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Published in: International Journal of Colorectal Disease 8/2013

01-08-2013 | Original Article

Normal values and pressure morphology for three-dimensional high-resolution anorectal manometry of asymptomatic adults: a study in 110 subjects

Authors: Yuwei Li, Xiaoqing Yang, Chen Xu, Yi Zhang, Xipeng Zhang

Published in: International Journal of Colorectal Disease | Issue 8/2013

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Abstract

Objectives

The purpose of this study is to evaluate normal values and pressure morphology of three-dimensional high-resolution anorectal manometry (3D-HRM) in asymptomatic volunteers and to determine the relationship between objective measurable values, gender, and age.

Patients and methods

Anorectal pressures and rectal sensation were evaluated in 110 asymptomatic volunteers (46 females and 64 males) ranging in age from 18 to 80 years (median age, 52 years) in left lateral position by three-dimensional high-resolution manometry.

Results

Maximum squeeze pressure, residual anal pressure, and intrarectal pressure were significantly higher in males compared to females (p < 0.05 each). Duration of sustained squeeze was significantly lower in males compared to females (p < 0.05). Maximum resting pressure, mean resting pressure, and maximum squeeze pressure were inversely correlated (r = −0.310, p < 0.01, r = −0.276, p < 0.01, and r = −0.198, p < 0.05) with age. The value of rectoanal pressure differential was −13.1 ± 5.8 mmHg which was negative during defecation. Overall variation coefficient in anorectal pressures ranged between 0.21 and 0.34.

