Anal Manometric Assessment of Patients with Anal Diseases and Defecation Disorders

Kim, Ki Hyun; Shim, Kang Sup; Kim, Kwang Ho; Park, Eung Bum

Abstract

A manometric assessment of anal pressure is known to be an objective method in evaluating anorectal physiology and the function of the anal sphincter. We employed anal menometry to study the anal pressure in patients with hemorrhoids, anal fistulas, anal fissures, constipation, and fecal incontinence. This study was performed in the period from April 1994 to May 1996. The total number of patients with defecation disorder or anal disease assessed in this period at our rectal clinic by using anal manometry was 227; A control group was comprised of 10 patients with no known anal diseases or symptoms. The patient group was catergorized as follows:123 cases of hemorrhoids, 24 cases of anal fistulas, 35 cases of anal fissures, 29 cases of constipation, and 16 cases of fecal incontinence. We measured the maximal anal resting pressure (MARP) and the maximal anal squeeze pressure (MASP) in these patients as well as in the control group. We found the MARP to be higher in patients with hemorrhoids, anal fistulas, and anal fissures, compared to the control group, while the MARP was lower in the constipation group; however, these results were not statistically significant. The anal pressures of hemorrhoid patients were studied with respect to symptom, classification, past history, and the duration of symptoms. The results were as follows:The MARP was found to be increased in hemorrhoid patients with prolapse and pain and for thrombosed external hemorrhoids while it was decreased in patients with a previous hemorrhoidectomy. Furthermore, the MARP was increased in anal fissure patients when the duration of the symptom was short. In conclusion, anal manometric assessment of patients with anal diseases or defecation disorders could be valuable in determining the surgical procedure; furthermore, it could be valuable in evaluating postoperative results in fecal incontinence patients.