Prior to undergoing anorectal manometry, patients are well informed regarding the need for this evaluation and are given an explanation of the technique. It is very important to let patients know that the investigation is relatively painless and that active participation is necessary to achieve accurate results. The test can usually be performed within 30 to 45 minutes. Patients are instructed to take one to two sodium phosphate enemas 2 hours prior to the evalua-tion.21 This cleansing is especially important in constipated patients, as the presence of large amounts of fecal content in the rectum impairs adequate positioning of the catheters.
Digital examination can jeopardize accurate pressure measurements; therefore, it should not be performed prior to anorectal manometry.22 The patient is placed in the left lateral decubitus position with knees and hips flexed. The manometry equipment is calibrated and the lubricated catheter inserted to the 6-cm marker. After equilibration of the system, the stationary manual pull-through technique is applied. At 1-cm intervals, resting, squeeze, and push pressures are recorded for 30 seconds. Furthermore, pressures during coughing are noted to assess the reflex activity of the external anal sphincter. An automatic continuous pull-through technique is then applied. The rectoanal inhibitory
reflex is elicited by rapid inflation of a rectal balloon while the catheter is placed in the high pressure zone (Fig. 8.9).
Sensibility, urge, and rectal volume testing by inflating the rectal balloon with water are the next steps. Finally, compliance can be calculated by comparing the pressure rise with the volume of fluid used.
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