12760 Anorectal Manometry

Overview

Anorectal manometry is a test that checks how well the muscles and nerves at the very end of your bowel are working. It looks at your anal sphincter (the ring of muscle that keeps stool and wind in) and your rectum (the lower part of your bowel that stores stool before you go to the toilet). A very thin, soft tube is gently placed into your back passage. The tube measures pressure and how your muscles squeeze and relax. It also checks how well your rectum senses when it is full. It is not surgery and it does not treat anything by itself. It gives your doctor information about why you might be having trouble pooing or trouble holding stool in.

The test itself is done in hospital bowel (gastroenterology) or pelvic floor clinics. The problems it checks for are very common. Long-term constipation and leaking stool affect millions of people worldwide, but many feel too embarrassed to mention them. If you have one of these problems, you are far from alone, and it is a normal thing to ask for help with.

It can be done at any age. It is most often used for adults who have long-lasting constipation that has not improved with usual treatment, or who leak stool or wind. It is also used for people being assessed before certain bowel or pelvic operations. In specialist children's centres it may be used for children with severe constipation or after surgery for bowel conditions. In older adults it is often used when stool leakage or constipation starts affecting daily life.

Symptoms

Common symptoms

• Straining a lot, or for a long time, when trying to poo
• Hard, pellet-like stools or needing to go less than three times a week
• A feeling that you have not fully emptied your bowel
• Needing to use a finger to help stool come out, or needing to press on the area between the back passage and the vagina
• Leaking a small amount of stool, or soiling your underwear without meaning to
• Not being able to hold wind in
• A sudden, urgent need to go to the toilet that is hard to control
• Long-term constipation that has not improved with fibre, fluids and lifestyle changes

Symptoms in children

• Constipation that has lasted a long time and has not got better with usual treatment
• Soiling (stool leaking into underwear) in a child who is already toilet trained
• Pain or crying when passing stool, often with holding-in behaviour
• Follow-up checks after surgery for a bowel problem present from birth

Symptoms in older adults

• New or worsening leaking of stool, sometimes after childbirth many years earlier or after surgery
• Constipation that started later in life, especially with a feeling of blockage
• A bulge or heaviness in the back passage area, which may be a sign of prolapse (when part of the bowel wall slips down)
• Problems that began after a stroke, spinal injury or nerve damage

Causes

Main causes

• The test itself is not caused by anything. It is used to look for reasons behind bowel problems. These can include pelvic floor muscles that squeeze instead of relaxing when you try to poo, which is called dyssynergic defecation.
• Weak anal sphincter muscles, which can cause leaking of stool or wind.
• Reduced feeling in the rectum, so you do not notice when you need to go.
• Nerve damage affecting the bowel or the muscles around it.
• A rectocele, where the wall between the rectum and the vagina bulges, trapping stool.
• Long-term straining, which can weaken the muscles over time.

Risk factors

• Childbirth, especially a long or difficult delivery or a tear
• Previous surgery in the pelvic area, back passage or lower bowel
• Long-term constipation and repeated straining
• Conditions that affect nerves, such as diabetes, a stroke or a spinal injury
• Getting older, as muscles and nerves can weaken with age
• A low-fibre diet or not drinking enough fluids, which makes stool hard
• Ignoring the urge to go to the toilet over a long period

When to see a doctor

See a doctor urgently if:

• You have new bleeding from your back passage
• You suddenly cannot control your bowel movements
• You have severe pain in your tummy with vomiting and cannot pass stool or wind
• You have a high temperature with pain or swelling around the back passage

Book a routine appointment if:

• You have been constipated for several weeks despite eating more fibre and drinking more fluids
• You often strain, or need to help stool out with your fingers or by pressing on your pelvic area
• You leak stool or wind, even a little, and it affects your confidence or daily life
• You feel you cannot fully empty your bowel
• Your doctor has suggested tests for your bowel and you have questions about them

Diagnosis

Anorectal manometry is one part of working out what is going on. Your doctor will start by asking about your bowel habits, diet, past pregnancies and surgeries, and any medicines you take. They may also examine your back passage with a gloved finger, which is quick and can show how strong the muscles feel. The manometry test adds detailed measurements that a physical examination cannot give. Results are looked at together with your symptoms, and often with other tests. No single test tells the whole story.

Tests that may be done

• Anorectal manometry: a thin tube measures pressure in the back passage and rectum, and a small balloon checks how well you feel it filling
• Balloon expulsion test: a small, soft balloon filled with water is placed in the rectum and you are asked to push it out, which shows whether your muscles relax properly
• Endoanal ultrasound or MRI: painless scans that create pictures of the sphincter muscles
• Defecating proctogram: an X-ray or MRI scan taken while you pass a special paste, showing how stool moves through
• Colonoscopy or flexible sigmoidoscopy: a camera test to look inside the bowel, used when bleeding or other warning signs need checking
• Blood tests to look for other causes such as thyroid problems or low iron

What to expect at your appointment

You will usually lie on your side with your knees bent. A doctor or specialist nurse gently places a thin, flexible tube, lubricated first, into your back passage. You may feel pressure or the need to go to the toilet, but this usually settles. The tube is connected to a machine that records pressure. You will be asked to relax, then squeeze as if holding in wind, then cough, then push down as if having a bowel movement. A small balloon on the tube may be gently filled with air or water so you can say when you first notice it and when it feels full. You may be given a small enema or suppository beforehand to clear the lower bowel, and you will be asked to empty your bladder. Most people go home straight after and can eat, drink and drive as normal. You may have a little wind or bloating for a short while.

