High-resolution anorectal manometry in children

Abstract

Anorectal manometry is one of the motility tests in children performed by pediatric gastroenterologist. It evaluates the motility function of anorectal tract. It is helpful for diagnosing children with constipation, rectal hypersensitivity, fecal incontinence, Hirschsprung disease, anal achalasia, and anorectal malformations. The most common indication to perform anorectal manometry is to diagnose Hirschsprung disease. It is a safe procedure. This paper discusses recent advances and reviews on anorectal motility disorders in children.

Keywords: Anal achalasia; Defecation dyssynergia; Fecal incontinence; Hirschsprung disease; Rectal sensations.

Fig. 1.

Stepwise analysis of anorectal biometrics based on London IAPWG (International Anorectal Physiology Working Group) [13] protocol. RAIR, recto anal inhibitory reflex.

Fig. 2.

Anorectal manometry during push maneuver showing paradoxical raised anal pressure with defecation suggests type 1 defecation dyssynergia (Images taken post consent from patient and subject to copy right Superspeciality Clinics & Endoscopy Center. Nagpur. Dr Yogesh Waikar).

Fig. 3.

Anorectal manometry images during rest, squeeze, and push. It depicts normal topographical graph while performing anorectal manometry in 3 states which are rest, squeeze, and push. In squeeze, maneuver anal pressure increases (red-purple color in the middle). In push, maneuver rectal pressure increases showed by yellow and red lines in upper part of topographical chart. Images taken post consent from patient and subject to copyright Superspeciality Clinics & Endoscopy Center (Nagpur), Dr. Yogesh Waikar

Fig. 4.

RAIR (recto anal inhibitory reflex) present rules out Hirschsprung disease. Reflex marked area shows reduction in anal pressure post rectal balloon inflation. Images taken post consent from patient and subject to copyright Superspeciality Clinics & Endoscopy Center (Nagpur), Dr. Yogesh Waikar.