Anorectal Manometry (anorectal + manometry)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Clinical trial: effects of botulinum toxin on levator ani syndrome , a double-blind, placebo-controlled study

S. S. C. RAO
Summary Background, Levator ani syndrome is characterized by anorectal discomfort/pain, treatment of which is unsatisfactory. We hypothesized that Botulinum toxin relieves spasm and improves symptoms. Aim, To perform a randomized, placebo-controlled, crossover study to examine the efficacy and safety of botulinum toxin in patients with levator ani syndrome. Methods, Twelve patients with levator ani syndrome (,1 year) received anal intra sphincteric injections of 100 units of botulinum toxin A and placebo at 90-day intervals using EMG guidance. Daily frequency, severity, duration and intensity of pain (VAS) were recorded. Anorectal manometry, balloon expulsion and pudendal nerve latency tests were performed to examine the physiological changes and adverse effects. Results, Seven patients (male/female = 4/3) completed the study and three had incomplete data, but all 10 underwent in an ITT analysis; two others dropped out. After administration of botulinum toxin, the mean frequency, intensity and duration of pain were unchanged (P = 0.31) compared with baseline. The 90-day mean VAS pain score was 6.79 ± 0.27 vs. baseline score of 7.08 ± 0.29 (P = 0.25). Anal sphincter pressures, rectal sensory thresholds, pudendal nerve latency and balloon expulsion times were unchanged after drug or placebo administration. Conclusions, Injection of botulinum toxin into anal sphincter is safe, but it does not improve anorectal pain in levator ani syndrome. [source]

Anorectal manometry and anal fissure treatment: authors' reply

R. D. Madoff
No abstract is available for this article. [source]

Botulinum toxin for recurrent anal fissure following lateral internal sphincterotomy,

G. Brisinda
Background: The aim of the study was to evaluate the efficacy of botulinum toxin injection in the treatment of recurrent anal fissure following lateral internal sphincterotomy. Methods: Eighty patients were treated with botulinum toxin (30 units Botox® or 90 units Dysport®), injected into two sites of the internal sphincter. Clinical and manometric results were recorded before and after treatment. If symptoms persisted at 2 months, the examiners could decide to re-treat the patient. The same preparation of serotype A of botulinum neurotoxin was used for reinjection. Results: One month after injection there was complete healing in 54 patients (68 per cent). Eight patients (10 per cent) reported mild incontinence of flatus that had disappeared spontaneously within 2 months. At 2 months, 59 patients (74 per cent) had a healing scar. After reinjection, 11 of 21 re-treated patients reported mild incontinence to flatus that lasted for a few weeks and resolved spontaneously. Anorectal manometry at 1 month demonstrated a significant reduction in both resting anal pressure and maximum voluntary squeeze pressure (P < 0·001). There were no relapses during a mean value of 57·9 months of follow-up. Conclusion: Botulinum toxin is efficacious in patients with recurrent anal fissure following lateral internal sphincterotomy. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Penile and clitoral stimulation for faecal incontinence: external application of a bipolar electrode for patients with faecal incontinence

F. A. Frizelle
Abstract Objective, The aim of this study was to assess the effect of a novel pudendal nerve stimulator on clinical and anorectal manometric parameters in patients with faecal incontinence. Method, Retrospective cohort analysis of consecutive patients presenting with faecal incontinence who had failed initial conservative treatment and were not suitable for surgical intervention in a university hospital incontinence clinic. Biofeedback using a pudendal nerve stimulator comprising a bipolar electrode applied to the base of the clitoris or penis. Electrical pulse voltage was self-titrated and defined periods of treatment were prescribed. Anorectal manometry and Cleveland incontinence scores were assessed. Results, There was a significant reduction in incontinence symptom score after pudendal nerve stimulator treatment in the 42 patients treated and who had a complete set of data (median age 57 years (range 37,81); 39 female, 3 male). This was accompanied by significant improvements (P < 0.05) in anal sphincter tone, maximal tolerated rectal volume and the sustained rectoanal inhibitory reflex. Conclusions, An externally applied pudendal nerve stimulator improves symptoms and physiological evidence of faecal incontinence but long-term follow up is not available for these patients. [source]