Conclusion

This study establishes normal values for anorectal pressure by 3D-HRM in asymptomatic volunteers. There are significant gender differences concerning squeeze patterns. Increasing age is associated with lower maximum resting pressure, mean resting pressure, and maximum squeeze pressure. Normal characteristic pressure morphology of anorectum can be obtained at rest, during squeeze, and bear down as in defecation by 3D-HRM.
Literature
1.
go back to reference Schuster MM, Coller JA, Barrett RC (1965) Simultaneous manometric recording of internal and external anal sphincter reflexes. Bull Johns Hopkins Hosp 116:79–88PubMed Schuster MM, Coller JA, Barrett RC (1965) Simultaneous manometric recording of internal and external anal sphincter reflexes. Bull Johns Hopkins Hosp 116:79–88PubMed
2.
go back to reference Arndorfer RC, Stef JJ, Dodds WJ (1977) Improved infusion system for intraluminal esophageal manometry. Gastroenterology 73(1):23–27PubMed Arndorfer RC, Stef JJ, Dodds WJ (1977) Improved infusion system for intraluminal esophageal manometry. Gastroenterology 73(1):23–27PubMed
3.
go back to reference Kwiatek MA, Pandolfino JE, Kahrilas PJ (2011) 3D-high resolution manometry of the esophagogastric junction. Neurogastroenterol Motil 23(11):461–469CrossRef Kwiatek MA, Pandolfino JE, Kahrilas PJ (2011) 3D-high resolution manometry of the esophagogastric junction. Neurogastroenterol Motil 23(11):461–469CrossRef
4.
go back to reference Jones MP, Post J, Crowell MD (2007) High-resolution manometry in the evaluation of anorectal disorders: a simultaneous comparison with water-perfused manometry. Am J Gastroenterol 102:850–855PubMedCrossRef Jones MP, Post J, Crowell MD (2007) High-resolution manometry in the evaluation of anorectal disorders: a simultaneous comparison with water-perfused manometry. Am J Gastroenterol 102:850–855PubMedCrossRef
5.
go back to reference Diamant NE, Kamm MA, Wald A et al (1999) AGA technical review on anorectal testing techniques. Gastroenterology 116(3):735–760PubMedCrossRef Diamant NE, Kamm MA, Wald A et al (1999) AGA technical review on anorectal testing techniques. Gastroenterology 116(3):735–760PubMedCrossRef
6.
go back to reference Rao SS (2010) Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Clin Gastroenterol Hepatol 8(11):910–919PubMedCrossRef Rao SS (2010) Advances in diagnostic assessment of fecal incontinence and dyssynergic defecation. Clin Gastroenterol Hepatol 8(11):910–919PubMedCrossRef
7.
go back to reference Corsetti M (2010) Anorectal manometry with water-perfused catheter in healthy adults with no functional bowel disorders. Colorectal Dis 12(3):220–225CrossRef Corsetti M (2010) Anorectal manometry with water-perfused catheter in healthy adults with no functional bowel disorders. Colorectal Dis 12(3):220–225CrossRef
8.
go back to reference Gundling F, Seidl H, Scalercio N et al (2010) Influence of gender and age on anorectal function: normal values from anorectal manometry in a large Caucasian population. Digestion 81(4):207–213PubMedCrossRef Gundling F, Seidl H, Scalercio N et al (2010) Influence of gender and age on anorectal function: normal values from anorectal manometry in a large Caucasian population. Digestion 81(4):207–213PubMedCrossRef
9.
go back to reference Florisson JM, Coolen JC, Bissett IP et al (2006) A novel model used to compare water-perfused and solid-state anorectal manometry. Tech Coloproctol 10(1):17–20PubMedCrossRef Florisson JM, Coolen JC, Bissett IP et al (2006) A novel model used to compare water-perfused and solid-state anorectal manometry. Tech Coloproctol 10(1):17–20PubMedCrossRef
10.
go back to reference Sun WM, Read NW (1989) Anorectal function in normal human subjects: effect of gender. Int J Colorectal Dis 4(3):188–196PubMedCrossRef Sun WM, Read NW (1989) Anorectal function in normal human subjects: effect of gender. Int J Colorectal Dis 4(3):188–196PubMedCrossRef
11.
go back to reference Kritasampan P, Lohsiriwat S, Leelakusolvong S (2004) Manometric tests of anorectal function in healthy adult Thai subjects. J Med Assoc Thai 87(5):536–542PubMed Kritasampan P, Lohsiriwat S, Leelakusolvong S (2004) Manometric tests of anorectal function in healthy adult Thai subjects. J Med Assoc Thai 87(5):536–542PubMed
12.
go back to reference Simpson RR, Kennedy ML, Nguyen MH et al (2006) Anal manometry: a comparison of techniques. Dis Colon Rectum 49(7):1033–1038PubMedCrossRef Simpson RR, Kennedy ML, Nguyen MH et al (2006) Anal manometry: a comparison of techniques. Dis Colon Rectum 49(7):1033–1038PubMedCrossRef
13.
