Anorectal functional testing: review of collective experience

Anorectal manometry includes a number of specific tests that are helpful in the diagnostic assessment of patients with fecal incontinence and constipation; their purpose is to delineate the pathophysiological mechanism for these symptoms. Some of these tests may also provide helpful information in the assessment of patients with rectal pain or diarrhea, but their sensitivity and specificity are less well established for these symptoms. Tests for which there is consensus regarding their clinical utility include 1) resting anal canal pressure, 2) anal canal squeeze pressure (peak pressure and duration), 3) the rectoanal inhibitory reflex elicited by balloon distension of the rectum, 4) anal canal pressure in response to a cough, 5) anal canal pressure in response to defecatory maneuvers, 6) simulated defecation by means of balloon or radiopaque contrast, 7) compliance of the rectum in response to balloon distension, and 8) sensory thresholds in response to balloon distension. Anal endosonography and pelvic floor electromyography from intra-anal plate electrodes are nonmanometric tests that are also specifically useful in the evaluation of constipation and fecal incontinence. The clinical utility of all anorectal manometric tests is limited by the relative absence of 1) standardization of test protocols and 2) normative data from a large number of healthy individuals. The interpretation of these diagnostic tests is also complicated by the fact that patients are able to compensate for deficits in specific physiological mechanisms maintaining continence and defecation by utilizing other biological and behavioral mechanisms.