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Pediatric Neurogastroenterology pp 117–128Cite as

Anorectal Manometry

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Abstract

Over the years, there has been progress in the available technology to perform anorectal manometry. For decades, the test had been executed using water-perfusion and sleeve catheter systems. In the past few years, there has been the introduction of both the high-resolution manometry (HRARM) and the 3D high-definition manometry (3DARM or 3DHDM), presenting us the ability to better investigate anorectal dynamics. We are now just beginning to elucidate how these newer systems may be used to expand our understanding, diagnosis, and treatment of patients with defecation disorders, particularly in pediatrics.

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References

  1. Loening-Baucke V. Constipation in children. Curr Opin Pediatr. 1994;6(5):556–61.

    Article  CAS  PubMed  Google Scholar 

  2. Bharucha AE, Pemberton JH, Locke GR. American gastroenterological association technical review on constipation. Gastroenterology. 2013;144(1):218–38.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bharucha AE. Pelvic floor: anatomy and function. Neurogastroenterol Motil. 2006;18(7):507–19.

    Article  CAS  PubMed  Google Scholar 

  4. Padda BS, Jung SA, Pretorius D, et al. Effects of pelvic floor muscle contraction on anal canal pressure. Am J Physiol Gastrointest Liver Physiol. 2007;292(2):G565–71.

    Article  CAS  PubMed  Google Scholar 

  5. Jorge JM, Wexner SD. Anatomy and physiology of the rectum and anus. Eur J Surg. 1997;163(10):723–31.

    CAS  PubMed  Google Scholar 

  6. Fritsch H, Brenner E, Lienemann A, et al. Anal sphincter complex: reinterpreted morphology and its clinical relevance. Dis Colon Rectum. 2002;45(2):188–94.

    Article  PubMed  Google Scholar 

  7. Kumar S, Ramadan S, Gupta V, et al. Manometric tests of anorectal function in 90 healthy children: a clinical study from Kuwait. J Pediatr Surg. 2009;44(9):1786–90.

    Article  PubMed  Google Scholar 

  8. Bajwa A, Emmanuel A. The physiology of continence and evacuation. Best Pract Res Clin Gastroenterol. 2009;23(4):477–85.

    Article  PubMed  Google Scholar 

  9. Penninckx F, Lestar B, Kerremans R. The internal anal sphincter: mechanisms of control and its role in maintaining anal continence. Baillieres Clin Gastroenterol. 1992;6(1):193–214.

    Article  CAS  PubMed  Google Scholar 

  10. Benninga MA, Wijers OB, van der Hoeven CW, et al. Manometry, profilometry, and endosonography: normal physiology and anatomy of the anal canal in healthy children. J Pediatr Gastroenterol Nutr. 1994;18(1):68–77.

    Article  CAS  PubMed  Google Scholar 

  11. Liu J, Guaderrama N, Nager CW, et al. Functional correlates of anal canal anatomy: puborectalis muscle and anal canal pressure. Am J Gastroenterol. 2006;101(5):1092–7.

    Article  PubMed  Google Scholar 

  12. Raizada V, Bhargava V, Karsten A, et al. Functional morphology of anal sphincter complex unveiled by high definition anal manometry and three dimensional ultrasound imaging. Neurogastroenterol Motil. 2011;23(11):1013–9.e460.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Lee YY, Erdogan A. Rao SS High resolution and high definition anorectal manometry and pressure topography: diagnostic advance or a new kid on the block? Curr Gastroenterol Rep. 2013;15(12):360.

    Article  PubMed  Google Scholar 

  14. Ambartsumyan L, Rodriguez L, Morera C, et al. Longitudinal and radial characteristics of intra-anal pressures in children using 3D high-definition anorectal manometry: new observations. Am J Gastroenterol. 2013;108(12):1918–28.

    Article  PubMed  Google Scholar 

  15. Lee TH, Bharucha AE. How to perform and interpret a high-resolution anorectal manometry test. J Neurogastroenterol Motil. 2016;22(1):46–59.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Di Lorenzo C, Hillemeier C, Hyman P, et al. Manometry studies in children: minimum standards for procedures. Neurogastroenterol Motil. 2002;14(4):411–20.

