Physiologic evaluation of the anorectum

Abstract

Pelvic floor physiology is a complex area of clinical study. Continence and voiding functions are not completely understood. Incontinence is an especially underrated problem. With the use of manometry and ultrasound, anorectal physiology is evaluated and correlated with clinical dysfunction. A description of a previously undescribed ultrasound technique to evaluate anorectal angles and puborectalis function is presented. The results in 10 controls and 53 symptomatic patients with different degrees of continence dysfunction are discussed. The controls showed anal pressures and anorectal angles of 29 cm H2O and 114 degrees at rest and 67 cm H2O and 95 degrees with contraction. Six of the symptomatic patients had complete incontinence to solid stools. The results of their pressures and angles were 14 cm H2O and 151 degrees at rest and 32 cm H2O and 124 degrees with contraction. The values of this group compared with controls is significantly different (P less than 0.05). Ultrasound is helpful in assessing the pelvic floor, both subjectively and objectively. It has the advantages of avoiding radiation and allowing a longer viewing time. It is less expensive compared with radiographic proctography and the data are complementary. Ultrasound and manometry may be useful for long-term follow-up of anorectal physiology.