Abstract
Understanding the physiology of defaecation and continence requires an appreciation of the interplay among the anal sphincter, rectum and pelvic floor, which although anatomically simple is physiologically complex. Whilst gold standards to define function remain elusive, there are in routine use a number of techniques for studying the motor and sensory elements of anorectal physiology. Furthermore, recent studies have proposed a key role for rectal compliance and sensitivity in the pathogenesis of faecal incontinence and rectal evacuation disorders. This chapter focuses primarily on the rationale for, and the clinical value of, performing these tests with only brief detail of the methodology.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
Bersma RJF, van Baren R, Koorevar M et al (1992) Anal endosonography: relationship with anal manometry and neurophysiologic tests. Dis Colon Rectum 35:944–949
Byrne CM, Pager CK, Rex J et al (2002) Assessment of quality of life in the treatment of patients with neuropathic fecal incontinence. Dis Colon Rectum 45:1431–1436
Caruana BJ, Wald A, Hinds JP et al (1991) Anorectal sensory and motor function in neurogenic faecal incontinence. Comparison between multiple sclerosis and diabetes mellitus. Gastroenterology 100:465–470
Craggs MD, Balasubramaniam AV, Chung EA et al (2006) Aberrant reflexes and function of the pelvic organs following spinal cord injury in man. Auton Neurosci 126–127:355–370
Emmanuel AV, Kamm MA, Middleton F (2002) Gut specific autonomic testing and bowel dysfunction in spinal cord injury. Gastroenterology 122 Supp 1:M1535
Engel AF, Kamm MA, Bartram CI et al (1995) Relationship of symptoms in faecal incontinence to specific sphincter abnormalities. Int J Colorectal Dis 10:152–155
Evans RC, Kamm MA, Hinton JM et al (1992) The normal range and a simple diagram for recording whole gut transit time. Int J Colorect Dis 7:15–17
Fynes MM, Donelly V, Behan M et al (1999) Effect of second vaginal delivery on anorectal physiology and faecal continence: a prospective study. Lancet 354:983–986
Hallan RI, Marzouk DE, Waldron DJ et al (1989) Comparison of digital and manometric assessment of anal sphincter function. Br Surg 76:973–975
Hinton JM, Lennard-Jones JE, Young AC (1969) A new method for studying gut transit times using radio-opapue markers. Gut 10:842–847
Jones MP, Post P, Crowell MD (2007) High-resolution manometry in the evaluation of anorectal disorders: a simultaneous comparison with water-perfused manometry. Am J Gastroenterol 102:850–855
Jorge JM, Wexner SD (1993) Aetiology and management of faecal incontinence. Dis Colon Rectum 36:77–97
Kamm MA, Lennard-Jones JE (1990) Rectal mucosal electrosensory testing. Evidence for a sensory neuropathy in severe constipation. Dis Colon Rectum 33:419–423
Kiff ES, Swash M (1984) Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 71:614–616
Loening-Baucke V, Anuras S (1984) Anorectal manometry in healthy elderly subjects. Am Geriatr Soc 32:636–639
Marquis P, De La Loge C, Dubois D et al (2005) Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire. Scand J Gastroenterol 40:540–551
Marcello PW, Barrett BS, Coller JA et al (1998) Fatigue rate index as a new measurement of external sphincter function. Dis Colon Rectum 41:336–343
McHugh SM, Diamnt NE (1987) Effect of age, gender and parity on anal canal pressures: contribution of impaired anal sphincter function to faecal incontinence. Dig Dis Sci 32:726–736
Metcalf AM, Phillips SF, Zinsmeister AR et al (1987) Simplifi ed assessment of segmental colonic transit. Gastroenterology 92:40–47
Miller R, Bartolo DCC, Roe AE et al (1988) Anal sensation and the continence mechanism. Dis Colon Rectum 31:433–438
Miner PB, Donnelly TC, Read NW (1990) Investigation of mode of action of action of biofeedback in treatment of faecal incontinence. Dig Dis Sci 35:1291–1298
Nicholls TJ, Solanki D, Emmanuel AV et al (2002) Inter-examiner reproducibility of anorectal motor and sensory function test. Gut 51, Supp II:A60
Norton C, Chelvanayagam S, Kamm MA (2002) Randomised controlled trial of biofeedback for faecal incontinence. Gut 51, Supp II:A61
Perry RE, Blatchford GJ, Christensen MA et al (1990) Manometric diagnosis of anal sphincter injuries. Am J Surg 159:112–117
Read NW, Harford WV, Schmulen AC et al (1979) A clinical study of patients with faecal incontinence and diarrhoea. Gastroenterology 76:747–756
Rogers J, Laurberg S, Misiewicz JJ et al (1989) Anorectal physiology validated: a repeatability study of the motor and sensory tests of anorectal function. Br J Surg 76:607–609
Sultan AH, Kamm MA, Talbot IC et al (1994) Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg 81:463–465
Sun WM, Read NW, Prior A et al (1990) Sensory and motor responses to rectal distension vary according to rate and pattern of balloon inflation. Gastroenterology 99:1008–1015
Taylor BM, Beart RW Jr, Phillips SF (1984) Longitudinal and radial variations of pressure in the human anal sphincter. Gastroenterology 86:693–697
Tobon F, Reid NCRW, Talbert JL et al (1968) Nonsurgical test for the diagnosis of Hirschsprung’s disease. New Engl J Med 278:188–194
Vaizey CJ, Carapet E, Cahill JA et al (1999) Prospective comparison of faecal incontinence grading systems. Gut 44:77–80
Voskuijl WP, van der Zaag-Loonen HJ, Ketel IJ et al (2004) Health related quality of life in disorders of defecation: the Defecation Disorder List. Arch Dis Child 89:1124–1127
van der Sijp JR, Kamm MA, Nightingale JM et al (1993) Radioisotope determination of regional colonic transit in severe constipation: comparison with radio opaque markers. Gut 34:402–408
Wexner SD (1997) Re: manometric tests of anorectal function in the management of defecation disorders. Am J Gastroenterol 92:1400
Wietek BM, Hinninghofen H, Jehle JC et al (2007) Asymmetric sphincter innervation is associated with fecal incontinence after anal sphincter trauma during childbirth. Neurourol Urodyn 26:134–139
Yang Y, Wexner SD (1994) Anal pressure vectography is of no apparent benefit for sphincter evaluation. Int J Colorectal Dis 9:989–996
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2008 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Emmanuel, A.V. (2008). Anorectal Physiology. In: Imaging Pelvic Floor Disorders. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-71968-7_11
Download citation
DOI: https://doi.org/10.1007/978-3-540-71968-7_11
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-71966-3
Online ISBN: 978-3-540-71968-7
eBook Packages: MedicineMedicine (R0)