Annals of Coloproctology

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Original Article

Anorectal Manometry Versus Patient-Reported Outcome Measures as a Predictor of Maximal Treatment for Fecal Incontinence: Lisa Ramage, Shengyang Qiu, Zhu Yeap, Constantinos Simillis, Christos Kontovounisios, Paris Tekkis, Emile Tan; Ann Coloproctol. 2019;35(6):319-326. Published online December 31, 2019; DOI: https://doi.org/10.3393/ac.2018.10.16

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Purpose
This study aims to establish the ability of patient-reported outcome measures (PROMs) and anorectal manometry (ARM) in predicting the need for surgery in patients with fecal incontinence (FI).
Methods
Between 2008 and 2015, PROMs data, including the Birmingham Bowel and Urinary Symptoms Questionnaire (BBUSQ), Short Form 36 (SF-36), Wexner Incontinence Score and ARM results, were prospectively collected from 276 patients presenting with FI. Spearman rank was used to assess correlations between specific PROMs questions and ARM assessments of sphincter motor function. Binomial regression analyses were performed to identify factors predictive of the need for surgery. Finally, receiver operating characteristic (ROC) curve analyses were performed to establish the utility of individual ARM and PROMs variables in predicting the need for surgical intervention in patients with FI.
Results
Two hundred twenty-eight patients (82.60%) were treated conservatively while 48 (17.39%) underwent surgery. On univariate analyses, all 4 domains of the BBUSQ, all 8 domains of the SF-36, and the Wexner Incontinence Score were significant predictors of surgery. Additionally, maximum resting pressure, 5-second squeeze endurance, threshold volume, and urge volume were significant. On ROC curve analyses, the only significant ARM measurement was the 5-second squeeze endurance. PROMs, such as the incontinence domain of the BBUSQ and five of the SF-36 domains, were identified as fair discriminators of the need for surgery.
Conclusion
PROMs are reliable predictors of maximal treatment in patients with FI and can be readily used in primary care to aid surgical referrals and can be applied in hospital settings as an aid to guide surgical treatment decisions.

Citations

Citations to this article as recorded by

Primary Anaplastic Lymphoma Kinase‐Positive Inflammatory Myofibroblastic Tumor of the Small Bowel Detected by Capsule Endoscopy: A Case Report
Tomoyuki Niwa, Yasushi Hamaya, Yusuke Asai, Tatsuhiro Ito, Satoru Takahashi, Shunya Onoue, Satoshi Osawa, Mayu Sakata, Hiroya Takeuchi, Ken Sugimoto
DEN Open.2026;[Epub] CrossRef
Capturing Patient Reported Outcomes Following Treatment of Benign Anorectal Disease Requires Significant Surgeon Commitment: Do Surgeons Really Want to Know?
Thomas Peponis, Marc S. Rubin, Ronald Bleday, Harrison T. Hubbell, Robert N. Goldstone, Joel E. Goldberg, Khawaja F. Ahmed, Liliana G. Bordeianou
World Journal of Colorectal Surgery.2025; 14(1): 1. CrossRef
Clinical Grade of Obstetric Anal Sphincter Injuries and Prediction of Mode of Birth Recommendations: A 20‐Year Retrospective Analysis
Nicola Adanna Okeahialam, Ranee Thakar, Abdul H. Sultan
BJOG: An International Journal of Obstetrics & Gynaecology.2025; 132(12): 1802. CrossRef
Correlation of Digital Rectal Examination and Anorectal Manometry with Patient-Reported Outcomes Among Women with Fecal Incontinence
Alayne Markland, Mary Ackenbom, Uduak Andy, Ben Carper, Eric Jelovsek, Douglas Luchristt, Shawn Menefee, Rebecca Rogers, Vivian Sung, Donna Mazloomdoost, Maria Gantz
International Urogynecology Journal.2024; 35(12): 2367. CrossRef
Pelvic floor investigations for anal incontinence: Are they useful to predict outcomes from conservative treatment?
Karina Cuinas, Linda Ferrari, Carlene Igbedioh, Deepa Solanki, Andrew Williams, Alexis Schizas, Alison Hainsworth
Neurourology and Urodynamics.2023; 42(5): 1122. CrossRef
Anorectal dysfunction in multiple sclerosis patients: A pilot study on the effect of an individualized rehabilitation approach
Martina Kovari, Jan Stovicek, Jakub Novak, Michaela Havlickova, Sarka Mala, Andrew Busch, Pavel Kolar, Alena Kobesova
NeuroRehabilitation.2022; 50(1): 89. CrossRef
Postpartum fecal incontinence. State of the problem
D.R. Markaryan, A.M. Lukyanov, T.N. Garmanova, M.A. Agapov, V.A. Kubyshkin
Khirurgiya. Zhurnal im. N.I. Pirogova.2022; (6): 127. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
Usefulness of Patient-Reported Outcome Measures and Anorectal Physiologic Tests in Predicting Clinical Outcome for Fecal Incontinence
Chang-Nam Kim
Annals of Coloproctology.2019; 35(6): 289. CrossRef

Review

Anorectal Physiology: Test and Clinical Application: Hyeon-Min Cho; J Korean Soc Coloproctol. 2010;26(5):311-315. Published online October 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.5.311

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8 Citations

Abstract PDF

The physiology of the anorectal region is very complex, and it is only recently that detailed investigations have given us a better understanding of its function. The methods that are used for the evaluation of anorectal physiology include anorectal manometry, defecography, continence tests, electromyography of the anal sphincter and the pelvic floor, and nerve stimulation tests. These techniques furnish a clearer picture of the mechanisms of anorectal disease and demonstrate pathophysiologic abnormalities in patients with disorders of the anorectal region. Therefore, therapeutic recommendations for anorectal disease can be made best when the anatomy and the physiology of the anorectal region are understood.