    Article  PubMed  Google Scholar 

  17. Soh JS, Lee HJ, Jung KW, et al. The diagnostic value of a digital rectal examination compared with high-resolution anorectal manometry in patients with chronic constipation and fecal incontinence. Am J Gastroenterol. 2015;110(8):1197–204.

    Article  PubMed  Google Scholar 

  18. Heinrich H, Fruehauf H, Sauter M, et al. The effect of standard compared to enhanced instruction and verbal feedback on anorectal manometry measurements. Neurogastroenterol Motil. 2013;25(3):230–7.e163.

    Article  CAS  PubMed  Google Scholar 

  19. Pfefferkorn MD, Croffie JM, Corkins MR, et al. Impact of sedation and anesthesia on the rectoanal inhibitory reflex in children. J Pediatr Gastroenterol Nutr. 2004;38(3):324–7.

    Article  PubMed  Google Scholar 

  20. Tran K, Kuo B, Zibaitis A, et al. Effect of propofol on anal sphincter pressure during anorectal manometry. J Pediatr Gastroenterol Nutr. 2014;58(4):495–7.

    Article  CAS  PubMed  Google Scholar 

  21. Keshtgar AS, Choudhry MS, Kufeji D, et al. Anorectal manometry with and without ketamine for evaluation of defecation disorders in children. J Pediatr Surg. 2015;50(3):438–43.

    Article  CAS  PubMed  Google Scholar 

  22. Scott SM, Gladman MA. Manometric, sensorimotor, and neurophysiologic evaluation of anorectal function. Gastroenterol Clin North Am. 2008;37(3):511–38, vii.

    Article  PubMed  Google Scholar 

  23. Belkind-Gerson J, Surjanhata B, Kuo B, et al. Bear-down maneuver is a useful adjunct in the evaluation of children with chronic constipation. J Pediatr Gastroenterol Nutr. 2013;57(6):775–9.

    Article  PubMed  Google Scholar 

  24. Xu C, Zhao R, Conklin JL, et al. Three-dimensional high-resolution anorectal manometry in the diagnosis of paradoxical puborectalis syndrome compared with healthy adults: a retrospective study in 79 cases. Eur J Gastroenterol Hepatol. 2014;26(6):621–9.

    PubMed  Google Scholar 

  25. Belkind-Gerson J, Goldstein AM, Kuo B. Balloon expulsion test as a screen for outlet obstruction in children with chronic constipation. J Pediatr Gastroenterol Nutr. 2013;56(1):23–6.

    Article  PubMed  Google Scholar 

  26. Hyman PE, Milla PJ, Benninga MA, et al. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2006;130(5):1519–26.

    Article  PubMed  Google Scholar 

  27. Li ZH, Dong M. Wang ZF Functional constipation in children: investigation and management of anorectal motility. World J Pediatr. 2008;4(1):45–8.

    Article  PubMed  Google Scholar 

  28. Sutphen J, Borowitz S, Ling W, et al. Anorectal manometric examination in encopretic-constipated children. Dis Colon Rectum. 1997;40(9):1051–5.

    Article  CAS  PubMed  Google Scholar 

  29. Benninga MA, Omari TI, Haslam RR, et al. Characterization of anorectal pressure and the anorectal inhibitory reflex in healthy preterm and term infants. J Pediatr. 2001;139(2):233–7.

    Article  CAS  PubMed  Google Scholar 

  30. de Lorijn F, Omari TI, Kok JH, et al. Maturation of the rectoanal inhibitory reflex in very premature infants. J Pediatr. 2003;143(5):630–3.

    Article  PubMed  Google Scholar 

  31. Tang YF, Chen JG, An HJ, et al. High-resolution anorectal manometry in newborns: normative values and diagnostic utility in Hirschsprung disease. Neurogastroenterol Motil. 2014;26(11):1565–72.

