Introduction
A long tube-like organ that connects with the small intestine at one end and with the anus at the other. The large intestine has four parts cecum, colon, rectum, and anal canal. Food that is partly digested passes through the large intestine, and excess water and nutrients are absorbed in the waste material,” stool” is then stored in the rectum and then excreted from the body through the anus. The anal valve or sphincter is a ring-shaped muscle that closes and opens located at the bottom of the anus and plays a key role in controlling bowel movements and functions. If any damage occurs to this muscle, it affects and weakens its functionality, resulting in incontinence and causing accidental loss of stools.
What Is Anorectal Manometry?
Anorectal manometry is a test procedure done to detect the work efficiency and muscle strength of the rectum and anus. This test helps in finding the function of the sphincter and the muscles in bowel movements. The anal sphincter is the valve that is made up of muscle, and it controls the closing and opening of the anus; it plays a major role in stopping and passing stools. Anorectal manometry is performed to see how well the valve is functioning. HR- ARM (high-resolution anorectal manometry) is increasingly replacing the standard conventional anorectal manometry. An increase in the usage of 3D images and high-definition anorectal manometry is giving great support and advances in the procedure. These advances in technology also include the development of bedside portable technology.
What Are the Types of Anorectal Manometry?
The types of anorectal manometry are:
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Non-High-Resolution Manometry (Non-HRM) - Used to generate a more refined view.
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High-Resolution Anorectal Manometry (HR-ARM) - Increased ease in analyzing results as pressure readings are displayed in color and a line plot.
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High-Definition Anorectal Manometry (HD-ARM or 3D Anorectal Manometry) - Benefits of both high-resolution and high-definition methods.
What Are the Indications of Anorectal Manometry?
Anorectal manometry is indicated in conditions like:
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In cases where stool passing is difficult.
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Constipation (a condition where there are less than three bowel movements a week).
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Hirschsprung’s disease in children (a condition that can cause blockage in the large intestine).
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Fecal incontinence (a situation where bowels are not in control, which results in leakage of feces).
How to Be Prepared for an Anorectal Manometry Test?
There are a few instructions to be followed before the manometry test, which will be provided by the healthcare provider. There would be restrictions on the diet and liquid intake a day before the test. Discussion related to medications taken is done, the intake of over-the-counter drugs is withdrawn, and individuals are prescribed smooth muscle relaxants before the test. In some cases, enemas are indicated before getting prepared for the test. Before the test, make sure to clean the anal area thoroughly as part of good hygiene. Dress comfortably and loosely. Make travel arrangements to and from the hospital, particularly if sedation is required.
What Happens During an Anorectal Manometry Test?
Anorectal manometry is a simple test and does not require any anesthesia. To perform the test, the following steps are taken:
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A catheter - anal tube with a balloon at the end, and this device is inserted into the anus and rectum. This device is connected to the catheter, which allows technicians to change the pressure in the balloon by inflating and deflating it with air.
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Computer software connected to a pressure device and control test settings records the data collected by the balloon catheter.
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This test usually takes around 30 minutes. Before the procedure, the healthcare provider would instruct the patient to empty the digestive tract and may recommend using one or more over-the-counter enemas.
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The individual undergoing the test would be draped in a hospital gown, and the procedure would be explained, along with taking a brief history of medical and physical conditions.
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The individual has to lie in the fetal position (lie on the left side and bring the knees up).
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Before the test, the healthcare provider will perform a digital rectal examination by inserting a gloved finger in the anus and detecting if any abnormality is present.
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A thermometer-sized flexible tube is used to deflate the balloon at the end and is inserted in the rectum. The tube is connected to a device that measures pressure.
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The healthcare provider will position the balloon at different depths inside the rectum to take several pressure readings.
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Then, the balloon is inflated to a certain size and asked to squeeze, push, relax, or cough at different intervals of time. This activity is repeated at different positions in the rectum with different balloon sizes. The pressure of the anal sphincter muscle is measured each time.
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The provider may also ask for any sensation felt in the rectum with different balloon sizes.
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When the test is done, the deflation of the balloon is done, and the balloon is removed.
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After the test is completed, individuals can drive home independently and return to normal activities.
What Happens After an Anorectal Manometry Test?
There is no use of anesthesia in the test procedure. Therefore, the recovery rate is fast after the test as well as the individual can drive home on their own and return to normal activities soon. Healthcare providers may recommend some suggestions depending on the findings found in the tests. These may include certain medications, muscle-strengthening exercises, dietary changes, and, in rare cases, surgery.
What Are the Risks and Complications Associated With the Anorectal Manometry Test?
Anorectal manometry is a safe procedure, a low-risk job, and complications are infrequent. Individuals allergic to latex should inform the health care provider or technician before the test. Failure of equipment is a rare complication, and it is remotely possible.
Conclusion
Anorectal manometry is a minimally invasive procedure, safe and effective in detecting the value function of the anus. It can help to determine muscles that are too tight or too loose and the muscles that are not engaging in the right bowel movement. This test requires minimal preparations and a set of instructions that needs to be followed. For minimal to rare complications, this test does give better results, such as in cases of fecal incontinence, evacuation disorders, and constipation.
