Skip to main content
SpringerLink
Log in

Physiologic Testing

  • Chapter
  • First Online:
The ASCRS Textbook of Colon and Rectal Surgery

Abstract

Functional anorectal symptoms are common and affect all ages of the population.1 Normal anorectal physiologic function is complex and relies on a multiplicity of factors, including a intact anatomy and an intact link between somatic and visceral function of the anus rectum and colon. Consequently, a comprehensive evaluation of anorectal function demands a combination of several tests that complement each other. There is no single test that can comprehensively assess the function of the pelvic floor. In the clinical setting, physiologic testing should always be a complement to a proper patient history, physical examination, and frequently other tests including endoscopy and other imaging studies. The history may be complemented by use of questionnaires and quality of life instruments. The clinical utility of some physiologic testing is limited because of a lack of reference data from healthy individuals and lack of standardization.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Whitehead W, Wald A, Diamant N, Enck P, Pemberton J, Rao S. Functional disorders of the anus and rectum. Gut. 1999;45 Suppl 2:II55–9.

    PubMed  PubMed Central  Google Scholar 

  2. Diamant N, Kamm M, Wald A, Whitehead W. AGA technical review on anorectal testing techniques. Gastroenterology. 1999;116:735–60.

    CAS  PubMed  Google Scholar 

  3. Rao S, Hatfield R, Soffer E, Rao S, Beaty J, Conklin J. Manometric tests of anorectal function in healthy adults. Am J Gastroenterol. 1999;94:773–83.

    CAS  PubMed  Google Scholar 

  4. Scott S, Gladman M. Manometric, sensorimotor, and neurophysiologic evaluation of anorectal function. Gastroenterol Clin North Am. 2008;37:511–38. vii.

    PubMed  Google Scholar 

  5. Rao S, Azpiroz F, Diamant N, Enck P, Tougas G, Wald A. Minimum standards of anorectal manometry. Neurogastroenterol Motil. 2002;14:553–9.

    CAS  PubMed  Google Scholar 

  6. Corrazziari E. Anorectal manometry: a round table discussion. Gastroenterol Int. 1989;2:115–7.

    Google Scholar 

  7. Lestar B, Penninckx F, Kerremans R. The composition of anal basal pressure. An in vivo and in vitro study in man. Int J Colorectal Dis. 1989;4:118–22.

    CAS  PubMed  Google Scholar 

  8. Sun W, Rao S. Manometric assessment of anorectal function. Gastroenterol Clin North Am. 2001;30:15–32.

    CAS  PubMed  Google Scholar 

  9. Rasmussen O. Anorectal function. Dis Colon Rectum. 1994;37:386–403.

    CAS  PubMed  Google Scholar 

  10. Read N, Sun W. Anorectal manometry. In: Henry M, Swash M, editors. Coloproctology and the pelvic floor. Oxford: Butterworth-Heinemann Ltd; 1992. p. 119–45.

    Google Scholar 

  11. Lowry A, Simmang C, Boulos P, Farmer K, Finan P, Hyman N, et al. Consensus statement of definitions for anorectal physiology and rectal cancer: report of the tripartite consensus conference on definitions for anorectal physiology and rectal cancer, Washington, D.C., May 1, 1999. Dis Colon Rectum. 2001;44:915–9.

    CAS  PubMed  Google Scholar 

  12. Taylor B, Beart RJ, Phillips S. Longitudinal and radial variations of pressure in the human anal sphincter. Gastroenterology. 1984;86:693–7.

    CAS  PubMed  Google Scholar 

  13. Bharucha A. Fecal incontinence. Gastroenterology. 2003;124:1672–85.

    PubMed  Google Scholar 

  14. McHugh S, Diamant N. Anal canal pressure profile: a reappraisal as determined by rapid pullthrough technique. Gut. 1987;28:1234–41.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Read N, Harford W, Schmulen A, Read M, Santa Ana C, Fordtran J. A clinical study of patients with fecal incontinence and diarrhea. Gastroenterology. 1979;76:747–56.

    CAS  PubMed  Google Scholar 

  16. Hiltunen K. Anal manometric findings in patients with anal incontinence. Dis Colon Rectum. 1985;28:925–8.

    CAS  PubMed  Google Scholar 

  17. Telford K, Ali A, Lymer K, Hosker G, Kiff E, Hill J. Fatigability of the external anal sphincter in anal incontinence. Dis Colon Rectum. 2004;47:746–52. discussion 52.

