High-resolution anorectal manometry (HR-ARM) and high-definition anorectal manometry (HD-ARM) catheters have closely spaced water-perfused or solid state circumferentially-oriented pressure sensors that provide much better spatiotemporal pressurization than non-high resolution catheters. This is a comprehensive review of HR-ARM and HD-ARM anorectal manometry catheter systems, the methods for conducting, analyzing, and interpreting HR-ARM and HD-ARM, and a comparison of HR-ARM with non-high resolution anorectal manometry. Compared to non-high resolution techniques, HR-ARM and HD-ARM studies take less time and are easier to interpret. However, HR-ARM and HD-ARM catheters are more expensive and fragile and have a shorter lifespan. Further studies are needed to refine our understanding of normal values and to rigorously evaluate the incremental clinical utility of HR-ARM or HD-ARM compared to non-high resolution manometry.
Anal Canal ; Catheters ; Constipation ; Fecal Incontinence ; Manometry* ; Physiology ; Reference Values

Although bidets are widely used in Korea, its effects on anorectal pressures have not been studied in detail in terms of the water settings used. Twenty healthy volunteers were placed on a toilet equipped with a bidet, and anorectal pressures were measured with a manometry catheter inserted into the rectum and anal canal before and after using the bidet at different water forces (40, 80, 160, 200 mN), temperatures (24degrees C vs 38degrees C), and water jet widths (narrow vs wide). The pressure at anal high pressure zone decreased from 96.1 +/- 22.5 to 81.9 +/- 23.3 mmHg at water jet pressure of 40 mN and 38degrees C wide water jet (P < 0.001), from 94.3 +/- 22.4 to 80.0 +/- 24.1 mmHg at water jet pressure of 80 mN and 38degrees C narrow water jet (P < 0.001), and from 92.3 +/- 22.4 to 79.6 +/- 24.7 mmHg at a water jet pressure of 80 mN and 38degrees C wide water jet (P < 0.001). At other settings, no significant changes were observed. Our results indicate that, in addition to cleansing effect, bidet could be used to reduce anal resting pressure in the same manner as the traditional warm sitz bath under the conditions of low or medium water jet pressure, a warm water temperature, and a wide type water jet.
Adult ; Anal Canal/physiology ; Female ; Humans ; Male ; Manometry ; Pressure ; Rectum/*physiology ; Temperature ; *Toilet Facilities ; Water

Although bidets are widely used in Korea, its effects on anorectal pressures have not been studied in detail in terms of the water settings used. Twenty healthy volunteers were placed on a toilet equipped with a bidet, and anorectal pressures were measured with a manometry catheter inserted into the rectum and anal canal before and after using the bidet at different water forces (40, 80, 160, 200 mN), temperatures (24degrees C vs 38degrees C), and water jet widths (narrow vs wide). The pressure at anal high pressure zone decreased from 96.1 +/- 22.5 to 81.9 +/- 23.3 mmHg at water jet pressure of 40 mN and 38degrees C wide water jet (P < 0.001), from 94.3 +/- 22.4 to 80.0 +/- 24.1 mmHg at water jet pressure of 80 mN and 38degrees C narrow water jet (P < 0.001), and from 92.3 +/- 22.4 to 79.6 +/- 24.7 mmHg at a water jet pressure of 80 mN and 38degrees C wide water jet (P < 0.001). At other settings, no significant changes were observed. Our results indicate that, in addition to cleansing effect, bidet could be used to reduce anal resting pressure in the same manner as the traditional warm sitz bath under the conditions of low or medium water jet pressure, a warm water temperature, and a wide type water jet.
Adult ; Anal Canal/physiology ; Female ; Humans ; Male ; Manometry ; Pressure ; Rectum/*physiology ; Temperature ; *Toilet Facilities ; Water

OBJECTIVESTo assess the tendency of manometric asymmetry, and to quantitatively evaluate the function of the anal sphincter.

METHODSUsing the PC polygram HR at the states of relax and squeeze, we compared the values of pressure asymmetry in the anorectum of 27 normal children with that of 12 children with fecal incontinence.

RESULTSIn the two states, the anal sphincter in normal children showed not only the gradient of pressure, but also a gradient of pressure asymmetry. Children with fecal incontinence did not show any gradients.

