Day‐to‐day reproducibility of anorectal sensorimotor assessments in healthy subjects

Bharucha, Adil E.; Seide, Barbara M.; Fox, Jean C.; Zinsmeister, Alan R.

doi:10.1111/j.1365-2982.2004.00499.x

Cited by 64 publications

(66 citation statements)

References 32 publications

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“…Average anal resting and squeeze pressures were measured using the station pull-through technique with water perfused manometry and summarized by the highest pressure in the anal canal (5).…”

Section: Methodsmentioning

confidence: 99%

Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence

Bharucha¹,

Daube²,

Litchy³

et al. 2012

American Journal of Physiology-Gastrointestinal and Liver Physi

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Bharucha AE, Daube J, Litchy W, Traue J, Edge J, Enck P, Zinsmeister AR. Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence. Am J Physiol Gastrointest Liver Physiol 303: G256 -G262, 2012. First published May 4, 2012 doi:10.1152/ajpgi.00099.2012.-While anal sphincter neurogenic injury documented by needle electromyography (EMG) has been implicated to cause fecal incontinence (FI), most studies have been uncontrolled. Normal values and the effects of age on anal sphincter motor unit potentials (MUP) are ill defined. The functional significance of anal sphincter neurogenic injury in FI is unclear. Anal pressures and EMG were assessed in 20 asymptomatic nulliparous women (age, 38 Ϯ 5 yr; mean Ϯ SE) and 20 women with FI (54 Ϯ 3 yr). A computerized program quantified MUP duration and phases. These parameters and MUP recruitment were also semiquantitatively assessed by experienced electromyographers in real time. Increasing age was associated with longer and more polyphasic MUP in nulliparous women by quantitative analysis. A higher proportion of FI patients had prolonged (1 control, 7 patients, P ϭ 0.04) and polyphasic MUP (2 controls, 9 patients, P ϭ 0.03) at rest but not during squeeze. Semiquantitative analyses identified neurogenic or muscle injury in the anal sphincter (11 patients) and other lumbosacral muscles (4 patients). There was substantial agreement between quantitative and semiquantitative analyses ( statistic 0.63 Ϯ 95% CI: 0.32-0.96). Anal resting and squeeze pressures were lower (P Յ 0.01) in FI than controls. Anal sphincter neurogenic or muscle injury assessed by needle EMG was associated (P ϭ 0.01) with weaker squeeze pressures (83 Ϯ 10 mmHg vs. 154 Ϯ 30 mmHg) and explained 19% (P ϭ 0.01) of the variation in squeeze pressure. Anal sphincter MUP are longer and more polyphasic in older than younger nulliparous women. Women with FI have more severe neurogenic or muscle anal sphincter injury, which is associated with lower squeeze pressures. aging; electromyography; pudendal neuropathy INITIALLY DOCUMENTED BY HISTOLOGICAL evidence of sphincter denervation (27), the concept that pudendal nerve injury contributes to anal weakness in fecal incontinence (FI) gained traction when prolonged pudendal nerve terminal motor latencies were documented in FI and after obstetric anal sphincter injury (2, 22, 30). However, prolonged pudendal nerve latencies are flawed markers of pudendal nerve function (13). Hence, needle electromyography (EMG) is the only technique that can reliably identify anal sphincter neurogenic injury that can result from damage to the sacral spinal cord, cauda equina, S2-4 spinal nerves, the pudendal nerve, or its branches as they enter the anal sphincter (28,29,34). Anal sphincter EMG can also identify local muscle trauma (3). However, anal sphincter EMG is not widely available and infrequently used, mainly when neurogenic injury is suspected, in clinical practice. Also, based on limited data that suggest that anal sphincter denervation predicts poore...

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Section: Methodsmentioning

confidence: 99%

Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence

Bharucha¹,

Daube²,

Litchy³

et al. 2012

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…In a study of 19 normal patients, mean resting pressure was 59 mmHg, mean squeezing pressure was 88 mmHg. 13 In a recent study of 50 patients with slow transit constipation evaluated by manometry, the pressure was found to be significantly lower than in normal controls. This may influence the risk of potential incontinence after subtotal colectomy with ileorectal anastomosis.…”

Section: Anorectal Manometrymentioning

confidence: 99%

Anorectal Physiologic Evaluation of Constipation

Denoya

Sands²

2008

Clinics in Colon and Rectal Surgery

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Chronic constipation is a widespread problem which affects 63 million people in North America alone. Although the majority of patients respond to changes in dietary fiber and water intake, as well as the judicious use of laxatives, a small portion will not and as a result, will be evaluated by gastroenterologists and colorectal surgeons. These patients most frequently have slow transit constipation, pelvic floor dysfunction, or some combination of the two. The physiologic evaluation of these patients comprises colonic transit studies, anorectal manometry, cinedefecography, electromyography, and pudendal nerve terminal motor latency testing. In this article, the authors describe the physiologic basis for these studies and review the techniques used in diagnosing these conditions.

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“…Além disso, não existe uma padronização mesmo nos diferentes serviços que possibilitem a confirmação da reprodutibilidade de resultados (1,6,7) . Em estudo realizado sobre a reprodutibilidade inter e intra-individual da manometria anal de pacientes normais foi encontrado reprodutibilidade de resultados apenas nos parâmetros comprimento do canal anal e pressão máxima de repouso (5) .…”

Section: Discussionunclassified

“…Isso é um dado muito importante encontrado, pois demonstra que o médico que recebe o exame não é dependente apenas da conclusão do médico examinador. Alguns trabalhos foram encontrados na literatura sobre a reprodutibilidade do exame (5,6,7) , nada encontramos sobre a reprodutibilidade dos laudos.…”

Section: Discussionunclassified

“…Mudanças nas pressões anal e retal durante a tentativa de evacuação (1,2,3,4) . Trabalhos anteriores estudaram a reprodutibilidade da manometria anal através do exame realizado com o mesmo grupo de pacientes, porém em períodos ou dias diferentes, seguindo a mesma téc-nica, e realizaram comparações entre exames realizados através de diferentes técnicas (5,6,7) . O objetivo desse trabalho foi analisar a reprodutibilidade dos laudos da manometria anal em pacientes constipados através da interpretação dos mesmos exames por diferentes examinadores em diferentes níveis de aprendizado verificando os resultados das pressões de repouso, contração e evacuação e as conclusões finais do exame.…”

Section: Introductionunclassified

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Reprodutibilidade de laudos de uma mesma manometria segundo diferentes examinadores

Cesar

Klug

Capelhuchnick

et al. 2007

Rev bras. colo-proctol.

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Day‐to‐day reproducibility of anorectal sensorimotor assessments in healthy subjects

Cited by 64 publications

References 32 publications

Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence

Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence

Anorectal Physiologic Evaluation of Constipation

Reprodutibilidade de laudos de uma mesma manometria segundo diferentes examinadores

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