    CAS  PubMed  Google Scholar 

  18. Marcello P, Barrett R, Coller J, Schoetz DJ, Roberts P, Murray J, et al. Fatigue rate index as a new measurement of external sphincter function. Dis Colon Rectum. 1998;41:336–43.

    CAS  PubMed  Google Scholar 

  19. Meunier P, Mollard P. Control of the internal anal sphincter (manometric study with human subjects). Pflugers Arch. 1977;370:233–9.

    CAS  PubMed  Google Scholar 

  20. Gowers W. The automatic action of the sphincter ani. Proc R Soc Lond. 1878;26:77–84.

    Google Scholar 

  21. Whitehead W, Orr W, Engel B, Schuster M. External anal sphincter response to rectal distention: learned response or reflex. Psychophysiology. 1982;19:57–62.

    CAS  PubMed  Google Scholar 

  22. Aaronson I, Nixon H. A clinical evaluation of anorectal pressure studies in the diagnosis of Hirschsprung’s disease. Gut. 1972;13:138–46.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Meunier P, Marechal J, Mollard P. Accuracy of the manometric diagnosis of Hirschsprung’s disease. J Pediatr Surg. 1978;13:411–5.

    CAS  PubMed  Google Scholar 

  24. Wu J, Schoetz DJ, Coller J, Veidenheimer M. Treatment of Hirschsprung’s disease in the adult. Report of five cases. Dis Colon Rectum. 1995;38:655–9.

    CAS  PubMed  Google Scholar 

  25. Azpiroz F, Enck P, Whitehead W. Anorectal functional testing: review of collective experience. Am J Gastroenterol. 2002;97:232–40.

    PubMed  Google Scholar 

  26. Sun W, Read N, Prior A, Daly J, Cheah S, Grundy D. Sensory and motor responses to rectal distention vary according to rate and pattern of balloon inflation. Gastroenterology. 1990;99:1008–15.

    CAS  PubMed  Google Scholar 

  27. Varma J, Smith A. Reproducibility of the proctometrogram. Gut. 1986;27:288–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Sun W, Read N, Miner P. Relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence. Gut. 1990;31:1056–61.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Chan C, Scott S, Williams N, Lunniss P. Rectal hypersensitivity worsens stool frequency, urgency, and lifestyle in patients with urge fecal incontinence. Dis Colon Rectum. 2005;48:134–40.

    PubMed  Google Scholar 

  30. Gladman M, Scott S, Chan C, Williams N, Lunniss P. Rectal hyposensitivity: prevalence and clinical impact in patients with intractable constipation and fecal incontinence. Dis Colon Rectum. 2003;46:238–46.

    PubMed  Google Scholar 

  31. Read N, Timms J, Barfield L, Donnelly T, Bannister J. Impairment of defecation in young women with severe constipation. Gastroenterology. 1986;90:53–60.

    CAS  PubMed  Google Scholar 

  32. Beck DE. A simplified balloon expulsion test. Dis Colon Rectum. 1992;35:597–8.

    CAS  PubMed  Google Scholar 

  33. Voderholzer W, Neuhaus D, Klauser A, Tzavella K, Müller-Lissner S, Schindlbeck N. Paradoxical sphincter contraction is rarely indicative of anismus. Gut. 1997;41:258–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Duthie G, Bartolo D. Anismus: the cause of constipation? Results of investigation and treatment. World J Surg. 1992;16:831–5.

    CAS  PubMed  Google Scholar 

  35. López A, Holmström B, Nilsson B, Dolk A, Johansson C, Schultz I, et al. Paradoxical sphincter reaction is influenced by rectal filling volume. Dis Colon Rectum. 1998;41:1017–22.

    PubMed  Google Scholar 

  36. Pezim M, Pemberton J, Levin K, Litchy W, Phillips S. Parameters of anorectal and colonic motility in health and in severe constipation. Dis Colon Rectum. 1993;36:484–91.

    CAS  PubMed  Google Scholar 

  37. Rao S. Diagnosis and management of fecal incontinence. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol. 2004;99:1585–604.