Chronic pouchitis is not related to small intestine bacterial overgrowth

Aleksandra Lisowska MD
Abstract Background: Restorative ileal pouch-anal anastomosis (IPAA) potentially may lead to upper gastrointestinal tract motility disturbances. In addition, a bacterial etiology of IPAA complication,pouchitis,has been suggested. The oro-anal transit time is significantly reduced in this patient group. Therefore, we investigated the hypothesis if IPAA constitutes a significant risk for small intestine bacterial overgrowth (SIBO). Methods: Twenty-eight patients age 23,71 years with IPAA operated due to ulcerative colitis without subjective symptoms of pouchitis were evaluated as outpatients according to the prescheduled follow-up after operation and included in the study. The modified Pouchitis Disease Activity Index (PDAI) was determined in all IPAA patients, including clinical, endoscopic, and histopathological (Moskowitz criteria) parameters. In addition, anorectal manometry was performed. The presence of SIBO was determined with the use of a glucose breath test (GBT). Results: In 1 subject (3.6%) an abnormal GBT result was recorded consistent with SIBO. In addition, 2 borderline values (7.1%) were documented. Both patients with SIBO as subjects with borderline values presented with low PDAI values. All patients with PDAI >7 had normal GBT results. In patients with SIBO the maximal tolerated rectal volume was significantly higher than in subjects without SIBO (P < 0.007). Similarly, the PDAI value was significantly lower (P < 0.014). Conclusions: Asymptomatic chronic pouchitis is not related to SIBO. However, excessive colonization of the small intestine does occur in some IPAA patients and needs to be kept in the differential diagnosis. (Inflamm Bowel Dis 2008) [source]

Study on functional constipation and constipation-predominant irritable bowel syndrome by using the colonic transit test and anorectal manometry

Li Xing ZHAN
OBJECTIVE: To investigate the visceral perception, anorectal pressure and colonic transit time (CTT) in patients with functional constipation and constipation-predominant irritable bowel syndrome (C-IBS), and to study the manometric abnormalities of these two conditions. METHODS: The CTT in patients with functional constipation and C-IBS was studied by using radiopaque markers. Rectal visceral perception thresholds, rectal compliance and anorectal pressure were examined by electric barostat. RESULTS: The CTT in both groups of constipated patients was abnormal. A lot of radiopaque markers remained in the right colon in C-IBS patients, whereas in patients with functional constipation, the radiopaque markers remained in each segment of the colon. The anorectal resting pressure, squeezing pressure and relaxation pressure were normal in both groups. Rectal compliance and defecation thresholds were much higher compared with controls, and the rectal visceral perception of functional constipation was also abnormal. CONCLUSIONS: The motility abnormalities of functional constipation and C-IBS occurred in different colonic segments. Results suggest that CTT measure­ment and anorectal manometry could be helpful in the differential diagnosis of these two conditions. [source]

Long-term continence after surgery for Hirschsprung's disease

Anthony G Catto-Smith
Abstract Aim:, Our aim was to examine the long-term bowel dysfunction that followed surgery for Hirschsprung's disease. Methods:, Of 414 patients diagnosed with Hirschsprung's disease between 1974 and 2002, 98 were interviewed using a structured questionnaire to provide an assessment of bowel function, medication, diet, physical and social limitations. Forty-two completed a prospective 4-week toileting diary and 16 underwent anorectal manometry. Results:, Four of the 98 patients had permanent stomas and 10 had Down's syndrome. Of the remaining 84 patients (mean age 12 ± 8 years, range 1.9,41.9 years), 13% (11/84) had heavy soiling by day and 17% (14/84) by night. Fifty percent reported episodic urgency, but 36% also reported episodic constipation. Stool consistency was looser in patients with a history of long segment disease. Some aspects of bowel function improved with age. Enuresis was much more frequent than expected. Sixty-four percent reported adverse reactions to foods, particularly to fruit, vegetables, fats and diary products, and 15% limited their social activities because of fecal incontinence. There were no significant differences in manometric parameters between those patients who soiled and those who did not. Conclusions:, Fecal incontinence is common after surgery for Hirschsprung's disease and has a significant impact on social activities. Some aspects of bowel function did improve with age. Adverse reactions to food were unexpectedly frequent and need to be further studied. [source]

