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Gastroenterology Clinics of North America
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DOI: 10.1016/s0889-8553(05)70165-5
  • Biology


The anorectum plays an important role in the regulation of defecation and in the maintenance of continence. 2,32 In the 1980s and 1990s, a wide range of tests were developed to assess anorectal function. 32 The most common and widely used test is anorectal manometry. 2,32 The American Gastroenterological Association 2 has endorsed this technique but has recognized that “it requires some degree of experience and familiarity with the test and its applications.” The position paper further acknowledged that there was a lack of consensus regarding which test to use and when. 2 This lack of consensus was confirmed in a multicenter study that compared current methods of performing anorectal manometry. In 7 centers across North America and Europe, no 2 centers used a similar probe, similar sensor configuration, or similar methodology. 24 This article reviews some of the tests that commonly are used for assessing anorectal and pelvic floor function, assesses the significance of these tests, and provides an approach for the manometric assessment of anorectal function. Tests for assessing anorectal function include the following: Tests commonly performed Anorectal manometry Anal endosonography Sphincter electromyography Object expulsion test Defecography Saline continence test Pudendal nerve terminal motor latency Tests performed in research laboratories Rectal barostat Anal vectorgraphy Rectoanal scintigraphy Ambulatory anorectal manometry MR imaging Videofluorodefecometry Each laboratory should develop its own normal range for interpreting results or if using normative data from the literature to adopt similar methodology. The reader is referred to Olsen's article in this issue for a discussion on neurophysiologic assessment of anorectal function. The present article focuses primarily on the manometric and sensory assessment of anorectal function. The purpose of anorectal manometry is to evaluate the integrated function of the defecation unit, including its motor and sensory function. From these measurements, it is possible to assess the expulsion forces, the resistance to bowel evacuation, the anorectal sensory responses, and the neuronal innervation.

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