    Article  PubMed  Google Scholar 

  32. Banasiuk M, Banaszkiewicz A, Dziekiewicz M, et al. Values from 3-dimensional high-resolution anorectal manometry analysis of children without lower gastrointestinal symptoms. Clin Gastroenterol Hepatol. 2016;14(7):993–1000.e3. doi:10.1016/j.cgh.2016.01.008.

    Article  PubMed  Google Scholar 

  33. Carrington EV, Grossi U, Knowles CH, et al. Normal values for high-resolution anorectal manometry: a time for consensus and collaboration. Neurogastroenterol Motil. 2014;26(9):1356–7.

    Article  CAS  PubMed  Google Scholar 

  34. Lee HJ, Jung KW, Han S, et al. Normal values for high-resolution anorectal manometry/topography in a healthy Korean population and the effects of gender and body mass index. Neurogastroenterol Motil. 2014;26(4):529–37.

    Article  CAS  PubMed  Google Scholar 

  35. Li Y, Yang X, Xu C, et al. Normal values and pressure morphology for three-dimensional high-resolution anorectal manometry of asymptomatic adults: a study in 110 subjects. Int J Colorectal Dis. 2013;28(8):1161–8.

    Article  PubMed  Google Scholar 

  36. Noelting J, Ratuapli SK, Bharucha AE, et al. Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient. Am J Gastroenterol. 2012;107(10):1530–6.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Coss-Adame E, Rao SS, Valestin J, et al. Accuracy and reproducibility of high-definition anorectal manometry and pressure topography analyses in healthy subjects. Clin Gastroenterol Hepatol. 2015;13(6):1143–50.e1.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Noviello C, Cobellis G, Romano M, et al. Diagnosis of Hirschsprung’s disease: an age-related approach in children below or above one year. Colorectal Dis. 2010;12(10):1044–8.

    Article  CAS  PubMed  Google Scholar 

  39. de Lorijn F, Kremer LC, Reitsma JB, et al. Diagnostic tests in Hirschsprung disease: a systematic review. J Pediatr Gastroenterol Nutr. 2006;42(5):496–505.

    Article  PubMed  Google Scholar 

  40. Banasiuk M, Banaszkiewicz A, Piotrowski D, et al. 3D high-definition manometry in evaluation of children after surgery for Hirschsprung’s disease: a pilot study. Adv Med Sci. 2015;61(1):18–22.

    Article  PubMed  Google Scholar 

  41. Wildhaber BE, Pakarinen M, Rintala RJ, et al. Posterior myotomy/myectomy for persistent stooling problems in Hirschsprung’s disease. J Pediatr Surg. 2004;39(6):920–6; discussion 20–6.

    Article  PubMed  Google Scholar 

  42. Koivusalo AI, Pakarinen MP, Rintala RJ. Botox injection treatment for anal outlet obstruction in patients with internal anal sphincter achalasia and Hirschsprung’s disease. Pediatr Surg Int. 2009;25(10):873–6.

    Article  CAS  PubMed  Google Scholar 

  43. Neilson IR, Yazbeck S. Ultrashort Hirschsprung’s disease: myth or reality. J Pediatr Surg. 1990;25(11):1135–8.

    Article  CAS  PubMed  Google Scholar 

  44. Doodnath R, Puri P. Internal anal sphincter achalasia. Semin Pediatr Surg. 2009;18(4):246–8.

    Article  PubMed  Google Scholar 

  45. Chumpitazi BP, Fishman SJ, Nurko S. Long-term clinical outcome after botulinum toxin injection in children with nonrelaxing internal anal sphincter. Am J Gastroenterol. 2009;104(4):976–83.

    Article  CAS  PubMed  Google Scholar 

  46. Doodnath R, Puri P. Long-term outcome of internal sphincter myectomy in patients with internal anal sphincter achalasia. Pediatr Surg Int. 2009;25(10):869–71.

    Article  PubMed  Google Scholar 

  47. Lecointe-Besancon I, Leroy F, Devroede G, et al. A comparative study of esophageal and anorectal motility in myotonic dystrophy. Dig Dis Sci. 1999;44(6):1090–9.

