The anorectal manometry procedure, or ARM, is used to evaluate the contractility of a patientâ€™s anus and rectum. This is a common test for the diagnosis and assessment of bowel movement issues such as constipation or fecal incontinence.
Preparing for a Manometry Procedure
Patients are typically required to take an enema several hours before undergoing an anorectal manometry in order to help clear fecal matter from the intestine. Eating is restricted immediately before the test as well.
The Manometry Procedure
The anorectal manometry procedure involves the use of a flexible tube that contains a small balloon at one end. This device is attached to a machine that measures pressure after the catheter is inserted into the rectum. The balloon is then slowly and carefully inflated to various sizes. This allows the machine to measure the actions of the anal sphincter muscle and its varying pressure when it is flexed and relaxed, as well as the patientâ€™s resting anal pressure.
The anal sphincter muscle helps to control bowel movements and prevent uncontrolled leakage of stool. Patients may be asked to squeeze, relax or tighten their sphincter muscles during the test. An anorectal manometry typically lasts for approximately 30 to 45 minutes. The procedure can be performed on both children and adults.
Risks of a Manometry Procedure
Anorectal manometry is considered a safe procedure with low risk of complications. The risks that may be associated with anorectal manometry include bleeding in the rectum or a tear in the rectal tissue.
An ultrasound is a fast, painless imaging technique that produces images of the internal organs through the use of high-frequency sound waves. Anal ultrasounds help to identify the integrity of anal sphincters and plan the selection of many treatments for anal incontinence and other benign conditions.
An ultrasound is a noninvasive, simple procedure that can produce images of the soft tissues, which often do not show up well on X-rays. There is no ionizing radiation used during this procedure and no serious side effects. Rectal ultrasounds help to stage rectal tumors and allows for accurate and efficient assessment of the depth of involvement of rectal cancers.
Preparation for anal and rectal ultrasound requires a clean out with one or two enemas prior to leaving for the facility.Â In cases of an ultrasound study being done at the time of colonoscopy, enemas are not required and the bowel preparation for the colonoscopy is adequate.
When the procedure begins, the patient lies down on an examination table and a small lubricated probe containing a transducer is gently inserted into the anal canal and rectum. The transducer enables sound waves to be transmitted back and forth between the body and the device, which is relayed as information and images to a monitor.
An ultrasound is typically painless, although patients may experience slight discomfort. Results are usually available immediately. The exam usually takes from 30 minutes to one hour to complete.
Defecography, also known as evacuation proctography or voiding proctography, is a procedure that is used to evaluate the amount of stool the rectum can contain as well as how efficient the rectum is at holding the stool. Defecography also measures the rectumâ€™s ability to fully eliminate stool. This type of testing is performed to identify or analyze anorectal disorders and the causes of obstructed defecation.
The defecography procedure gathers information on the mechanisms of the rectum and anal canal in real time, usingÂ Â fluoroscopic imaging or magnetic resonance.ï»¿ A defecography is typically completed in approximately 15 minutes. Patients should adhere to any instructions provided by their doctor prior to the defecography.
To begin the procedure, a barium paste is injected into the rectum. The patient will then sit on a defecography chair, which is a toilet-like seat that is attached to an X-ray table. The imaging device provides a view, in real time, of the actions and changes taking place within the rectum and anal canal as the patient defecates into the chair.
During the defecography process, the barium becomes identifiable as a bright white color on the scan results. The barium will reveal the patientâ€™s bowel movements and activity in the rectum. This allows the physician to examine and evaluate possible causes of incontinence, constipation, impaired defecation and other disorders.
Pudendal Nerve Testing
To diagnose pudendal nerve compression, a medical history is taken and a physical exam is conducted. A pudendal nerve block, which is an injection of corticosteroids to disrupt nerves signals, may be used to confirm the diagnosis. If the nerve block is successful in relieving the pain, it can help determine that pudendal nerve compression is the cause and also subsequently be performed as a form of treatment. Other treatment methods may include:
- Avoiding activities that may worsen symptoms
- Muscle relaxants
- Application of topical lidocaine
- Physical therapy
In more severe cases, surgery may be recommended as a last resort to relieve the compression on the pudendal nerve.