    PubMed  Google Scholar 

  38. Haynes W, Read N. Ano-rectal activity in man during rectal infusion of saline: a dynamic assessment of the anal continence mechanism. J Physiol. 1982;330:45–56.

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Read N, Haynes W, Bartolo D, Hall J, Read M, Donnelly T, et al. Use of anorectal manometry during rectal infusion of saline to investigate sphincter function in incontinent patients. Gastroenterology. 1983;85:105–13.

    CAS  PubMed  Google Scholar 

  40. Henry M, Parks A, Swash M. The pelvic floor musculature in the descending perineum syndrome. Br J Surg. 1982;69:470–2.

    CAS  PubMed  Google Scholar 

  41. Oettle G, Roe A, Bartolo D, Mortensen N. What is the best way of measuring perineal descent? A comparison of radiographic and clinical methods. Br J Surg. 1985;72:999–1001.

    CAS  PubMed  Google Scholar 

  42. Cheong D, Vaccaro C, Salanga V, Wexner S, Phillips R, Hanson M, et al. Electrodiagnostic evaluation of fecal incontinence. Muscle Nerve. 1995;18:612–9.

    CAS  PubMed  Google Scholar 

  43. Hill J, Hosker G, Kiff E. Pudendal nerve terminal motor latency measurements: what they do and do not tell us. Br J Surg. 2002;89:1268–9.

    CAS  PubMed  Google Scholar 

  44. Wexner S, Marchetti F, Salanga V, Corredor C, Jagelman D. Neurophysiologic assessment of the anal sphincters. Dis Colon Rectum. 1991;34:606–12.

    CAS  PubMed  Google Scholar 

  45. Bharucha A. Outcome measures for fecal incontinence: anorectal structure and function. Gastroenterology. 2004;126:S90–8.

    PubMed  Google Scholar 

  46. Rasmussen O, Christiansen J, Tetzschner T, Sørensen M. Pudendal nerve function in idiopathic fecal incontinence. Dis Colon Rectum. 2000;43:633–6. discussion 6–7.

    CAS  PubMed  Google Scholar 

  47. Madoff R, Parker S, Varma M, Lowry A. Faecal incontinence in adults. Lancet. 2004;364:621–32.

    PubMed  Google Scholar 

  48. Scott M, Lunniss P. Investigations of anorectal function. London: Springer London; 2007.

    Google Scholar 

  49. Swash M. Electromyography in pelvic floor disorders. 2nd ed. Oxford: Butterworth-Heinemann Ltd; 1992.

    Google Scholar 

  50. Sørensen M, Tetzschner T, Rasmussen O, Christiansen J. Relation between electromyography and anal manometry of the external anal sphincter. Gut. 1991;32:1031–4.

    PubMed  PubMed Central  Google Scholar 

  51. Pinho M, Hosie K, Bielecki K, Keighley M. Assessment of noninvasive intra-anal electromyography to evaluate sphincter function. Dis Colon Rectum. 1991;34:69–71.

    CAS  PubMed  Google Scholar 

  52. Neill M, Swash M. Increased motor unit fibre density in the external anal sphincter muscle in ano-rectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psychiatry. 1980;43:343–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  53. Rogers J, Laurberg S, Misiewicz J, Henry M, Swash M. Anorectal physiology validated: a repeatability study of the motor and sensory tests of anorectal function. Br J Surg. 1989;76:607–9.

    CAS  PubMed  Google Scholar 

  54. Bartolo D, Jarratt J, Read M, Donnelly T, Read N. The role of partial denervation of the puborectalis in idiopathic faecal incontinence. Br J Surg. 1983;70:664–7.

    CAS  PubMed  Google Scholar 

  55. Rogers J, Levy D, Henry M, Misiewicz J. Pelvic floor neuropathy: a comparative study of diabetes mellitus and idiopathic faecal incontinence. Gut. 1988;29:756–61.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. Womack N, Morrison J, Williams N. The role of pelvic floor denervation in the aetiology of idiopathic faecal incontinence. Br J Surg. 1986;73:404–7.

    CAS  PubMed  Google Scholar 

  57. Infantino A, Melega E, Negrin P, Masin A, Carnio S, Lise M. Striated anal sphincter electromyography in idiopathic fecal incontinence. Dis Colon Rectum. 1995;38:27–31.

