Normal variation in anorectal manometry

Cali, Rebecca L.; Blatchford, Garnet J.; Perry, Richard E.; Pitsch, Richard M.; Thorson, Alan G.; Christensen, Mark A.

doi:10.1007/bf02251969

Cited by 66 publications

(41 citation statements)

References 11 publications

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“…We observed an age-and parityrelated diminished squeezing pressure. However, in agreement with several other studies, this decline was not significant [13,14] .…”

Section: Discussionsupporting

confidence: 75%

Anorectal Function Testing and Anal Endosonography in the Diagnostic Work-Up of Patients with Primary Pelvic Organ Prolapse

Groenendijk

Birnie

Boeckxstaens³

et al. 2008

Gynecol Obstet Invest

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Aim: To study the pathophysiology of defecation disorders in patients with primary pelvic organ prolapse (POP) and the diagnostic potential of anorectal function testing (AFT) including endosonography in the work-up of these patients. Methods: 59 Patients were evaluated with a validated questionnaire, clinical examination, AFT and endosonography. Results: Women with POP showed lower squeezing pressure, postponed first sensation and desire, lower capacity and prolonged pudendal nerve terminal latency time compared to healthy controls (all p < 0.01). Manometric findings did not differ significantly between patients with and without constipation. Patients with fecal incontinence had significantly lower resting and squeezing pressures than patients without fecal incontinence and an increased risk of an external sphincter defect (odds ratio = 12.75, 95% confidence interval 2.40–66.67). Although digital rectal examination could quantify absent, decreased and normal squeezing pressure, the positive predictive value for external sphincter defects was low (0.32). Conclusion: AFT indicates the presence of neuromuscular damage of the anorectal region in patients with POP. AFT is not useful in the work-up of patients with POP and constipation, because it fails to discriminate between symptomatic and asymptomatic patients. In cases of fecal incontinence, AFT and endosonography are helpful to distinguish between functional and anatomical problems.

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“…We observed an age-and parityrelated diminished squeezing pressure. However, in agreement with several other studies, this decline was not significant [13,14] .…”

Section: Discussionsupporting

confidence: 75%

Anorectal Function Testing and Anal Endosonography in the Diagnostic Work-Up of Patients with Primary Pelvic Organ Prolapse

Groenendijk

Birnie

Boeckxstaens³

et al. 2008

Gynecol Obstet Invest

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“…Unfortunately, measurement of functional canal length was not possible with the manometric equipment used in this study, however, no relationship between EAS shortening and incontinence scores has been found. Previous work investigating differences in physiologic measurements of the anal canal has however not shown a shortening of the functional anal canal length with parity 13 , although no study has measured functional canal length before and after delivery in the same women. Furthermore, sphincter shortening after childbirth has important implications if surgery to the anal canal is being considered, because similar surgery involving the anterior canal will involve a greater proportion of the EAS in parous than nulliparous women.…”

Section: Discussionmentioning

confidence: 90%

Alteration of anal sphincter morphology following vaginal delivery revealed by multiplanar anal endosonography

Williams

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective To assess morphologic change in the anal sphincters in the absence of endosonographic evidence of trauma after vaginal delivery. Design Prospective observational study.Setting District general hospital.Population Consecutively booked nulliparous pregnant women attending antenatal clinic.Methods All women were examined using three-dimensional anal endosonography, simple manometry and had questionnaire assessment of incontinence before and after delivery. Main outcome measures Components of the anal canal were measured in the axial, sagittal and coronal planes and paired pre-and post-delivery examinations were compared. Any changes were related to changes in continence and anal canal manometry. Results Twenty-two women had a vaginal delivery and no endosonographic evidence of perineal trauma after delivery. After delivery, there was significant shortening of the length of the anterior external anal sphincter [EAS] (mean 21.7 vs 20.5 mm, P ¼ 0.02) when measured in the sagittal plane, which increased in anterior angulation with respect to the axis of the anal canal (10j vs 13.8j, P ¼ 0.03). In the axial plane, no change was seen in the thickness of any of the sphincter components after delivery. None of these morphologic changes correlated with changes in manometry or continence score. Conclusions Anal sphincter morphology changes after an otherwise atraumatic vaginal delivery. This change does not correlate with any functional symptoms.

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“…However, published normal values differ. This can be related, at least in part, to differences in methodology, in the small numbers of healthy people investigated, and to the comparison of (only) 2 groups with an large age difference [6,7]. Yet, it might also be due to discrepancies in the study population (female:male ratio, age distribution) since Felt-Bersma et al [8] observed a broad range of anal pressures when measuring normal individuals of different ages and gender.…”

Section: Introductionmentioning

confidence: 99%

Influence of Gender and Age on Anorectal Function: Normal Values from Anorectal Manometry in a Large Caucasian Population

Gundling

Seidl²,

Scalercio³

et al. 2010

Digestion

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Introduction: In the literature, data on the effects of gender and age on the pressure data of anorectal manometry differ. Possible reasons are investigation of only small numbers of healthy people and comparison of only 2 groups with large age differences. In addition, data about the influence of gender or age on anorectal sensation are sparse. Therefore, the aim of the present study was to determine the influence of gender and age on anorectal manometry in a large healthy female and male cohort spanning a great age range. Methods: Anorectal manometry was performed in 72 women and 74 men with a median age of 64 years in both groups (ranges: women 22–90 years; men 23–88 years). We determined mean anal resting and squeeze pressure as well as minimal rectal balloon volume for perception and for urge/desire to defecate. The Mann-Whitney U test was used to analyze for gender differences, regression analysis to search for age influences. Results: Squeeze pressure (p = 0.007) and perception threshold (p < 0.001) are significantly lower in females, while the mean resting pressure and urge threshold are similar in females and males. Mean resting pressure (women p < 0.0001; men p = 0.03) and mean squeeze pressure decrease (women p < 0.0001; men p = 0.004) with age. An age-related increase in sensory thresholds (= decreased rectal sensitivity) is only seen in females (perception threshold p = 0.01; urge threshold p = 0.04). Conclusion: Most of the parameters measured by anorectal manometry (anal canal pressure, sensory thresholds) are influenced by gender and age. Therefore, the results of anorectal manometry must be interpreted in relation to sex- and age-adapted normal values.

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Normal variation in anorectal manometry

Cited by 66 publications

References 11 publications

Anorectal Function Testing and Anal Endosonography in the Diagnostic Work-Up of Patients with Primary Pelvic Organ Prolapse

Anorectal Function Testing and Anal Endosonography in the Diagnostic Work-Up of Patients with Primary Pelvic Organ Prolapse

Alteration of anal sphincter morphology following vaginal delivery revealed by multiplanar anal endosonography

Influence of Gender and Age on Anorectal Function: Normal Values from Anorectal Manometry in a Large Caucasian Population

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