Anorectal Physiology Testing

Some patients with symptoms suggestive of pelvic floor dysfunction can benefit from undergoing anorectal physiology testing. These tests are most useful for people with either faecal incontinence/leakage or severe defecation problems or constipation. Generally we will perform these tests if the cause of a patient’s symptoms are not obvious, for information regarding treatment planning, or if we are considering a surgical intervention for a pelvic floor problem.

The tests are performed while you are awake and normally take about 20-30 minutes. Generally they are very well tolerated and discomfort is minimal. A colorectal nurse specialist is also present for your entire procedure.

We perform these tests at a dedicated state-of-the-art anorectal lab at Queen Elizabeth II Hospital. This is the most modern anorectal physiology lab currently available in Queensland and the assessment includes filling out of questionnaires, a detailed history and examination, and specific tests.

The specific tests performed are:

  1. 3D anal manometry – this measures the tone/strength of the anal sphincter and pelvic floor muscles, as well as the function of the muscles with certain manoevures. Problems with coordination of pelvic floor muscles and sphincter weakness/deficiency can be diagnosed with these tests.
  2. Rectoanal inhibitory reflex test – this test is simple and quick to perform. It can be a useful test to look for evidence of Hirschsprung’s disease (a rare congenital anorectal disorder).
  3. Rectal sensation testing – using a balloon, the sensitivity and compliance of the rectum can be measured. Rectal hyposensitivity can be found in patients with chronic constipation, and hypersensitivity in people with chronic pain, inflammatory bowel disease or following rectal surgery.
  4. 3D endoanal ultrasound – this test gives precise high-definition images of the anal sphincter complex. It can be particularly useful in evaluating patients for obstetric anal sphincter injury, anal fistulae, or following anal surgery.
  5. Pudendal nerve testing – this test can give surgeons a clue as to the presence of a “neuropathic” problem or nerve injury, usually related to obstetric trauma.
  6. Anorectal EMG (electromyography) – this is a test of the muscle function in the pelvic floor. It can be useful in detection of problems with pelvic floor muscle coordination or “dyssynergia”.

Prior to the tests, patients are asked to fill out questionnaires regarding their symptoms. These questionnaires can reveal the severity of patients’ symptoms as well as how much they affect quality of life.

Discuss with your surgeon the utility of undergoing anorectal physiology tests for your symptoms.

Below are links to further information on anorectal physiology tests, and the specific questionnaires that we use.

Patient Questionnaire

Information regarding anorectal physiology tests

Faecal incontinence and constipation severity and quality of life scores