    CAS  PubMed  Google Scholar 

  58. Burnett S, Speakman C, Kamm M, Bartram C. Confirmation of endosonographic detection of external anal sphincter defects by simultaneous electromyographic mapping. Br J Surg. 1991;78:448–50.

    CAS  PubMed  Google Scholar 

  59. Sultan A, Kamm M, Talbot I, Nicholls R, Bartram C. Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg. 1994;81:463–5.

    CAS  PubMed  Google Scholar 

  60. Law P, Kamm M, Bartram C. A comparison between electromyography and anal endosonography in mapping external anal sphincter defects. Dis Colon Rectum. 1990;33:370–3.

    CAS  PubMed  Google Scholar 

  61. Felt-Bersma R, van Baren R, Koorevaar M, Strijers R, Cuesta M. Unsuspected sphincter defects shown by anal endosonography after anorectal surgery. A prospective study. Dis Colon Rectum. 1995;38:249–53.

    CAS  PubMed  Google Scholar 

  62. Felt-Bersma R, Cuesta M, Koorevaar M, Strijers R, Meuwissen S, Dercksen E, et al. Anal endosonography: relationship with anal manometry and neurophysiologic tests. Dis Colon Rectum. 1992;35:944–9.

    CAS  PubMed  Google Scholar 

  63. Tjandra J, Milsom J, Schroeder T, Fazio V. Endoluminal ultrasound is preferable to electromyography in mapping anal sphincteric defects. Dis Colon Rectum. 1993;36:689–92.

    CAS  PubMed  Google Scholar 

  64. Enck P, von Giesen H, Schäfer A, Heyer T, Gantke B, Flesch S, et al. Comparison of anal sonography with conventional needle electromyography in the evaluation of anal sphincter defects. Am J Gastroenterol. 1996;91:2539–43.

    CAS  PubMed  Google Scholar 

  65. Deen K, Kumar D, Williams J, Olliff J, Keighley M. Anal sphincter defects. Correlation between endoanal ultrasound and surgery. Ann Surg. 1993;218:201–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  66. Sentovich S, Wong W, Blatchford G. Accuracy and reliability of transanal ultrasound for anterior anal sphincter injury. Dis Colon Rectum. 1998;41:1000–4.

    CAS  PubMed  Google Scholar 

  67. Emblem R, Dhaenens G, Stien R, Mørkrid L, Aasen A, Bergan A. The importance of anal endosonography in the evaluation of idiopathic fecal incontinence. Dis Colon Rectum. 1994;37:42–8.

    CAS  PubMed  Google Scholar 

  68. Cazemier M, Terra M, Stoker J, de Lange de Klerk E, Boeckxstaens G, Mulder C, et al. Atrophy and defects detection of the external anal sphincter: comparison between three-dimensional anal endosonography and endoanal magnetic resonance imaging. Dis Colon Rectum. 2006;49:20–7.

    PubMed  Google Scholar 

  69. Engel A, Kamm M, Sultan A, Bartram C, Nicholls R. Anterior anal sphincter repair in patients with obstetric trauma. Br J Surg. 1994;81:1231–4.

    CAS  PubMed  Google Scholar 

  70. Sultan A, Kamm M, Hudson C, Bartram C. Third degree obstetric anal sphincter tears: risk factors and outcome of ­primary repair. BMJ. 1994;308:887–91.

    CAS  PubMed  PubMed Central  Google Scholar 

  71. Dobben A, Terra M, Deutekom M, Slors J, Janssen L, Bossuyt P, et al. The role of endoluminal imaging in clinical outcome of overlapping anterior anal sphincter repair in patients with fecal incontinence. AJR Am J Roentgenol. 2007;189:W70–7.

    PubMed  Google Scholar 

  72. Terra M, Beets-Tan R, van der Hulst V, Dijkgraaf M, Bossuyt P, Dobben A, et al. Anal sphincter defects in patients with fecal incontinence: endoanal versus external phased-array MR imaging. Radiology. 2005;236:886–95.

    PubMed  Google Scholar 

  73. Terra M, Beets-Tan R, van der Hulst V, Deutekom M, ­Dijkgraaf M, Bossuyt P, et al. MRI in evaluating atrophy of the external anal sphincter in patients with fecal incontinence. AJR Am J Roentgenol. 2006;187:991–9.