Citations

Citations to this article as recorded by

How Can We Treat If We Do Not Measure: A Systematic Review of Neurogenic Bowel Objective Measures
Argy Stampas, Amisha Patel, Komal Luthra, Madeline Dicks, Radha Korupolu, Leila Neshatian, George Triadafilopoulos
Topics in Spinal Cord Injury Rehabilitation.2024; 30(3): 10. CrossRef
Anal endosonographic assessment of the accuracy of clinical diagnosis of obstetric anal sphincter injury
Angharad Jones, Linda Ferrari, Paula Igualada Martinez, Eugene Oteng-Ntim, Alison Hainsworth, Alexis Schizas
International Urogynecology Journal.2022; 33(11): 2977. CrossRef
Anatomy, physiology, and updates on the clinical management of constipation
Graham Dupont, Lauren Wahl, Tamara Alcala Dominguez, TL Wong, Robert Haładaj, Grzegorz Wysiadecki, Joe Iwanaga, R. Shane Tubbs
Clinical Anatomy.2020; 33(8): 1181. CrossRef
Pelvic floor functional bowel disorders in gynaecology
Marika Britton, Sushil Maslekar, Fiona Marsh
The Obstetrician & Gynaecologist.2020; 22(4): 275. CrossRef
Pelvic floor investigations for bowel dysfunction (part 2): anorectal physiology (manometry)
Deepa Solanki, Fiona Hibberts, Andrew B Williams
Gastrointestinal Nursing.2019; 17(5): 24. CrossRef
Transanal irrigation for bowel dysfunction: the role of the nurse
Lindsey Shaw
British Journal of Nursing.2018; 27(21): 1226. CrossRef
Anal sphincter dysfunction in multiple sclerosis: an observation manometric study
Silvia Marola, Alessia Ferrarese, Enrico Gibin, Marco Capobianco, Antonio Bertolotto, Stefano Enrico, Mario Solej, Valter Martino, Ines Destefano, Mario Nano
Open Medicine.2016; 11(1): 509. CrossRef
Preventing, assessing, and managing constipation in older adults
Francis Toner, Edith Claros
Nursing.2012; 42(12): 32. CrossRef

Original Article

Anorectal Physiology in the Rectal Prolapse Patient.: Son, Kyung Soo , Joo, Jae Sik , Wexner, Steven D; J Korean Soc Coloproctol. 1998;14(3):467-476.

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Abstract PDF: PURPOSE
The aim of our study was to evaluate the physiological spectrum of anorectal dysfunction among patients with full thickness circunferential rectal prolapse. MATERIAL AND METHODS: Between January 1988 and March 1995, 88 patients who visited department colorectal surgery, Cleveland Clinic Florida with rectal prolapse were studied. There were 8 males and 80 females, with a mean age 69 (range 28~101) years. Patients underwent a detailed history and the following anorectal physiology tests were performed: anal canal manometry, pudendal nerve terminal motor latency (PNTML) assessment, anal electromyography and cinedefecography.4 standard continence scoring system, based on the frequency and type of incontinence (0=full continence, 20=complete incontinence) was used. Patients with rectal prolapse (n=88) were divided into two subgroups: Group I=continent patients (n=33) and Group II= incontinent patients (n=55).
RESULTS
There were statistically significant differences between each group when comparing mean resting pressures, anal pressures, anal canal length, rectal compliance, rectoanal inhibitory reflex, increased fiber density, the occurrence of premature evacuation (p<0.001), and rectal capacity (p<0.05). However, dynamic changes of anorectal angle, resting anorectal angle, puborectalis length, and rectal sensitivity were not significantly different (p>0.05) between groups.
CONCLUSION
Continence may be disturbed in patients with rectal prolapse; knowledge of impairment in continence may assist in surgical management.

Review

Biofeedback Therapy in Patients with Functional Evacuation Disorders.: Park, Ung Chae; J Korean Soc Coloproctol. 2003;19(4):260-269.

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14 Download

Abstract PDF: Biofeedback therapy has emerged as a useful adjunct for patients with functional evacuation disorders over the past decade. The goals of biofeedback retraining may vary and could depend on the underlying dysfunction. In patients with obstructive defecation, the goals are to relax the anal sphincter, improve rectoanal coordination, and improve sensory perception. Methods of biofeedback therapy varied widely between centers. However, no difference was described when EMG-based biofeedback was compared to manometry-based biofeedback, or when visual or auditory feedback was given. In regards to biofeedback adjuncts, including sensory retraining with either an intrarectal balloon, a portable home-training unit or both can be practicable. There are inconsistencies in the literature regarding the patient selection criteria for biofeedback treatment. The patient group is not homogeneous. Different case selection, different regimens and different methods of biofeedback may explain the variability in success rate. Quality research that would assist in predicting outcome is still lacking. Although no specific denominator could possibly be assigned to correctly predict the overall outcome of therapy, biofeedback is not successful in all patients with outlet obstructed constipation. Results with success rates is ranging from 8.3 percent to 100 percent. The treatment of constipation by biofeedback has been viewed with some skepticism as the low success rate may simply be a placebo effect. The majority of scepticism to therapeutic outcome are derived from entry criteria for treatment. Lower success rates have been described when entry criteria were broadened. Prebiofeedback clinical findings which are presupposed to prognostic relevance are age, gender, duration of symptoms and presence of rectal pain, lower motor neuron disease, and psychiatric problems. I feel strongly that informations about the predictive factors are vital to all physicians either performing or recommending biofeedback to their patients. If biofeedback could be undertaken according to specific criteria, we, colorectal surgeon will save a fruitless endeavour, one would expect more improvements in more patients. Additional well-designed controlled trials are needed to establish the clinical and physiologic factors.

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