Neurophysiological testing in anorectal disorders

MUSCLE AND NERVE, Issue 3 2006
Jean-Pascal Lefaucheur MD, PhDArticle first published online: 15 JUL 200
Abstract The neurophysiological techniques currently available to evaluate anorectal disorders include concentric needle electromyography (EMG) of the external anal sphincter, anal nerve terminal motor latency (TML) measurement in response to transrectal electrical stimulation or sacral magnetic stimulation, motor evoked potentials (MEPs) of the anal sphincter to transcranial magnetic cortical stimulation, cortical recording of somatosensory evoked potentials (SEPs) to anal nerve stimulation, quantification of electrical or thermal sensory thresholds (QSTs) within the anal canal, sacral anal reflex (SAR) latency measurement in response to pudendal nerve or perianal stimulation, and perianal recording of sympathetic skin responses (SSRs). In most cases, a comprehensive approach using several tests is helpful for diagnosis: needle EMG signs of sphincter denervation or prolonged TML give evidence for anal motor nerve lesion; SEP/QST or SSR abnormalities can suggest sensory or autonomic neuropathy; and in the absence of peripheral nerve disorder, MEPs, SEPs, SSRs, and SARs can assist in demonstrating and localizing spinal or supraspinal disease. Such techniques are complementary to other methods of investigation, such as pelvic floor imaging and anorectal manometry, to establish the diagnosis and guide therapeutic management of neurogenic anorectal disorders. Muscle Nerve, 2005 [source]

Effect of acute acoustic stress on anorectal function and sensation in healthy humans,

S. Gonlachanvit
Abstract, Little is known about the effects of acute acoustic stress on anorectal function. To determine the effects of acute acoustic stress on anorectal function and sensation in healthy volunteers. Ten healthy volunteers (7 M, 3 F, mean age 34 ± 3 years) underwent anorectal manometry, testing of rectal compliance and sensation using a barostat with and without acute noise stress on separate days. Rectal perception was assessed using an ascending method of limits protocol and a 5-point Likert scale. Arousal and anxiety status were evaluated using a visual analogue scale. Acoustic stress significantly increased anxiety scores (P < 0.05). Rectal compliance was significantly decreased with acoustic stress compared with control (P < 0.000001). In addition, less intraballoon volume was needed to induce the sensation of severe urgency with acoustic stress (P < 0.05). Acoustic stress had no effect on hemodynamic parameters, anal sphincter pressure, threshold for first sensation, sensation of stool, or pain. Acute acoustic stimulation increased anxiety scores, decreased rectal compliance, and enhanced perception of severe urgency to balloon distention but did not affect anal sphincter pressure in healthy volunteers. These results may offer insight into the pathogenesis of stress-induced diarrhoea and faecal urgency. [source]

Minimum standards of anorectal manometry

S. S. C. Rao
First page of article [source]

Asymmetric sphincter innervation is associated with fecal incontinence after anal sphincter trauma during childbirth

Beate M. Wietek
Abstract Aims Functional asymmetry of pelvic floor innervation has been shown to exist in healthy subjects, and has been proposed to be a predictor of increased risk for fecal incontinence in case of trauma. However, this remains to be shown for different clinical conditions such as traumatic childbirth. Methods A conventional surface EMG system was used to assess the innervation of the external anal sphincter. A symmetry index was used to define the relative EMG amplitude asymmetry of the external anal sphincter between 0 (symmetric) and 1 (asymmetric). Three cohorts were studied: 40 nulliparous women in the third trimester (Study 1), 15 primiparous women within 6 months following vaginal delivery without clinically apparent anal sphincter trauma (Study 2), and 50 women after childbirth-related third or fourth degree perineal tear 6,12 months postpartum (Study 3). Furthermore, all women underwent conventional anorectal manometry. Results Sixteen or forty nulliparous women reported signs of fecal incontinence; however, relative asymmetry was not correlated to symptom severity (P,=,0.345), and not to manometric measures (Study 1). In Study 2, Women who had suffered clinically apparent anal sphincter trauma (P,=,0.07) tended to have a stronger association between incontinence and asymmetry. In Study 3, 19/50 women reported moderate to severe incontinence. Asymmetry and symptom severity were significantly correlated (P,<,0.001). Patients with incontinence had a significantly higher asymmetry score than their continent counterparts. Conclusion Functional asymmetry of anal sphincter innervation is significantly associated with incontinence symptoms, but only after childbirth-related sphincter injuries and therefore, should be regarded as an additional risk factor. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]

Randomized clinical trial comparing conservative and surgical treatment of neurogenic faecal incontinence

A. Österberg
Background: The treatment of choice in idiopathic (neurogenic) faecal incontinence is controversial. In a randomized study levatorplasty was compared with anal plug electrostimulation of the pelvic floor with respect to functional outcome and physiological variables. Methods: Thirty-one patients underwent levatorplasty and 28 anal plug electrostimulation of the pelvic floor over 3 years. The results were evaluated at 3, 12 and 24 months after completion of treatment by means of a validated questionnaire and anorectal manometry and manovolumetry. Results: Incontinence scores were significantly reduced during the entire observation period in both groups (P < 0·001) as was the use of pads (P = 0·003 to P < 0·001). The proportion of patients reporting improvement in physical and social handicap was greater in the levatorplasty group after 3, 12 and 24 months (P = 0·036 to P < 0·001). No significant changes in physiological variables were observed in either group. Conclusion: Better results were obtained with levatorplasty than with anal plug electrostimulation of the pelvic floor in patients with idiopathic (neurogenic) faecal incontinence. Levatorplasty should be therefore be considered the treatment of choice for this condition. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Long-term effects of stapled haemorrhoidectomy on internal anal function and sensitivity,

Dr D. F. Altomare
Background: Stapled haemorrhoidectomy is gaining wide acceptance but there is still some concern about the risk of injury to the internal anal sphincter (IAS). IAS function and morphology, and anal canal sensitivity were studied prospectively in patients undergoing this operation. Methods: Twenty patients (11 women; mean age 43 years) with stage III haemorrhoids entered the study. All underwent preoperative anorectal manometry, rectoanal inhibitory reflex (RAIR) testing and three-dimensional transanal ultrasonography. A test of anal sensation was administered to evaluate ability to discriminate between air and warm water. All the investigations were repeated 6 months after the operation. Results: The mean(s.d.) maximal resting pressure was 87(30) mmHg before surgery and 81(20) mmHg afterwards (P not significant). The maximal squeeze pressure did not change after operation (178(43) versus 174(60) mmHg). The RAIR showed the same features in 19 of 20 patients before and 18 of 20 after operation. Three-dimensional ultrasonography demonstrated no changes in the width of the IAS (mean(s.d.) 2·1(4) mm before and 2·1(3) mm after surgery). The ability of the anal mucosa to discriminate air from warm water improved in five patients. Continence scores did not differ significantly after 6 months. Conclusion: Stapled haemorrhoidectomy does not affect the function and morphology of the IAS in the long term. The sensitivity of the anal canal can improve in patients with preoperative sensory impairment. © 2001 British Journal of Surgery Society Ltd [source]

Doppler guided haemorrhoidal arterial ligation with recto-anal-repair (RAR) for the treatment of advanced haemorrhoidal disease

COLORECTAL DISEASE, Issue 10Online 2010
P. Walega
Abstract Objective, A modification of Doppler guided haemorrhoidal artery ligation (DGHAL) to include the addition of recto-anal repair is reported. Preliminary results of function and safety of third and fourth degree haemorrhoidals are given. Method, Thirty patients underwent DGHAL combined with recto-anal-repair (RAR). Each had rectal examination, anorectal manometry and Quality of Life assessment before and 3 months after the procedure. Results, Twenty-nine patients were included in the final analysis. There were three (10.34%) patients of intra-operative and one (3.45%) of postoperative bleeding. Three months after RAR (17.24%) patients with minor residual mucosal prolapse were detected, three (10.34%) patients reported residual symptoms. There was no case of recurrent bleeding. Anal manometry at 3 months after RAR was significantly lower than before the procedure (P < 0.05). One (3.45%) patient reported occasional soiling 3 months after RAR. Conclusion, Recto-anal-repair is safe in treating third and fourth degree haemorrhoids with no major complications and low rate of residual disease. [source]

Assessment of sonographic quality of anal sphincter muscles in patients with faecal incontinence

I. Pinsk
Abstract Objective, The main application of endoanal ultrasonography (US) in evaluation of faecal incontinence is to identify surgically correctable sphincter defects. The aim of our study was to determine whether qualitative changes in echogenicity and in uniformity of internal (IAS) and external (EAS) anal sphincter muscles detected on endoanal US correlate with other anal laboratory tests and modified Wexner faecal incontinence functional score. Method, Records on 99 patients having complete information on anorectal manometry, faecal incontinence scoring and available endoanal US imaging of the anal sphincters were included in statistical analysis. Anatomic appearance and changes in echogenicity of the anal sphincter muscles were recorded according to the proposed scoring system. Endoanal US defect and quality component scores for IAS and EAS as well as the total score were correlated with anal laboratory tests and incontinence score using Spearman's correlations test. Results, There was a trend for correlation between IAS quality score and incontinence score (P = 0.06), but no correlation for IAS defect score. EAS defect score had a significant negative correlation with maximum squeeze pressure (MSP) (P = 0.031). Distal EAS quality score had a significant correlation with incontinence score (P = 0.002). EAS total score correlated with MSP (P = 0.02) and incontinence score (P = 0.006). Endoanal US total score was significantly correlated with incontinence score (P = 0.006), maximal resting (MRP) (P = 0.035) and MSP (P = 0.045) and high pressure anal canal zone length (P = 0.03). Conclusion, Sonographic morphology of anal sphincter muscles correlates with anal laboratory tests and functional incontinence score. Qualitative ultrasound scoring instrument may improve evaluation of patients with faecal incontinence. [source]

A prospective evaluation of occult disorders in obstructed defecation using the ,iceberg diagram'

M. Pescatori
Abstract Objective, Surgical treatment of constipation and obstructed defecation (OD) carries frequent recurrences, as OD is an ,iceberg syndrome' characterized by ,underwater rocks' or occult diseases which may affect the outcome of surgery. The aim of this study was to evaluate occult disorders in order to alert the clinician of these and minimize failures. Method, One hundred consecutive constipated patients with OD symptoms, 81 female patients, median age 52 years, underwent perineal examination, proctoscopy, anorectal manometry, and anal/vaginal ultrasound. Anorectal physiology and imaging tests were also carried out when indicated, as well as psychological and urogynaecological consultation. Symptoms were graded using a modified 1,20 constipation score. Both evident (e.g. rectocele) and occult (e.g. anismus) diseases were prospectively evaluated using a novel ,iceberg diagram'. The type of treatment, whether conservative or surgical, was also recorded. Results, Fifty-four (54%) patients had both mucosal prolapse and rectocele. All patients had at least two occult OD-related diseases, 66 patients had at least three: anxiety-depression, anismus and rectal hyposensation were the most frequent (66%, 44% and 33% respectively). The median constipation score was 11 (range 2,20), the median number of ,occult disorders' was 5 (range 2,8). Conservative treatment was carried out in most patients. Surgery was carried out in 14 (14%) patients. Conclusion, The novel ,iceberg diagram' allowed the adequate evaluation of OD-related occult diseases and better selection of patients for treatment. Most were managed conservatively, and only a minority were treated by surgery. [source]