CONCLUSIONGradients of pressure and pressure asymmetry can quantitatively evaluate the function of the anal sphincter.

Adolescent ; Anal Canal ; physiology ; Child ; Child, Preschool ; Fecal Incontinence ; physiopathology ; Female ; Humans ; Male ; Manometry ; Rectum ; physiology

Adolescent ; Anal Canal ; physiopathology ; Child ; Constipation ; physiopathology ; Female ; Gastrointestinal Motility ; physiology ; Humans ; Male ; Rectum ; physiopathology

PURPOSE: Anorectal manometry is a way of investigation for anti-rectal sphincters. In this paper we evaluated the usefulness of anorectal manometry in constipation patients and compared the anal spnincter function in control, constipation and encopresis patients. METHOD: We analysed the data of anorectal function studies in normal children (control, n=11), children with constipation (constipation group, n=20) and children with encopresis (encopresis group, n=16). RESULTS: The specific manometric parameters in normal children were like as follows; external anal sphinter pressure 21.0+/-8.00 mmHg, internal anal sphicter pressure 30.0+/- 14.57 mmHg, conscious rectal sensitivity threshold 11.4+/-4.52 mmHg. The above results were not different from that of previous studies except conscious rectal sensitivity threshold, which was slightly lower than that of others. Internal and external anal sphincter pressure were elevated significantly in constipation and encopresis groups than in control, which results was the same in conscious rectal sensitivity threshold. But the values of rectoanal inhibitory threshold and percent relaxation of rectoanal inhibitory reflex were not different among control group, constipation group and encopresis group. External sphincter activity was increased during the act of bearing down for defecation in none of the child in control group, in 6 of 17 children in constipation group and 5 of 12 children in encopresis group. CONCLUSION: With the results of above we could say that complete history taking and physical examination are important in diagnosis of constipation, and we could say also that the anorectal manometry was a valuable tool to understand the physiology of normal defecation and the pathophysiology of constipation and encopresis.
Anal Canal ; Child* ; Constipation* ; Defecation ; Diagnosis ; Encopresis ; Humans ; Manometry* ; Physical Examination ; Physiology ; Reflex ; Relaxation

BACKGROUND/AIMS: The Anopress device is a new portable manometry system. The aim of this study is to formulate normative data using this new device by recording the anorectal function of asymptomatic subjects. Patient comfort was also assessed. METHODS: Anorectal function was assessed in asymptomatic volunteers using the Anopress. All volunteers were examined in a standardized way in accordance with the study protocol. Normative values for the Anopress were obtained from the recorded data and patient comfort was assessed using a visual analogue scale. RESULTS: We recruited 153 healthy volunteers. Eighty were female (23 parous; median age 39.5 [interquartile range {IQR}, 28.75–53.00]) and 73 were male (median age 40.5 [IQR, 29.00–52.25]). For the female cohort, the following normal range (2.5–97.5 percentile) values were recorded across the whole anal canal: resting pressure 40.0–103.0 mmHg; squeeze increment 35.0–140.6 mmHg; endurance 1.3–9.0 seconds; involuntary squeeze 41.1–120.8 mmHg; and strain pressure 22.1–77.9 mmHg. Similarly, the following male normal range (2.5–97.5 percentile) values were recorded across the whole anal canal: resting pressure 38.3–99.6 mmHg; squeeze increment 42.5–154.8 mmHg; involuntary squeeze 40.0–123.6 mmHg; endurance 2.0–10.0 seconds; and strain pressure 11.0–72.1 mmHg. The median visual analogue scale scores for discomfort during the measurement was 0.0 (IQR, 0.00–0.00). CONCLUSIONS: Normative values for the Anopress device have been calculated by this study. The Anopress appears to be a safe and well tolerated way of measuring pressures from the entire anal canal. Further comparisons with other standard and commonly used manometry tests are, however, required to verify its reliability.
Anal Canal ; Cohort Studies ; Female ; Healthy Volunteers ; Humans ; Male ; Manometry ; Physiology ; Reference Values ; Volunteers

