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Anorectal manometry (ARM) is a medical test used to measure pressures in the anus and rectum and to assess their function. [ 1 ] [ 2 ] The test is performed by inserting a catheter , that contains a probe embedded with pressure sensors, through the anus and into the rectum. [ 3 ]
Anorectal manometry involves two separate tests: the balloon expulsion test and anal sphincter electromyography (EMG). These tests are performed in order to properly identify and diagnose dyssynergia. In order to prepare for these tests, a patient must fast and perform specific enemas recommended by their doctor two hours before their tests.
Anismus can be subcategorized into 4 types based on the results of anorectal manometry testing: [22] Type 1: The patient can generate and adequate rise in intra-abdominal pressure, yet there is a paradoxical increase in anal sphincter pressures.
Furthermore, 2 of the following 3 tests must show abnormal results: balloon expulsion test, anorectal manometry or anal surface electromyography, or imaging (e.g. defecography). [31] Two subcategories exist within the functional defecation disorders category: Inadequate defecatory propulsive (F3a) and Dyssynergic defecation (F3b). [31]
It has also been reported that there is a high false positive rate of anismus diagnosis with anorectal manometry for similar reasons. [5] Rectocele: This is the most common finding with this type of imaging. Almost always, this is an anterior rectocele where the anterior rectal wall bulges forward, into the vagina in females.
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The rectoanal inhibitory reflex (RAIR), also known as the anal sampling mechanism, anal sampling reflex, rectosphincteric reflex, or anorectal sampling reflex, is a reflex characterized by a transient involuntary relaxation of the internal anal sphincter in response to distention of the rectum. [1]
This pelvic floor muscle is normally supposed to relax, thereby straightening the anorectal angle and allowing rectal contents to be evacuated. Dyssynergic defecation causes high pressure in the rectum and in the anal canal, [ 1 ] which causes lengthening [ 1 ] and compression of the rectal tissues, which in turn leads to ischema of the mucosa ...