    Article  CAS  PubMed  Google Scholar 

  48. Tabbers MM, DiLorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58(2):258–74.

    Article  CAS  PubMed  Google Scholar 

  49. Caldaro T, Romeo E, De Angelis P, et al. Three-dimensional endoanal ultrasound and anorectal manometry in children with anorectal malformations: new discoveries. J Pediatr Surg. 2012;47(5):956–63.

    Article  PubMed  Google Scholar 

  50. Siddiqui A, Rosen R, Nurko S. Anorectal manometry may identify children with spinal cord lesions. J Pediatr Gastroenterol Nutr. 2011;53(5):507–11.

    PubMed  Google Scholar 

  51. Raghunath N, Glassman MS, Halata MS, et al. Anorectal motility abnormalities in children with encopresis and chronic constipation. J Pediatr. 2011;158(2):293–6.

    Article  PubMed  Google Scholar 

  52. Feinberg L, Mahajan L, Steffen R. The constipated child: is there a correlation between symptoms and manometric findings? J Pediatr Gastroenterol Nutr. 2008;47(5):607–11.

    Article  PubMed  Google Scholar 

  53. Keshtgar AS, Ward HC, Clayden GS. Pathophysiology of chronic childhood constipation: functional and morphological evaluation by anorectal manometry and endosonography and colonic transit study. J Pediatr Surg. 2013;48(4):806–12.

    Article  PubMed  Google Scholar 

  54. Rao SS, Welcher KD. Leistikow JS Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol. 1998;93(7):1042–50.

    Article  CAS  PubMed  Google Scholar 

  55. Bharucha AE. Difficult defecation: difficult problem assessment and management; what really helps? Gastroenterol Clin North Am. 2011;40(4):837–44.

    Article  PubMed  Google Scholar 

  56. Bharucha AE, Fletcher JG, Seide B, et al. Phenotypic variation in functional disorders of defecation. Gastroenterology. 2005;128(5):1199–210.

    Article  PubMed  Google Scholar 

  57. Bharucha AE. Rao SS An update on anorectal disorders for gastroenterologists. Gastroenterology. 2014;146(1):37–45.e2.

    Article  PubMed  Google Scholar 

  58. Ratuapli SK, Bharucha AE, Noelting J, et al. Phenotypic identification and classification of functional defecatory disorders using high-resolution anorectal manometry. Gastroenterology. 2013;144(2):314–22.e2.

    Article  PubMed  Google Scholar 

  59. Grossi U, Carrington EV, Bharucha AE, et al. Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defecation. Gut. 2016;65(3):447–55. doi:10.1136/gutjnl-2014-308835.

    Article  PubMed  Google Scholar 

  60. Rao SS, Benninga MA, Bharucha AE, et al. ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders. Neurogastroenterol Motil. 2015;27(5):594–609.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pediatric Neurogastroenterology, MassGeneral Hospital for Children, Boston, MA, USA

    Claire Zar-Kessler M.D.

  2. Department of Pediatric Neurogastroenterology and Motility Program, MassGeneral Hospital for Children, Boston, MA, USA

    Jaime Belkind-Gerson M.D. M.Sc.

Authors
  1. Claire Zar-Kessler M.D.
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  2. Jaime Belkind-Gerson M.D. M.Sc.
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Corresponding author

Correspondence to Claire Zar-Kessler M.D. .

Editor information

Editors and Affiliations

  1. Division of Pediatric Gastroenterology Hepatology and Nutrition, CHU Sainte-Justine, Montreal, Québec, Canada

    Christophe Faure

  2. Department of Paediatric Gastroenterology, UCL Institute of Child Health, London, United Kingdom

    Nikhil Thapar

  3. Division of Pediatric Gastroenterology Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, Ohio, USA

    Carlo Di Lorenzo

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© 2017 Springer International Publishing Switzerland

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Zar-Kessler, C., Belkind-Gerson, J. (2017). Anorectal Manometry. In: Faure, C., Thapar, N., Di Lorenzo, C. (eds) Pediatric Neurogastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-319-43268-7_10

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  • DOI: https://doi.org/10.1007/978-3-319-43268-7_10

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  • Online ISBN: 978-3-319-43268-7

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