It is intended for people who have been referred for the procedure, as well as anyone supporting them. It explains the purpose of the test, how it is carried out, and the key information you may find helpful before attending your appointment.
Introduction
What are anorectal physiology studies?
Anorectal physiology tests provide information on the functioning and structure of muscles in the anal canal. These muscles are important in bowel continence.
These tests can also investigate the nerve supply to these muscles and how sensitive the rectum is to filling.
Why do I need these tests?
These tests have been requested by your consultant so they can determine what is causing your bowel problems and decide on appropriate treatment.
The most common bowel problems we see are faecal incontinence and constipation, but these tests can also help in the management of anal fissure, infection and haemorrhoids (piles).
Before your procedure
Is any preparation needed?
No preparation is required for the tests. You may eat and drink before and after the tests and continue all prescribed medications as normal. Sometimes patients find it useful if they have had a bowel motion on the day of the tests though we do not require you to take any bowel preparation (i.e. laxatives, enemas).
During your procedure
Who will carry out the tests?
The tests will be carried out by a fully trained and experienced healthcare specialist (Physiologist). There will also be a chaperone present in the clinic room.
Upon arrival
Upon arrival to the department (see attached map for directions) you will be asked to take a seat in the waiting room. You will then have an interview with the physiologist to discuss your symptoms and the tests. You will be given the opportunity at this point to ask any questions you may have.
What will happen during the tests?
If you decide to go ahead with these investigations we will ask you to change into a hospital gown and remove your clothes from the waist down. Your privacy and dignity will be upheld at all times. You will be asked to lie on a clinic couch on your left hand side in a private clinic room. A number of tests can be carried out which are described below:
Anorectal manometry
This will measure how strong your anal canal muscles are.
A thin probe (about the size of a straw), with a small deflated balloon attached to the end, will be passed into the anal canal and rectum. You will be asked by the physiologist to either stay relaxed, or push against this tube. This will be fully explained at the time of your appointment.
Rectal sensitivity
This can determine how aware you are to your rectum filling. The small balloon that is attached to the probe is positioned in your rectum and slowly inflated with air – this may mimic the need to go to the toilet. We will ask you to tell us when you start to feel this. We will also inflate this balloon to check for a nerve reflex.
Endoanal ultrasound
This is a safe and non-ionising medical imaging test that will help us look at the anal canal and see whether there are any breaks or thinning to the muscles. An ultrasound probe (about the size of a finger) will be passed into the rectum and slowly moved out whilst images are recorded.
Pudendal nerve latencies
This test assesses the function of the nerve which helps your anal canal muscle contract (squeeze). A gloved finger with a stimulating electrode attached is passed into the anal canal. The electrode will gently stimulate the nerve and the response in your muscle is recorded.
You may feel a slight twitching sensation in your anal canal when the nerve is stimulated.
Please note:
You may not require all of these tests – your consultant and the physiologist performing the tests will decide which tests are important to you.
Will the tests be painful?
Most patients do not find these tests painful. Some patients with on-going anal pain may find them slightly uncomfortable, but once the tests are completed, there should be no lasting effects.
How long will the tests take?
The tests usually take about 40 minutes, but given time for changing, clinical interview and questions you can expect to be in the department for one hour.
Risks, benefits and alternatives
There are no reported risks with these tests.
The information obtained from anorectal physiology is very specific and there is no alternative test that can be performed which will provide the same information. Together with other tests you may have undergone i.e. x-rays, colonoscopy, our results will be used by your consultant to diagnose you and hopefully provide further treatment.
After your procedure
What will happen after my tests?
Once your tests are complete you will be free to leave the department and resume your normal daily activities. If you drive in yourself, you should be able to drive home immediately afterwards.
When will I find out the results?
A report of the findings from the various tests will be sent to your consultant who will discuss them with you at your next outpatient appointment
What if I have any other questions?
This leaflet is only a short account of anorectal physiology. It is important that you know the reason for these tests and are happy for them to be performed.
Gastrointestinal physiology department
If you require more information, have any special requirements or need to reschedule your appointment for a later date, please contact the gastrointestinal physiology department.
