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Clinical indications for anorectal function investigations.

R J Felt-Bersma1

  • 1Dept. of Gastroenterology, Academic Hospital, Utrecht, The Netherlands.

Scandinavian Journal of Gastroenterology. Supplement
|January 1, 1990
PubMed
Summary

Anorectal function tests aid in understanding fecal incontinence and constipation, but their clinical use is limited. Combining test results and considering patient eligibility for treatments like biofeedback is crucial for effective diagnosis and management.

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Pelvic Floor Disorders

Background:

  • Growing interest in anorectal function investigation tests and new techniques.
  • Normal values in tests show overlap between controls and patients, limiting individual test indications.
  • Combined test results offer greater diagnostic strength.

Purpose of the Study:

  • To provide guidelines for the selective use of anorectal function tests.
  • To clarify the clinical utility of these tests in specific patient populations.
  • To enhance understanding of fecal incontinence and constipation pathogenesis.

Main Methods:

  • Review and synthesis of current literature on anorectal function tests.
  • Analysis of the diagnostic value of individual tests versus combined results.

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  • Evaluation of test indications based on patient eligibility for treatments like surgery or biofeedback.

    • Main Results:

    • Pure clinical indications for individual tests are small; combined results are more valuable.
    • Anorectal function tests are not indicated if patients are ineligible for surgery or biofeedback.
    • Defecography can identify intussusception as a cause of incontinence.
    • Anal EMG during defecography can diagnose spastic pelvic floor syndrome in constipation.

    Conclusions:

    • Selective use of anorectal function tests is recommended, guided by specific clinical scenarios.
    • Tests are most beneficial when combined and considered alongside treatment options.
    • Further research is needed to clarify the clinical consequences of findings like pudendal neuropathy.