go back to reference Diamant NE, Kamm MA, Wald A et al (1999) American gastroenterological association medical position statement on anorectal testing techniques. Gastroenterology 116:732–760CrossRef Diamant NE, Kamm MA, Wald A et al (1999) American gastroenterological association medical position statement on anorectal testing techniques. Gastroenterology 116:732–760CrossRef
14.
go back to reference Rao SS, Azpiroz F, Diamant N et al (2002) Minimum standards of anorectal manometry. Neurogastroenterol Motil 14:553–559PubMedCrossRef Rao SS, Azpiroz F, Diamant N et al (2002) Minimum standards of anorectal manometry. Neurogastroenterol Motil 14:553–559PubMedCrossRef
15.
16.
go back to reference Ciriza-de-Los-Rios C, Ruiz-de-Leon-San-Juan A, Diaz-Rubio Garcia M et al (2010) Differences in the pressures of canal anal and rectal sensitivity in patients with fecal incontinence, chronic constipation and healthy subjects. Rev Esp Enferm Dig 102(12):683–690PubMedCrossRef Ciriza-de-Los-Rios C, Ruiz-de-Leon-San-Juan A, Diaz-Rubio Garcia M et al (2010) Differences in the pressures of canal anal and rectal sensitivity in patients with fecal incontinence, chronic constipation and healthy subjects. Rev Esp Enferm Dig 102(12):683–690PubMedCrossRef
17.
go back to reference Jameson JS, Chia YW, Kamm MA et al (1994) Effect of age, sex and parity on anorectal function. Br J Surg 81(11):1689–1692PubMedCrossRef Jameson JS, Chia YW, Kamm MA et al (1994) Effect of age, sex and parity on anorectal function. Br J Surg 81(11):1689–1692PubMedCrossRef
18.
go back to reference Fox JC, Fletcher JG, Zinsmeister AR et al (2006) Effect of aging on anorectal and pelvic floor functions in females. Dis Colon Rectum 49(11):1726–1735PubMedCrossRef Fox JC, Fletcher JG, Zinsmeister AR et al (2006) Effect of aging on anorectal and pelvic floor functions in females. Dis Colon Rectum 49(11):1726–1735PubMedCrossRef
19.
go back to reference Felt-Bersma RJ, Gort G, Meuwissen SG (1991) Normal values in anal manometry and rectal sensation: a problem of range. Hepatogastroenterology 38(5):444–449PubMed Felt-Bersma RJ, Gort G, Meuwissen SG (1991) Normal values in anal manometry and rectal sensation: a problem of range. Hepatogastroenterology 38(5):444–449PubMed
20.
21.
go back to reference Rao SS, Hatfield R, Soffer E (1999) Manometric tests of anorectal function in healthy adults. Am J Gastroenterol 94:773–783PubMedCrossRef Rao SS, Hatfield R, Soffer E (1999) Manometric tests of anorectal function in healthy adults. Am J Gastroenterol 94:773–783PubMedCrossRef
22.
go back to reference Schroeder HD, Reske-Nielsen E (1983) Fiber types in the striated urethral and anal sphincters. Acta Neuropathol 60:278–281CrossRef Schroeder HD, Reske-Nielsen E (1983) Fiber types in the striated urethral and anal sphincters. Acta Neuropathol 60:278–281CrossRef
23.
go back to reference McHugh SM, Diamant NE (1987) Anal canal pressure profile: a reappraisal as determined by rapid pullthrough technique. Gut 28:1234–1241PubMedCrossRef McHugh SM, Diamant NE (1987) Anal canal pressure profile: a reappraisal as determined by rapid pullthrough technique. Gut 28:1234–1241PubMedCrossRef
24.
go back to reference Rao SS, Welcher KD, Leistikow JS (1998) Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol 93:1042–1050PubMedCrossRef Rao SS, Welcher KD, Leistikow JS (1998) Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol 93:1042–1050PubMedCrossRef
25.
go back to reference Chiarioni G, Nardo A, Vantini I et al (2010) Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome. Gastroenterology 138:1321–1329PubMedCrossRef Chiarioni G, Nardo A, Vantini I et al (2010) Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome. Gastroenterology 138:1321–1329PubMedCrossRef
26.
go back to reference Noelting J, Ratuapli SK (2012) Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient. Am J Gastroenterol 107:1530–1536PubMedCrossRef Noelting J, Ratuapli SK (2012) Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient. Am J Gastroenterol 107:1530–1536PubMedCrossRef
27.
go back to reference Liu J, Guaderrama N, Nager CW et al (2006) Functional correlates of anal canal anatomy: puborectalis muscle and anal canal pressure. Am J Gastroenterol 101(5):1092–1097PubMedCrossRef Liu J, Guaderrama N, Nager CW et al (2006) Functional correlates of anal canal anatomy: puborectalis muscle and anal canal pressure. Am J Gastroenterol 101(5):1092–1097PubMedCrossRef
Metadata
Title
Normal values and pressure morphology for three-dimensional high-resolution anorectal manometry of asymptomatic adults: a study in 110 subjects
Authors
Yuwei Li
Xiaoqing Yang
Chen Xu
Yi Zhang
Xipeng Zhang
Publication date
01-08-2013
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 8/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-013-1706-9

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