Potential Pitfalls and Tips

Technical problems can occur with the catheters. Electronic catheters are fragile, and water-perfused catheters can give altered results if air bubbles are in the system. Occasionally, a channel records high pressures incorrectly due to either blockage by close apposition of the

Figure 8.9. Rectoanal inhibitory reflex. 1, channel 1; 2, channel 2; 3, balloon; 4, channel 4.

Figure 8.10. High-pressure zone. Typical longitudinal sphincter profile of a normal anal sphincter generated by a continuous pull-through technique. The high-pressure zone is defined by increase in pressure of 50% while the catheter is pulled out.

Figure 8.10. High-pressure zone. Typical longitudinal sphincter profile of a normal anal sphincter generated by a continuous pull-through technique. The high-pressure zone is defined by increase in pressure of 50% while the catheter is pulled out.

catheter to the anal wall or by stool particles. Often, a slight adjustment of the catheter will solve this problem. A lengthy investigation can modify pressures by the accumulation of water in the rectum. Eliciting the rectonal inhibitory reflex is sometimes difficult or impossible due to the rapid distention of the rectal wall, such as in patients with megarectum. Instead of eliciting the reflex, the too slow inflation will lead to repetitive relaxation of the internal anal sphincter.

Patient-dependent problems can occur during the squeeze phase. Often patients squeeze the buttocks rather than the anal sphincters, leading to erroneous results and catheter displacement. Furthermore, maximal squeeze pressures are strongly dependent on the patient's cooperation and effort.

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