Treatment

The test does not treat anything by itself. Its job is to guide the right treatment for you. Once your results are known, your doctor or specialist nurse will explain what they found and what usually helps for that pattern of results. Treatment is very often non-surgical, and simple muscle training helps many people.

Self-care at home

• Eat regular meals with plenty of fibre from fruit, vegetables, wholegrains, beans and lentils, and increase fibre slowly so your body adjusts
• Drink fluids regularly through the day, and more in hot weather or when active
• Sit with your feet supported and lean slightly forward, which helps your muscles relax
• Do not rush or strain on the toilet, and avoid sitting there for long periods with a phone
• Go when you feel the urge rather than putting it off
• Keep a simple diary of your bowel habits to share with your doctor or nurse
• Stay active, as movement helps keep the bowel working well
• Use a footstool so your knees are a little higher than your hips, which can make passing stool easier

Medical treatments

Treatment depends on what the test shows. If your pelvic floor muscles squeeze instead of relaxing, the main treatment is pelvic floor muscle training with a specially trained physiotherapist, often using biofeedback. Biofeedback means learning to sense and control muscles with the help of a screen or sound. This is a teaching technique, not a medicine, and it helps many people. If the muscles are weak, a physiotherapist can teach strengthening exercises. If stool is hard, your doctor may suggest treatments to soften it or help it pass, and may adjust any medicines that affect the bowel. Your doctor may also talk about bowel habit training, ways to manage urgency, and small devices or therapies used in specialist clinics. Any medicine changes should be discussed with your doctor or pharmacist, who can advise on what is suitable for you. Surgery is considered only for some problems, such as a damaged sphincter muscle or severe leakage that has not improved with other treatment.

When is surgery considered?

Most people do not need surgery after this test. Surgery may be discussed if you have a clear physical problem, such as a torn sphincter muscle after childbirth, a rectal prolapse, or severe leakage that has not improved with muscle training and other treatments. Options in specialist care can include repair of the sphincter muscle or a small implanted device that stimulates the nerves controlling the bowel. Your specialist team would explain the benefits and risks, and the decision is always yours.

Living with this condition

Bowel problems can affect work, travel, social life and confidence. It helps to plan ahead in a practical way. Keep spare underwear and wipes in a small bag, know where toilets are on your route, and use absorbent pads if you need them. These are sensible steps, not a sign of failure. Build a regular toilet routine, for example after breakfast when the bowel is naturally more active, and give yourself unhurried time.

Lifestyle tips

• Keep to a regular meal pattern and do not skip breakfast
• Take gentle daily exercise such as walking, which helps the bowel
• Avoid long periods of sitting and take breaks to move
• Limit very fatty or spicy foods if they seem to make urgency worse for you
• Cut down on fizzy drinks if wind is a problem
• Reduce caffeine and alcohol if they seem to trigger urgency
• Avoid lifting heavy objects by bending your back, and use your legs instead

Diet and exercise

A balanced diet with enough fibre and fluids is the foundation. Aim for fibre from a range of foods rather than suddenly adding a lot at once, as this can cause wind and bloating at first. Drink regularly, and notice how your body responds to different foods. If you are thinking of cutting out foods, ask your doctor or a dietitian first, because removing whole food groups can do more harm than good. Exercise helps the bowel move and supports your pelvic floor. Walking, swimming and cycling are all good choices. Pelvic floor exercises taught by a physiotherapist are often the most useful exercise of all for these problems.

Mental health and emotional wellbeing

It is very common to feel embarrassed, worried or low when bowel problems affect daily life. Some people avoid going out, or feel anxious about finding a toilet. These feelings are understandable, and they are worth mentioning to your doctor or nurse. Talking about them often helps, and practical support can reduce the worry. If low mood or anxiety is affecting your sleep, appetite or daily life, please tell someone. If you are in crisis or having thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away, and reach out to someone you trust.

Prevention

Anorectal manometry is a test, so it is not something you prevent. However, many of the bowel problems the test looks for are less likely if you look after your bowel over the years: eat enough fibre, drink enough fluids, stay active, go when you feel the urge, and avoid long-term straining. Doing pelvic floor exercises, especially after childbirth, can help protect the muscles. If constipation or leaking starts, getting help early is much easier than waiting years.

Screening programmes

There is no general screening programme for muscle problems of the back passage. Bowel cancer screening, where it is offered in your country, is a separate programme and is important for people in the eligible age range. If you are offered it, it is worth doing. Ask your doctor if you are unsure whether you are due.

Complications

If left untreated

• Constipation can become long-lasting, with hard stool that is painful to pass
• Stool can build up and cause leakage around the hard stool, which is often mistaken for diarrhoea
• Muscles can become weaker over time with repeated straining
• Leaking stool or wind can lead to skin soreness and infection around the back passage
• Everyday life can shrink, with people avoiding travel, work events and social occasions
• Piles (swollen veins at the back passage) and tears in the skin can become more likely with repeated straining

Long-term outlook

The outlook is genuinely encouraging for most people. Once the test shows what is happening, treatment can be aimed at the right problem, and muscle training helps many people have much better control and comfort. Some people need a combination of approaches and time to see a change, and progress is often gradual rather than instant. If one approach does not work, there are usually other options to discuss with your specialist team. The most important step is often simply asking for help, which you have already begun by reading this.

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