High‐resolution anal manometry: Repeatability, validation, and comparison with conventional manometry

Abstract

Background Accurate measurement of anal sphincter function is potentially of value in defining treatment of common pelvic floor disorders. The aim of this study was to establish repeatability and validate high‐resolution anorectal manometry (HRAM) by comparison to conventional manometry (CM). Arising from this work would be definitive normal range data. Methods Eighty healthy volunteers (40 female) underwent a test‐retest repeatability study. A 16‐channel water‐perfused HRAM catheter was compared to an 8‐channel conventional catheter using a station pull‐through technique. Key Results High‐resolution anorectal manometry had similar precision to conventional manometry when measuring resting pressure (intraclass correlation coefficient [ICC] 0.73 vs 0.68, HRAM vs CM) and squeeze increment (ICC 0.90 vs 0.94, HRAM vs CM). HRAM measured resting pressures 10% lower than CM and squeeze pressure 27% higher than CM. Conclusions and Inferences High‐resolution anorectal manometry is a valid technique with comparable precision to CM. HRAM measurements differ considerably to CM, and a new set of normal values must be used.

Systematic evaluation of cough‐anorectal pressure responses in health and in fecal incontinence: A high‐resolution anorectal manometry study

“…4 Most notably, Mazor et al 21 Table 2, we identified 22.8% of our incontinent population with isolated cough-related anorectal pressure dysfunction. The LLN for maximum incremental anal pressure in this study (30 mm Hg) was slightly higher than that reported by Gosling, 22 who included fewer parous than nulliparous healthy subjects, and lower compared to the 43 mm Hg reported by Rasijeff. 20 The LLN for maximum anal pressure during cough (94 mm Hg) was higher than in previous studies ranging between 82 and 86 mm Hg.…”

“…While cough-anorectal pressure responses have been documented previously, 18,[20][21][22] no study has applied HR-ARM to qualitatively and quantitatively study changes with parity (in health) and with disease (fecal incontinence). This was the aim of the current study through systematic, retrospective analysis of HR-ARM recordings.…”

Anorectal Physiology Testing for Prolapse—What Tests are Necessary?

“…2). 6,8,9 An enema preparation is optional but when used, should clearly be documented along with other medications the patient is on that could affect anorectal function. The study is usually performed with the patient in the left lateral decubitus position.…”

Comparison of anorectal function measured using wearable digital manometry and a high resolution manometry system

“…Most of that difference was caused by the results from two men (Fig 5D-blue outliers). Interestingly, the literature reports higher pressure readings of HR-ARM compared to the standard conventional manometry [21][22][23][24][25], especially in men compared to women [26]. Indeed, recent papers on HR-ARM have suggested that new standards and limits are needed for HR-ARM based on the catheter type and size to address systematic differences in pressure measurements [25,27].…”

“…We believe that there are three main reasons why there was a difference between recorded AS pressures using DM and HR-ARM. The first is the hypersensitivity of HR-ARM in squeeze test [24,25,27], which could be due to the relatively high bending stiffness of its probe. Any bending of the probe due to posterior movement of the anterior rectal wall would cause the HR-ARM probe to measure high tissue contact stress (force per unit area) in the vicinity of its tip, where the shaft is bent over the anorectal angle, as well as at the anal sphincter, rather than just measuring fluid pressure within the AS or rectum [28].…”