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Simplified solid sphere test to investigate anal sphincter strength in patients with anorectal diseases
1Department of Surgery, Tampere University Hospital, Finland.
Purpose:
The solid sphere test has not gained general acceptance to investigate anal sphincters, despite its simplicity and low cost. We studied continent and incontinent patients to evaluate whether the solid sphere test is suitable in assessment of anal sphincter function.
Methods:
Seventy colorectal patients with anal incontinence of varying severity were studied by means of incontinence grading, solid sphere test, and anal manometry.
Results:
Anal sphincter strength, studied using the solid sphere test, declined gradually with increasing severity of anal incontinence from 1,186 (+/- 334, SD) g in 28 continent patients to 619 (+/- 256, SD) g in 13 patients with daily soiling (P < 0.001). The test also correlated with anal manometry; there was positive correlation with maximum basal pressure (r = 0.643, P < 0.001) and maximum voluntary contraction pressure (r = 0.393, P < 0.01).
Conclusion:
The solid sphere test is useful in the primary assessment of patients with anal incontinence as a screening test, but alone it is too inaccurate for clinical decision making.