PURPOSE: The aim was to evaluate the discriminating accuracy of anorectal manometry (ARM) between nonconstipated (NC) subjects and functionally constipated (FC) subjects, and between FC subjects with and without functional defecation disorder (FDD). METHODS: Among female patients who visited anorectal physiology unit, those who could be grouped to following categories were included; FC group with FDD (+FDD subgroup), or without FDD (−FDD subgroup) and NC group. ARM was performed and interpreted not only with absolute pressure values, but also pattern classification and quantification of pressure changes in the rectum and anus during attempted defecation. RESULTS: There were 76 subjects in NC group and 75 in FC group. Among FC group, 63 subjects were in −FDD subgroup and 12 in +FDD subgroup. In pattern classification of pressure changes, type 0, as ‘normal’ response, was only slightly more prevalent in NC group than in FC group. When all ‘abnormal’ types (types 1–5) were considered together as positive findings, the sensitivity and specificity of pattern classification in diagnosing FC among all subjects were 89.3% and 22.7%. Those values in diagnosing FDD among FC group were 91.7% and 11.1%. Manometric defecation index (MDI) as a quantification parameter was significantly different between −FDD and +FDD subgroups. Other conventional absolute pressures were mostly comparable between the groups. CONCLUSION: Among all parameters of ARM, MDI was useful to diagnose FDD in FC patients. Other parameters including the pattern classification were questionable in their ability to diagnose FDD.
Anal Canal ; Arm ; Classification ; Constipation ; Defecation* ; Female ; Humans ; Manometry* ; Physiology ; Rectum ; Sensitivity and Specificity

OBJECTIVETo investigate the change pattern of substance P (SP) in the portal vein during the rectoanal inhibitory reflex (RAIR), and its physiologic significance; the influence of external splanchnic nerve of rectum and anal to the RAIR.

METHODSThe rats were divided into seven groups, among them there were six groups, which were first divided into two big groups according to whether the external splanchnic nerve to the rectum and anal were cut off, one is no cut-off external splanchnic nerve group, the other is cut-off external splanchnic nerve group. Each group were further divided, according to the distance of the balloon-sac on Foley's tube in the rectum away from anal verge, into 2, 4, 6 centimeter groups; A control group with Foley's tube put into the rectum, but the balloon-sac on Foley's tube did not pumped up with water. Measure and compare the value and change of SP in the portal vein during the RAIR.

RESULTSThe comparison of SP in portal vein, among the 2, 4 centimeter groups with cut-off external splanchnic nerve, all groups with intact external splanchnic nerve supply and control group, had no statistic difference (P>0.05). The comparison between the 6 centimeter group with intact external splanchnic nerve group and the 2, 4 centimeter groups with cut-off external splanchnic nerve, P<0.01, the statistic difference was significant. The comparison between 6 centimeter group of intact and cut-off external splanchnic nerve, P<0.01, the difference was significant.

CONCLUSIONThe reason for the stimulation on upper rectum dose not induce the RAIR is related with this stimulation result in the release of SP, the exciting mediator to internal sphincter. The external splanchnic nerve supply of rectum and anal canal have influence on the change of SP of the portal vein during RAIR.

Anal Canal ; physiology ; Animals ; Female ; Male ; Portal Vein ; physiology ; Rats ; Rats, Sprague-Dawley ; Rectum ; physiology ; Substance P ; metabolism

AIMTo prove the hypothesis that cavernosus muscles' contraction during coitus affects the reflex contraction of anal sphincters.

METHODSElectromyographic response of external and internal anal sphincters to ischiocavernosus and bulbocavernosus muscle stimulation was studied in 17 healthy volunteers (10 men, 7 women, mean aged 38.3+/-11.6 years). The test was repeated after individual anesthetization of anal sphincters and the two cavernosus muscles, and after using saline instead of lidocaine.

RESULTSUpon stimulation of each of the two cavernosus muscles, external and internal anal sphincters recorded increased electromyographic activity. Anal sphincters did not respond to stimulation of the anesthetized cavernosus muscles nor did anesthetized anal sphincters respond to cavernosus muscles' stimulation. Saline infiltration did not affect anal sphincteric response to cavernosal muscles' stimulation.

CONCLUSIONCavernosus muscles' contraction is suggested to evoke anal sphincteric contraction, which seems to be a reflex and mediated through the "Cavernoso-anal reflex". Anal sphincteric contraction during coitus presumably acts to close the anal canal to thwart flatus or fecal leak.

Adult ; Anal Canal ; physiology ; Electric Stimulation ; Electromyography ; Female ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; physiology ; Reference Values ; Reflex ; physiology