Anorectal pressures measured with high-resolution manometry in healthy people—Normal values and asymptomatic pelvic floor dysfunction

Nicholas R. Oblizajek, Sangeetha Gandhi, Mayank Sharma, Subhankar Chakraborty, Anjani Muthyala, David Prichard, Kelly Feuerhak, Adil Eddie Bharucha

Research output: Contribution to journalArticle

Abstract

Background: High-resolution manometry (HRM) is used to measure rectoanal pressures in defecatory disorders and fecal incontinence. This study sought to define normal values for rectoanal HRM, ascertain the effects of age and BMI on rectoanal pressures, and compare pressures in asymptomatic women with normal and prolonged balloon expulsion time (BET). Methods: High-resolution manometry pressures and BET were measured in 163 asymptomatic healthy participants. Women (96) and men (47) with normal BET were used to estimate normal values and the effects of age/BMI on pressures using a Medtronic 4.2-mm-diameter rectoanal catheter. Key Results: Age is associated with lower resting pressure, higher rectal pressure during evacuation, and a higher rectoanal gradient during evacuation in women and men. In women, the BET is also inversely correlated with age while the BMI is correlated with a higher threshold volume for discomfort and a longer BET. The anal squeeze pressure increment, squeeze duration, and HPZ length are higher in men than women. The rectoanal gradient during evacuation is also lower (ie, more negative) in asymptomatic women with an abnormal than a normal BET. Conclusions & Inferences: These findings provide an expanded database of normal values for anorectal HRM in men and women. Age and sex affect anal resting and squeeze pressures, respectively; rectal pressure during evacuation is also higher in older people. Less than 15% of asymptomatic people have BET >60 seconds, which is associated with manometry features of impaired evacuation.

Original languageEnglish (US)
Article numbere13597
JournalNeurogastroenterology and Motility
DOIs
StatePublished - Jan 1 2019

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Pelvic Floor
Manometry
Pressure
Reference Values
Fecal Incontinence
Sexual Behavior
Healthy Volunteers
Catheters
Databases

Keywords

  • anorectal manometry
  • balloon expulsion test
  • constipation
  • defecatory disorders
  • pelvic floor dysfunction

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology

Cite this

Anorectal pressures measured with high-resolution manometry in healthy people—Normal values and asymptomatic pelvic floor dysfunction. / Oblizajek, Nicholas R.; Gandhi, Sangeetha; Sharma, Mayank; Chakraborty, Subhankar; Muthyala, Anjani; Prichard, David; Feuerhak, Kelly; Bharucha, Adil Eddie.

In: Neurogastroenterology and Motility, 01.01.2019.

Research output: Contribution to journalArticle

Oblizajek, Nicholas R. ; Gandhi, Sangeetha ; Sharma, Mayank ; Chakraborty, Subhankar ; Muthyala, Anjani ; Prichard, David ; Feuerhak, Kelly ; Bharucha, Adil Eddie. / Anorectal pressures measured with high-resolution manometry in healthy people—Normal values and asymptomatic pelvic floor dysfunction. In: Neurogastroenterology and Motility. 2019.
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AB - Background: High-resolution manometry (HRM) is used to measure rectoanal pressures in defecatory disorders and fecal incontinence. This study sought to define normal values for rectoanal HRM, ascertain the effects of age and BMI on rectoanal pressures, and compare pressures in asymptomatic women with normal and prolonged balloon expulsion time (BET). Methods: High-resolution manometry pressures and BET were measured in 163 asymptomatic healthy participants. Women (96) and men (47) with normal BET were used to estimate normal values and the effects of age/BMI on pressures using a Medtronic 4.2-mm-diameter rectoanal catheter. Key Results: Age is associated with lower resting pressure, higher rectal pressure during evacuation, and a higher rectoanal gradient during evacuation in women and men. In women, the BET is also inversely correlated with age while the BMI is correlated with a higher threshold volume for discomfort and a longer BET. The anal squeeze pressure increment, squeeze duration, and HPZ length are higher in men than women. The rectoanal gradient during evacuation is also lower (ie, more negative) in asymptomatic women with an abnormal than a normal BET. Conclusions & Inferences: These findings provide an expanded database of normal values for anorectal HRM in men and women. Age and sex affect anal resting and squeeze pressures, respectively; rectal pressure during evacuation is also higher in older people. Less than 15% of asymptomatic people have BET >60 seconds, which is associated with manometry features of impaired evacuation.

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