Qualifying Patients for Anorectal Manometry

Published on Dec 20, 2023

Anorectal Manometry presents an enormous opportunity for clinics and health systems to enhance their practice, treat more patients, and grow their businesses. But, like with the addition of any new procedure, the process can pose questions and present operational issues.

We asked Dr. Abhitabh Patil from Center for Digestive Care/Gastro Florida his tips on how to qualify patients for anorectal manometry. Watch the video below and read on to learn:

  • Common complaints from patients and how you can avoid them to give the best possible experience

  • The most important anatomy and physiology of the anorectum

  • How to perform the anorectal manometry, along with balloon expulsion testing

  • Management strategies on how you can easily implement the process into your practice without disrupting your current operations

Watch Now: Qualifying Patients for Anorectal Manometry

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Qualifying Patients for Anorectal Manometry: Key Steps

Qualifying Patients

Anorectal manometry is used to assess the internal anal sphincter and external anal sphincter as well as rectal sensations and expulsion patterns. A pressure-sensitive catheter is placed into the anorectum to measure resting and squeeze pressures of the anal canal.

There is a simple algorithm for patients who present with a suspected defecation disorder. Start off by, of course, performing a history, a physical examination, including a thorough rectal exam. If you suspect that there's a defecation disorder or an expulsion disorder, start by performing an anorectal manometry with a balloon expulsion test.

Related Content: Increase Profits and Patient Experience with Anorectal Manometry

Reviewing the Anatomy of the Anorectum

The anorectum is a very complex group of muscles. At the top, you have the pubulorectalis muscle. In the anorectal canal, you have the internal anal sphincter and the external anal sphincter. Above the internal anal sphincter, typically we have the hemorrhoidal plexus, which we call the internal hemorrhoids, and below the dentate line, we have the external hemorrhoids.

In the resting state, the pubulorectalis muscle is contracted. This changes the angle from the rectum and the sigmoid colon to make an S shape. This itself holds the stool inside the rectal vault. During defecation, this process is reversed.

Patients also have a reflex called the rectoanal inhibitory reflex. When the rectum is distended, a nerve impulse is sent to the spinal cord, which is then returned to relax the internal anal sphincter. This is called the rectoanal inhibitory reflex. This also ends up straightening the muscles and allowing for defecation from the sigmoid colon and rectum out of the anus, or expulsion.

How to Conduct Anorectal Manometry

Digital rectal exam is probably the most important component of the physical examination. Start by inserting the finger into the anal canal. What you want to palpate for is the resting tone of the anus. You should feel a slight squeeze around the finger. You should be also able to palpate any tenderness that may be a sign of an anal abscess or perianal abscess.

The next thing we do is ask the patient to squeeze. Here, what we're feeling for is contraction of the external anal sphincter against your finger. Next, we ask the patient to squeeze and hold as if they're holding a bowel movement. This is where we can palpate the pubulorectalis muscle. We should feel the muscle contracting and making an S shape.

Next, we ask the patient to bear down like they're having a bowel movement. This allows us to see if they're able to reverse all of these muscular contractions. During this process, you should feel a give inside the rectal canal. The pubulorectalis muscle should relax. The sigmoid colon should straighten, and you should feel relaxation on the internal anal sphincter as well as the external anal sphincter. This allows expulsion of stool, and you should be able to feel your finger slipping out the anal canal.

Related Content: 5 Benefits of Portable Anorectal Manometry

Additional Testing for Diagnostics

If the anorectal manometry test is normal, there is no defecation disorder present. If the anorectal manometry or balloon expulsion test is abnormal, then consider performing further testing. If it's indeterminate, consider defecography, and if the defecography is normal, then there's no defecation disorder. If it's abnormal, then pursue the abnormal result. If the anorectal manometry and the balloon expulsion test are abnormal, then you have a defecation disorder, and this should be pursued.

Let's go over some of the diagnostic tests that are used to evaluate defecatory disorders. First most common is a colonoscopy. This is very helpful for excluding underlying colorectal cancer or other mechanical causes. Anoscopy can be used to evaluate the anal rectum. Colon transit studies can be helpful for evaluating slow transit constipation. MRI pelvis can evaluate for structural or anatomic disorders as well as defecography.

mcompass®: Anorectal Manometry and Manometric Biofeedback for Pediatrics and Adults

Now you can do anorectal manometry in your own practice, on your terms. mcompass is the better, simpler way to do anorectal manometry. Whether you’re looking to introduce anorectal manometry for the first time, enhance how you perform the procedure or want to increase workflow with additional services and offer more options to more patients, the mcompass® Anorectal Manometry (ARM) System gives you real results, real fast.

A new concept in anorectal manometry, mcompass is the leading portable, simple-to-use device that will integrate into the workflow of any practice and make providing new services a reality for a broad range of physicians.

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Medspira’s mission is to make clinically-inspired medical devices available to more healthcare professionals and their patients. Our innovative mcompass® system is the leading portable device for anorectal manometry. Manometric biofeedback offerings are available as well with easy-to-install software and disposable attachments.

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