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Update of tests of colon and rectal structure and function.
J Clin Gastroenterol. 2006 Feb; 40(2):96-103.JC

Abstract

This review deals with the indications, methods, strengths, and limitations of anorectal testing in clinical practice. In chronic constipation, anal manometry and a rectal balloon expulsion test, occasionally supplemented by defecography, are useful to identify a functional defecatory disorder, because symptoms may respond to pelvic floor retraining. In patients with fecal incontinence, diagnostic testing complements the clinical assessment for evaluating the pathophysiology and guiding management. Manometry measures anal resting and squeeze pressures, which predominantly reflect internal and external anal sphincter function, respectively. Defecation may be indirectly assessed by measuring the recto-anal pressure gradient during straining and by the rectal balloon expulsion test. Endoanal ultrasound and magnetic resonance imaging (MRI) can identify anal sphincter structural pathology, which may be clinically occult, and/or amenable to surgical repair. Only MRI can identify external sphincter atrophy, whereas ultrasound is more sensitive for internal sphincter imaging. By characterizing rectal evacuation and puborectalis contraction, barium defecography may demonstrate an evacuation disorder, excessive perineal descent or a rectocele. Dynamic MRI can provide similar information and also image the bladder and genital organs without radiation exposure. Because the measurement of pudendal nerve latencies suffers from several limitations, anal sphincter electromyography is recommended when neurogenic sphincter weakness is suspected.

Authors+Show Affiliations

Department of Medicine, Clinical Enteric Neuroscience Translational & Epidemiological Research Program, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. bharucha.adil@mayo.edu

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Review

Language

eng

PubMed ID

16394868

Citation

Bharucha, Adil E.. "Update of Tests of Colon and Rectal Structure and Function." Journal of Clinical Gastroenterology, vol. 40, no. 2, 2006, pp. 96-103.
Bharucha AE. Update of tests of colon and rectal structure and function. J Clin Gastroenterol. 2006;40(2):96-103.
Bharucha, A. E. (2006). Update of tests of colon and rectal structure and function. Journal of Clinical Gastroenterology, 40(2), 96-103.
Bharucha AE. Update of Tests of Colon and Rectal Structure and Function. J Clin Gastroenterol. 2006;40(2):96-103. PubMed PMID: 16394868.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Update of tests of colon and rectal structure and function. A1 - Bharucha,Adil E, PY - 2006/1/6/pubmed PY - 2006/4/21/medline PY - 2006/1/6/entrez SP - 96 EP - 103 JF - Journal of clinical gastroenterology JO - J. Clin. Gastroenterol. VL - 40 IS - 2 N2 - This review deals with the indications, methods, strengths, and limitations of anorectal testing in clinical practice. In chronic constipation, anal manometry and a rectal balloon expulsion test, occasionally supplemented by defecography, are useful to identify a functional defecatory disorder, because symptoms may respond to pelvic floor retraining. In patients with fecal incontinence, diagnostic testing complements the clinical assessment for evaluating the pathophysiology and guiding management. Manometry measures anal resting and squeeze pressures, which predominantly reflect internal and external anal sphincter function, respectively. Defecation may be indirectly assessed by measuring the recto-anal pressure gradient during straining and by the rectal balloon expulsion test. Endoanal ultrasound and magnetic resonance imaging (MRI) can identify anal sphincter structural pathology, which may be clinically occult, and/or amenable to surgical repair. Only MRI can identify external sphincter atrophy, whereas ultrasound is more sensitive for internal sphincter imaging. By characterizing rectal evacuation and puborectalis contraction, barium defecography may demonstrate an evacuation disorder, excessive perineal descent or a rectocele. Dynamic MRI can provide similar information and also image the bladder and genital organs without radiation exposure. Because the measurement of pudendal nerve latencies suffers from several limitations, anal sphincter electromyography is recommended when neurogenic sphincter weakness is suspected. SN - 0192-0790 UR - https://www.unboundmedicine.com/medline/citation/16394868/Update_of_tests_of_colon_and_rectal_structure_and_function_ L2 - http://dx.doi.org/10.1097/01.mcg.0000196190.42296.a9 DB - PRIME DP - Unbound Medicine ER -