High-Resolution Anorectal Manometry - New Insights in the Diagnostic Assessment of Functional Anorectal Disorders

Abstract

Functional anorectal disorders such as faecal incontinence (FI), functional anorectal pain, and functional defecation disorders (FDD) are highly prevalent and represent a high socioeconomic burden. Several tests of anorectal function exist in this setting; however, high-resolution anorectal manometry (HR-ARM) is a new tool that depicts pressure all along the anal canal and can assess rectoanal coordination. HR-ARM is used in the diagnosis of FI and especially FDD although data in health is still sparse, and pressure phenomena seen during simulated defecation, such as dyssynergia, are highly prevalent in health.

MRI anatomy and pathology of the anal canal

“…Functional anorectal pain and functional defecation disorders are prevalent and have a considerable impact on quality of life, yet remain underdiagnosed, as the patients may not report the symptoms due to perceived social stigma . Functional anorectal pain can be caused by levator ani syndrome, unspecified anorectal pain, and proctalgia fugax . Functional defecation disorders include pelvic floor dyssynergia, also known as anismus or spastic pelvic floor syndrome .…”

“…34 Functional anorectal pain can be caused by levator ani syndrome, unspecified anorectal pain, and proctalgia fugax. 34 Functional defecation disorders include pelvic floor dyssynergia, also known as anismus or spastic pelvic floor syndrome. 19 In pelvic floor dyssynergia, the failure of relaxation or paradoxical contraction of the puborectalis muscle during defecation results in symptoms of constipation, prolonged and incomplete defecation, and delay between opening of the anal canal and initiation of defecation.…”

Esfinteroplastia anal en el tratamiento de la incontinencia fecal por trauma obstétrico

“…El estudio neurofisiológico no solamente permite establecer la neuropatía pudenda, con lo que cabe anticipar peores resultados postoperatorios, sino que constituye además un documento médico-legal que certifica la afectación neurológica antes de cualquier procedimiento quirúrgico. Con respecto a la manometría, existe en la actualidad la posibilidad de realizarla en un formato de alta resolución y tridimensional, aportando valiosa información de las presiones ano-rectales, aunque aún restan ensayos para determinar su utilidad y eficacia en el tratamiento de la incontinencia y otros trastornos funcionales defecatorios 22 . La ecografía muestra el defecto a nivel de la capa hiperecoica que constiuye el EAE, y ocasionalmente de la capa hipoecoica interna correspondiente al esfínter liso (figura 1).…”

“…Interesa medir el grado de separación entre los cabos musculares y por lo tanto la apertura del ángulo anterior que forman, para definir en primer lugar si la reparación está indicada. Clásicamente se indicaba para defectos mayores a 90 grados 22 aunque la Sociedad Americana de Cirujanos Colo-rectales establece la indicación para pacientes sintomáticos sin especificar la magnitud de la lesión 23 . También va a definir si la misma es factible, para lo cual el ángulo debe ser menor de 150-180 grados 24 .…”

Functional Diagnosis in Upper and Lower Gastrointestinal Diseases: Relevance for Conservative, Interdisciplinary and Surgical Therapies

“…Witte et al [7] as well as Heinrich and Misselwitz [8] discuss the information needed from the functional laboratory before and after surgery. Furthermore, Heinrich and Misselwitz [8] place emphasis on the role of high-resolution anorectal manometry as a promising new tool in the diagnosis of functional anorectal disorders.…”