Anorectal Manometry in Children

Abstract

Anorectal disorders are common in children. They are related to structural and/or functional abnormalities of the anorectum or pelvic floor with a variety of symptoms. Therefore, diagnostic tests to evaluate anorectal function can help to better understand the underlying pathophysiology and aetiology as well as facilitate patient management. During the past decades, substantial efforts have been made to improve anorectal function testing; however, more advanced investigations might lead to difficulties in interpretation. Additionally, a great diversity of equipment and protocols are used among centres, which may lead to heterogeneous interpretation of results. More studies to standardize methods of testing and validate reference values are strongly recommended in children. This review updates on the current indications and the protocol of anorectal manometry.

Pediatric Neurogastroenterology and Motility: Moving Rapidly Into the Future

“…The London Classification for anorectal disorders has recently been finalized by an International Working Group promoting standardized methodology and nomenclature to describe disorders of anorectal motor and sensory function in adults, as assessed by anorectal HRM (33). In children, the motility working groups of the British and European Societies of Paediatric Gastroenterology, Hepatology and Nutrition have proposed indications and protocols for pediatric anorectal manometry and recommended parameters for interpretation and reporting (34,35). In the coming years, we are bound to see improvements of HRM protocols in children, incorporating amalgamation with other test parameters and improved analyses, as well as better classification of the range of GI motility disorders (Fig.…”

The Effect of Dexmedetomidine Sedation on Lower Gastrointestinal Motility in Children—Is It Suitable for Anorectal Manometry?

“…Anorectal manometry (ARM) is the most common motility study performed in children, and is frequently used as part of the diagnostic workup for children with chronic severe constipation in order to evaluate the neuromuscular function of the rectum and anus [1,2]. There are many indications for anorectal manometry.…”

“…These include anorectal symptoms (chronic constipation, fecal incontinence, and fecal urgency), spinal cord malformation, anorectal malformations, neuromuscular disorders, rectal trauma, suspected Hirschsprung disease cases, and evaluation of constipation in post-surgical Hirschsprung disease patients. Anorectal manometry can also assist with the selection of a specific and appropriate treatment, such as an injection of botulinum toxin to the anal sphincter or use of biofeedback therapy [2]. ARM is performed by inserting a catheter into the anal canal, which is capable of measuring pressure in the anal canal.…”

“…ARM is performed by inserting a catheter into the anal canal, which is capable of measuring pressure in the anal canal. There are two types of anorectal manometry equipment: A conventional manometry that uses only a few sensors to measure the pressure in the anal canal and presents these measurements as line traces, and a high-resolution manometry, that uses many closely spaced sensors to perform the measurements, and then present the results in a more detailed manner, as a pressure map of the anorectum [2].…”

“…The RAIR is a physiological involuntary reflex elicited by the distension of the rectum wall, which is then followed by a decrease in internal anal sphincter pressure (IASP). This relaxation occurs when the myenteric postganglionic parasympathetic neurons release nitric oxide and VIP [2], and this release can be elicited with the distention of a balloon in the rectum, such as during ARM. When there is an absence of ganglion cells in the intestine, such as in patients with Hirschsprung's disease, there is a lack of relaxation of the sphincter which results in obstruction in the distal colonic.…”