, and nursing care. Approximately $400 million/year we...

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“…Published studies vary about whether the examining finger provides as much useful information as formal anal manometry [15, 16, 17, 18, 19]. However, closer examination of the data suggests that in individual patients the digital assessment was often incorrect, sometimes markedly so.…”

Section: Discussionmentioning

confidence: 99%

Prospective Assessment of the Clinical Value of Anorectal Investigations

Vaizey

Kamm

2000

Digestion

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Background/Aim: Anorectal physiological testing and imaging have become part of routine colorectal and gastro-enterological practice, but their clinical value is controversial. We prospectively evaluated the new diagnostic information, impact on management and prognostic information provided by anorectal testing. Methods: One hundred consecutive patients referred for testing were studied. The referring doctor’s diagnosis, reason for referral, planned management and expectation of the value of investigations were recorded. Incontinent patients underwent anorectal physiological testing and endo-anal ultrasound. Patients with constipation underwent anorectal physiological testing and a study of whole-gut transit time to distinguish between slow and normal transit. Constipated patients over age 45, or those younger patients who digitated to assist defaecation, also underwent evacuation proctography to identify large rectoceles. Results: Fifty-one patients had faecal incontinence. Of 12 patients with suspected anterior external anal sphincter obstetric damage, all of whom were planned for surgical repair, 3 were unsuitable for repair, 3 had a normal sphincter, 2 had a weak but structurally intact sphincter, and 1 had internal anal sphincter damage only. Of 6 patients with failed anterior repair, 3 had a defect suitable for repeat repair, 2 had intact repairs and good function, and 1 had extensive damage requiring reconstructive surgery. The tests also influenced management for incontinent patients after haemorrhoidectomy surgery (n = 5), after fistula surgery (n = 5), with congenital abnormalities (n = 3), after cerebrovascular accident (n = 1) and those with no presumptive diagnosis (n = 15). Of the 20 patients referred with constipation, demonstration of a recto-anal reflex in 1 patient with a megarectum excluded the need for full-thickness biopsy. A further patient with altered electrosensation went on to have a neurological lesion defined. Definition of slow transit in some patients did not immediately affect management. New information or a change in management was provided in patients referred for pre-operative assessment (n = 13). Information was gained in only 1 of 7 patients with solitary rectal ulcer and in none of the 8 patients with anal pain. Conclusion: Anorectal assessment provides important diagnostic and prognostic information and directly alters management in patients with benign anorectal disorders.

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Comparison of digital and manometric assessment of anal sphincter function

Cited by 125 publications

References 14 publications

Accuracy of Anorectal Manometry in Patients with Fecal Incontinence

Accuracy of Anorectal Manometry in Patients with Fecal Incontinence

Diagnosis and Management of Fecal Incontinence

Prospective Assessment of the Clinical Value of Anorectal Investigations

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