What is anorectal testing?
Anorectal testing is performed to examine and diagnose symptoms of constipation or faecal incontinence. There are several types of anorectal tests that can help gastroenterologists, such as Dr Elliot determine the strength and function of the anal sphincter muscles.
Anorectal tests include:
While these tests are used to diagnose the severity of constipation and faecal incontinence, they are also used to study anal sphincter disruption and tumours of the anorectum too.
Who needs anorectal testing?
Anorectal testing is required for patients who are suffering from symptoms of chronic constipation or faecal incontinence. Chronic constipation is characterised by the frequent inability to pass stools. When bowel movements do occur, straining is often involved, and stools are hard or dry. Faecal incontinence is a condition where the muscles of the anus are too weak and bowel movements, such as passing loose stools or gas, cannot be controlled.
If left untreated, both constipation and faecal incontinence can lead to further complications such as rectal prolapse or other, more severe issues. Constipation, in particular, is often a sign of underlying medical conditions such as colorectal cancer, inflammatory bowel disease and irritable bowel syndrome.
How is anorectal testing performed?
There are several types of anorectal tests that can be performed to diagnose constipation and faecal incontinence by measuring the strength and function of the anal sphincter muscles.
During this procedure, Dr Elliot will test the strength of both the resting pressure and contracting pressure of your external sphincter muscles. The sphincters are muscles that help regulate the timing of bowel movements. If the anal sphincter muscles tighten or relax at the wrong time, incontinence or constipation may occur.
Defaecography and Transit Study test
Defaecography is used to examine patients who experience chronic constipation or incontinence and helps Dr Elliot identify structural or functional abnormalities of the pelvic floor. During this test, you will drink a contrast solution to opacify the small bowel. The bladder is opacified by inserting a small tube into the bladder. The rectum is opacified via a plastic syringe with barium paste. A series of rapid sequence x-rays are done while emptying the bladder and the rectal content. The procedure is painless and will only take a few minutes.
During a transit study, you are asked to swallow a capsule with metal balls or metal rings that can be detected on an x-ray. X-rays are taken of the abdomen to assess the rate at which the rings pass through your bowels over a period of five days.
Pudendal nerve testing
The pudendal nerve elevates the external genitalia of both sexes, as well as the sphincters of the bladder and the rectum. If this nerve is damaged, constipation or faecal incontinence may occur. During the pudendal nerve test, Dr Elliot will measure the amount of time it takes for a stimulation of the pudendal nerves to reach the external anal sphincter. This can help pinpoint issues affecting the nerve that may be causing constipation or faecal incontinence.
Ultrasound imaging of the anorectal sphincter provides structural information about the sphincter muscles of patients who experience symptoms of constipation and faecal incontinence. An anorectal ultrasound can supplement functional information about the sphincter muscles obtained from other anorectal tests. The ultrasound is, therefore, an important addition to all forms of anorectal testing.
Anorectal ultrasound testing is also used to assess pre-operative stages of anorectal cancers, extra-rectal abnormalities and benign lesions.