    PubMed  Google Scholar 

  74. Ekberg O, Nylander G, Fork F. Defecography. Radiology. 1985;155:45–8.

    CAS  PubMed  Google Scholar 

  75. Mahieu P, Pringot J, Bodart P. Defecography: I. Description of a new procedure and results in normal patients. Gastrointest Radiol. 1984;9:247–51.

    CAS  PubMed  Google Scholar 

  76. Mahieu P, Pringot J, Bodart P. Defecography: II. Contribution to the diagnosis of defecation disorders. Gastrointest Radiol. 1984;9:253–61.

    CAS  PubMed  Google Scholar 

  77. Bremmer S, Mellgren A, Holmström B, Udén R. Peritoneocele and enterocele. Formation and transformation during rectal evacuation as studied by means of defaeco-peritoneography. Acta Radiol. 1998;39:167–75.

    CAS  PubMed  Google Scholar 

  78. Bremmer S, Mellgren A, Holmström B, López A, Udén R. Peritoneocele: visualization with defecography and peritoneography performed simultaneously. Radiology. 1997;202:373–7.

    CAS  PubMed  Google Scholar 

  79. Schouten W, Briel J, Auwerda J, van Dam J, Gosselink M, Ginai A, et al. Anismus: fact or fiction? Dis Colon Rectum. 1997;40:1033–41.

    CAS  PubMed  Google Scholar 

  80. Müller-Lissner S, Bartolo D, Christiansen J, Ekberg O, Goei R, Höpfner W, et al. Interobserver agreement in defecography – an international study. Z Gastroenterol. 1998;36:273–9.

    PubMed  Google Scholar 

  81. Ferrante S, Perry R, Schreiman J, Cheng S, Frick M. The reproducibility of measuring the anorectal angle in defecography. Dis Colon Rectum. 1991;34:51–5.

    CAS  PubMed  Google Scholar 

  82. Mellgren A, Bremmer S, Johansson C, Dolk A, Udén R, ­Ahlbäck S, et al. Defecography. Results of investigations in 2,816 patients. Dis Colon Rectum. 1994;37:1133–41.

    CAS  PubMed  Google Scholar 

  83. Shorvon P, McHugh S, Diamant N, Somers S, Stevenson G. Defecography in normal volunteers: results and implications. Gut. 1989;30:1737–49.

    CAS  PubMed  PubMed Central  Google Scholar 

  84. Penninckx F, Debruyne C, Lestar B, Kerremans R. Observer variation in the radiological measurement of the anorectal angle. Int J Colorectal Dis. 1990;5:94–7.

    CAS  PubMed  Google Scholar 

  85. Halligan S, Bartram C, Park H, Kamm M. Proctographic features of anismus. Radiology. 1995;197:679–82.

    CAS  PubMed  Google Scholar 

  86. Bremmer S, Udén R, Mellgren A. Defaeco-peritoneography in the diagnosis of rectal intussusception and rectal prolapse. Acta Radiol. 1997;38:578–83.

    CAS  PubMed  Google Scholar 

  87. Bremmer S. Peritoneocele. A radiological study with defaeco-peritoneography. Acta Radiol Suppl. 1998;413:1–33.

    CAS  PubMed  Google Scholar 

  88. Jorge JM, Yang YK, Wexner SD. Incidence and clinical significance of sigmoidoceles as determined by a new classification system. Dis Colon Rectum. 1994;37(11):1112–7.

    CAS  PubMed  Google Scholar 

  89. Vanbeckevoort D, Van Hoe L, Oyen R, Ponette E, De ­Ridder D, Deprest J. Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. J Magn Reson Imaging. 1999;9:373–7.

    CAS  PubMed  Google Scholar 

  90. Bharucha A. Update of tests of colon and rectal structure and function. J Clin Gastroenterol. 2006;40:96–103.

    PubMed  Google Scholar 

  91. Fielding J, Griffiths D, Versi E, Mulkern R, Lee M, Jolesz F. MR imaging of pelvic floor continence mechanisms in the supine and sitting positions. AJR Am J Roentgenol. 1998;171:1607–10.

    CAS  PubMed  Google Scholar 

  92. Hetzer F, Andreisek G, Tsagari C, Sahrbacher U, Weishaupt D. MR defecography in patients with fecal incontinence: imaging findings and their effect on surgical management. Radiology. 2006;240:449–57.

