Analyzing the Role of Anal Sphincter Pressure in Rectocele Formation

Purpose: Constipation is a common entity in society with various factors in the etiology. In this study, we evaluated the role of anal sphincter pressure of patients who refer to surgery clinic with complaint of constipation.Methods: Sixty patients who refer to surgery clinic with complaint of constipation and were diagnosed with constipation due to Rome III criteria between July 2010 and September 2014. These patients were evaluated with defecography and were divided into 2 groups based on presence of rectocele. Both groups’ anal sphincter pressures were evaluated using anal manometry and findings were compared.Results: The patients with rectocele and without rectocele using defecography were inspected with anal manometry regarding resting tone pressure, squeeze pressure, maximum squeeze pressure and simulated defecation response pressure, first sensation volume, urge sensation volume, and maximum tolerable volume. Results were compared and no significant difference was found regarding groups with rectocele and without rectocele (P > 0.05).Conclusion: We have proved the hypothesis arguing that increased sphincter pressures do not play a role in the formation of rectocele by inducing an obstruction and the formation of dilation in proximal bowel, and demonstrated that the presence of rectocele is not dependent on an increase in sphincter pressures.

Comparison of Anorectal Function Measured using Wearable Digital Manometry and a High Resolution Manometry System

There is a need for a lower cost manometry system for assessing anorectal function in primary and secondary care settings. We developed an index finger-based system (termed “digital manometry”) and tested it in healthy volunteers, patients with chronic constipation, and fecal incontinence. Anorectal pressures were measured in 16 participants with the digital manometry system and a 23-channel high-resolution anorectal manometry system. The results were compared using a Bland-Altman analysis at rest as well as during maximum squeeze and simulated defecation maneuvers. Myoelectric activity of the puborectalis muscle was also quantified simultaneously using the digital manometry system. The limits of agreement between the two methods were −7.1 ± 25.7 mmHg for anal sphincter resting pressure, 0.4 ± 23.0 mmHg for the anal sphincter pressure change during simulated defecation, −37.6 ± 50.9 mmHg for rectal pressure changes during simulated defecation, and −20.6 ± 172.6 mmHg for anal sphincter pressure during the maximum squeeze maneuver. The change in the puborectalis myoelectric activity was proportional to the anal sphincter pressure increment during a maximum squeeze maneuver (slope = 0.6, R2 = 0.4). Digital manometry provided a similar evaluation of anorectal pressures and puborectalis myoelectric activity at an order of magnitude less cost than high-resolution manometry, and with a similar level of patient comfort. Digital Manometry provides a simple, inexpensive, point of service means of assessing anorectal function in patients with chronic constipation and fecal incontinence.

NORMAL VALUES OF ANAL SPHINCTER PRESSURE MEASURED WITH NON-PERFUSION WATER SPHINCTEROMETER

There are presented normal values of anal pressure at rest and squeezing measured with non-perfusion water sphincterometer S4402 by MSM ProMedico GmbH. MATERIALS AND METHODS. 73 patients with colon adenomas before polypectomy underwent sphincterometry. All patients had no any complaints of fecal incontinence and outlet obstruction (0 points by Wexner incontinence scale and 0 points by outlet obstruction our clinic scale). Male were 28 (38,4%), average age 56,2± 10,2 years, female - 45 (61,6%), average age 54,9± 13,7 years. RESULTS. Male normal values: average rest anal pressure - 52,1 ± 19,8 mm Hg, maximum rest anal pressure - 60,3 ± 21,9 mm Hg., average squeezing anal pressure - 118,2± 41,5 mm Hg, maximum squeezing anal pressure -174,2± 56,8 mm Hg. Female normal values: average rest anal pressure - 37,1 ± 15,3 mm Hg. maximum rest anal pressure - 43,8± 15,5 mm Hg, average squeezing anal pressure - 75.1 ± 29.5 mm Hg, maximum squeezing anal pressure - 99,1 ± 39,7 mm Hg. CONCLUSION. There were detected normal values of anal pressure at rest and squeezing to use in approximate assessment of anal sphincter function. To perform comprehensive evaluation with this sphincterometer, elaboration of new software is required.

Pelvic organ prolapse and anorectal manometry: a prospective study

The aim of this study was to evaluate associations between anal sphincter pressure and stage of prolapse and bowel and prolapse symptoms among women undergoing prolapse surgery and to determine whether anal sphincter pressure could predict symptomatic and anatomical outcomes of prolapse surgery. Fortytwo women with pelvic organ prolapse (POP) stage 2-3 were included in this prospective longitudinal study. Pre- and postoperative evaluation by means of a symptom questionnaire, clinical examination and anorectal manometry. The vaginal prolapse surgery included at the very least posterior colporrhaphy. Analysis of variance and covariance and logistic regression models were used for statistical analyses. The anal sphincter pressure at rest and squeeze was significantly lower in women with the symptom vaginal protrusion than in the women without the symptom. No associations were found between anal sphincter pressure and the extent or degree of prolapse or subjective and anatomical outcomes of POP surgery. The prolapse symptom vaginal protrusion is associated with a low anal sphincter pressure but the anal sphincter pressure does not seem to predict the outcome of POP surgery, neither regarding symptoms nor anatomy.