[Anorectal functional study. The state of the art]

Area of Science:

• Gastroenterology and Colorectal Surgery
• Pelvic Floor Disorders
• Diagnostic Imaging and Electrophysiology

Background:

• Disturbances in anal continence and evacuation are common, impacting quality of life.
• Advancements in understanding pelvic floor anatomy and physiology have improved diagnostic capabilities.
• Numerous techniques are available to objectively measure anorectal and pelvic floor function.

Purpose of the Study:

• To review and describe key diagnostic techniques for evaluating anorectal and pelvic floor function.
• To highlight the utility of these tests in diagnosing conditions such as fecal incontinence and constipation.
• To emphasize the role of these investigations in patient management.

Main Methods:

• Anorectal manometry assesses sphincter resistance and rectoanal inhibitory reflex.
• Pudendal latencies evaluate external anal sphincter innervation, useful in neurogenic incontinence.
• Electromyography (EMG) studies pelvic floor muscle function, detecting neurogenic damage or traumatic injury.
• Anal endosonography visualizes anal sphincter morphology, comparable to EMG but less invasive.
• Defecography provides dynamic radiological assessment of the pelvic floor during defecation.

Main Results:

• Anorectal manometry is crucial for assessing anal canal resistance and reflexes.
• Prolonged pudendal latencies indicate neurogenic causes of fecal incontinence.
• EMG can identify specific patterns of muscle fiber dysfunction in incontinence.
• Anal endosonography accurately assesses sphincter damage with high patient acceptance.
• Defecography evaluates pelvic floor dynamics, aiding diagnosis of rectal prolapse and constipation.

Conclusions:

• These diagnostic tests provide valuable, reproducible data on pelvic floor function.
• They significantly aid in the evaluation of patients with pelvic floor disorders.
• Clinical judgment remains paramount, with these tests serving as adjuncts to diagnosis and management.