    PubMed  Google Scholar 

  93. Lamb G, de Jode M, Gould S, Spouse E, Birnie K, Darzi A, et al. Upright dynamic MR defaecating proctography in an open configuration MR system. Br J Radiol. 2000;73:152–5.

    CAS  PubMed  Google Scholar 

  94. Roos J, Weishaupt D, Wildermuth S, Willmann J, Marincek B, Hilfiker P. Experience of 4 years with open MR defecography: pictorial review of anorectal anatomy and disease. Radiographics. 2002;22:817–32.

    PubMed  Google Scholar 

  95. Bharucha A, Fletcher J, Seide B, Riederer S, Zinsmeister A. Phenotypic variation in functional disorders of defecation. Gastroenterology. 2005;128:1199–210.

    PubMed  Google Scholar 

  96. Shafik A. Recto-colic reflex: role in the defecation mechanism. Int Surg. 1996;81:292–4.

    CAS  PubMed  Google Scholar 

  97. Martelli H, Devroede G, Arhan P, Duguay C, Dornic C, ­Faverdin C. Some parameters of large bowel motility in normal man. Gastroenterology. 1978;75:612–8.

    CAS  PubMed  Google Scholar 

  98. Metcalf A, Phillips S, Zinsmeister A, MacCarty R, Beart R, Wolff B. Simplified assessment of segmental colonic transit. Gastroenterology. 1987;92:40–7.

    CAS  PubMed  Google Scholar 

  99. Jorge JM, Wexner SD, Ehrenpreis ED. The lactulose hydrogen breath test as a measure of orocaecal transit time. Eur J Surg. 1994;160(8):409–16.

    CAS  PubMed  Google Scholar 

  100. Lundin E, Karlbom U, Westlin J, Kairemo K, Jung B, Husin S, et al. Scintigraphic assessment of slow transit constipation with special reference to right- or left-sided colonic delay. Colorectal Dis. 2004;6:499–505.

    CAS  PubMed  Google Scholar 

  101. Maqbool S, Parkman H, Friedenberg F. Wireless capsule motility: comparison of the SmartPill GI monitoring system with scintigraphy for measuring whole gut transit. Dig Dis Sci. 2009;54:2167–74.

    PubMed  Google Scholar 

  102. Rao SS, Kuo B, McCallum RW, Chey WD, Dibaise JK, Hasler WL, et al. Investigation of colonic and whole gut transit with wireless motility capsule and radioopaque markers in constipation. Clin Gastroenterol Hepatol. 2009;7:537–44.

    PubMed  Google Scholar 

Download references

Acknowledgments.

This chapter was written by Lee E. Smith and Garnet J. Blatchford in the first edition of this textbook.

Author information

Authors and Affiliations

  1. Director, Department of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA

    Anders F. Mellgren MD, PhD

  2. Pelvic Floor Center, Minneapolis, MN, USA

    Anders F. Mellgren MD, PhD

Authors
  1. Anders F. Mellgren MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Colon and Rectal Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA

    David E. Beck MD, FACS, FASCRS

  2. Department of Colorectal Surgery, Lahey Clinic, Tufts University School of Medicine, Burlington, Massachusetts, USA

    Patricia L. Roberts MD, FACS, FASCRS

  3. Section of Colon and Rectal Surgery, Rush Medical Center, Chicago, Illinois, USA

    Theodore J. Saclarides MD, FACS, FASCRS

  4. Department of Surgery, Spectrum Health, Grand Rapids, Michigan, USA

    Anthony J. Senagore MD, FACS, FASCRS

  5. Department of Surgery, UCI Medical Center, Orange, California, USA

    Michael J. Stamos MD, FACS, FASCRS

  6. Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA

    Steven D. Wexner MD, FACS, FASCRS, FRCS, FRCS(Ed)

Rights and permissions

Reprints and permissions

Copyright information

© 2011 ASCRS (American Society of Colon and Rectal Surgeons)

About this chapter

Cite this chapter

Mellgren, A.F. (2011). Physiologic Testing. In: Beck, D.E., Roberts, P.L., Saclarides, T.J., Senagore, A.J., Stamos, M.J., Wexner, S.D. (eds) The ASCRS Textbook of Colon and Rectal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1584-9_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-1584-9_4

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-1581-8

  • Online ISBN: 978-1-4419-1584-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation