Rectal Manometry

Rectal manometry helps to determine the causes of fecal inconeinence and constipation. Fecal incontenance is the loss of voluntary control of the bowls resulting in the passage of feces or gas. It can have several causes but a common cause is damage to the muscles or nerves in the rectum and anus.
The procedure measures the pressure and coordination of the sphincter muscles in the rectum and anus using a manometric probe that is inserted into the rectum. The probe is fitted with a balloon that is inflated with fluid and is drawn back through the rectum and anus. Measurements are taken at several locations with the patient at rest and while the patient exerts pressure on the balloon. The feeling and action is similar to having a bowel movement.
Fecal incontinence can occur in anyone, especially the elderly, but it is often a result of damage associated with childbirth. Non-surgical treatments including changes in diet, certain medications and exercises can help most women to cope with the condition.

Rectal manometry may also be referred to as anal manometry or anal-rectal manometry. This is an outpatient procedure with little or no associated discomfort.

Procedure: ManoScan™ AR Anorectal Manometry

What are the Risks of the Procedure?
Procedure complications are rare. The risks of ManoScanTM AR high resolution manometry include perforation or bleeding of the intestinal wall. Patients with previous rectal surgery, bowel inflammation, or bowel obstruction may have a higher risk for iatrogenic bowel perforation. Medical, endoscopic, or surgical intervention may be necessary to address any of these complications, should they occur. The system is not compatible for use in an MRI magnetic field. Please consult your physician or refer to for detailed information.

What is ManoScan™ AR Anorectal Manometry?
Anorectal manometry is a test used to evaluate the function and coordination of the sphincter and pelvic floor muscles of the anorectal anatomy. This study also assesses the measurement of resting and squeeze pressures, as well as the length of the anal canal.

Anorectal manometry may be performed to test for conditions such as chronic constipation, fecal incontinence (inability to control bowel movements), rectal prolapse (condition where the rectum protrudes from the anus), or Hirschprung’s Disease (congenital condition where the nerves in the wall of the colon are missing). This test may also be used in pre-operative evaluations to assess sphincter function prior to rectal or anal surgery. In addition, anorectal manometry may be used in conjunction with biofeedback training which can be an effective treatment and technique using anal manometry and special exercises to strengthen the anal muscle.

How Anorectal Manometry is Performed
A technician or nurse will perform this test after explaining the procedure to you. You will change into a hospital gown and be asked to lie on your left side with your hips and knees flexed. Since you will need to squeeze and relax during the procedure, you will not be sedated. A small, well-lubricated catheter or probe, which is no thicker than a human finger, is inserted into your rectum. The catheter or probe is connected to a monitor that measures the pressures of several muscles in your rectum.

During the study, a small balloon at the tip of the catheter or probe will be inflated to assess the normal reflex pathways. You will be asked to squeeze, relax, and push at various times, allowing the technician to measure the anal sphincter muscle pressure. Two other tests may be performed including an anal sphincter electromyography (EMG) that evaluates the nerve supply to the pelvic floor and/or anal muscle and a balloon expulsion test that measures the time it takes to expel the balloon from the rectum.

Preparation for Anorectal Manometry
Food & Drink: Please refrain from eating and drinking after midnight before your test.
Medications: Prior to your test, you should consult with your physician regarding the prescribed medications you take. Some medications can affect the muscles of your esophagus and alter the results of your study. These medications include pain medications, sedatives, tranquilizers, antispasmodics, and promotility medications.
Some medications will not affect the procedure and may be continued as per your doctor’s instructions. This includes medications for the following conditions: heart diseases, high blood pressure, and diabetes.
It is important that you consult with your physician regarding all the medications you are taking prior to your study.
Your physician should obtain your medical history prior to your test and can answer any other questions or concerns you may have at that time.

Womens’ Fecal Incontinence

As many as one in five adult women may suffer from loss of bowel control, according to a new study from Australia.
Bladder problems were also common in women who reported poor bowel control, known as fecal incontinence. Overall, the chance of being incontinent generally increased with age.
Estimates of how many people have incontinence vary greatly, possibly in part because people who have it might be embarrassed and reluctant to talk about the condition. Some evidence suggests that changes in the body due to aging or childbirth may increase a person’s chance of having fecal incontinence.
“What was important about this study is that we don’t have a lot of information about this issue in healthy individuals living in the community,” Dr. Susan Davis, one of the study’s authors from Monash University in Melbourne, Australia, told Reuters Health.
To try to fill in some of that missing information, Davis and her colleagues distributed questionnaires to 442 women between the ages of 26 and 82. Women answered a range of questions about their health and behavioral habits, including some related to symptoms of urinary and fecal incontinence.
A total of 91 women, or about 20 of every 100 women in the study, reported having “loose” fecal incontinence, involving leakage of liquid stool, at some point in the previous 3 months. Twenty of those, or 5 of every 100 women, also said that at some point in the last three months they had “well-formed” fecal incontinence.
Both kinds of fecal incontinence were generally more common in older women. For example, about 1 in 3 women ages 65 to 74 reported incontinence, compared to about 1 in 7 of those aged 45 to 54.
Women who suffered from loose fecal incontinence were more likely to also have leaking bladders, compared to women who didn’t report any fecal incontinence. That’s probably because the same kind of nerves and tissues that would affect both kinds of incontinence, Davis said. The link remained when researchers took into account the age and weight of women.
Whether or not a woman had given birth did not affect her chances of being incontinent.
Previous research, in various types of people, have generally found lower rates of incontinence – between 2 and 17 of every 100 study participants, the authors report. Davis and her colleagues believe their method of measuring the prevalence of fecal incontinence through a questionnaire may be more accurate than face to face or telephone interviews, which may make women more embarrassed about telling researchers they are incontinent.
However, the findings, published in the journal Menopause, could also be an overestimate of how common fecal incontinence really is. Although the women were originally picked from the population at large, they all volunteered to be in a study about urinary incontinence, and it’s possible that women agreed to participate because the topic applied to them. If urinary incontinence and fecal incontinence truly are related, this group of women might not be representative of the population at large.
Dr. Emily Lukacz, who studies incontinence at the University of California, San Diego, said that although the estimate that 20 of every 100 women have fecal incontinence is on the high end, it’s not outside of a realistic range. But fecal incontinence is not something many people talk about. “Unfortunately, I think a lot of the lack of awareness of this probably comes from embarrassment,” Lukacz, who was not involved in the study, told Reuters Health.
The findings show that many women with fecal incontinence may be suffering unnecessarily, Davis said. Doctors could make a difference by asking their patients with urinary incontinence if they also have symptoms of fecal incontinence, she said. And women, even if they are embarrassed, shouldn’t keep the condition to themselves. In some cases, it may take only a small lifestyle change – such as eating more fiber – to solve the problem, Davis said.
Lukacz agreed. “There are a lot of behavioral things and dietary things and exercises (that) improve fecal incontinence just as well as some of the surgical procedures,” she said. The most important message for people with fecal incontinence, she added, is “that they don’t have to live with it.”
“It is important that if women are bothered by this they should speak to their doctor,” Davis said, “because it could be something that’s very simple to sort out.”