This data was presented in abstract form during the following meetings: Neurogastroenterology & Motility, 2009. 21(s1): p. 15–98. Swiss Med Wkly 2009;139 (Suppl. 176)G4.
The effect of standard compared to enhanced instruction and verbal feedback on anorectal manometry measurements
Article first published online: 6 NOV 2012
© 2012 Blackwell Publishing Ltd
Neurogastroenterology & Motility
Volume 25, Issue 3, pages 230–e163, March 2013
How to Cite
Heinrich, H., Fruehauf, H., Sauter, M., Steingötter, A., Fried, M., Schwizer, W. and Fox, M. (2013), The effect of standard compared to enhanced instruction and verbal feedback on anorectal manometry measurements. Neurogastroenterology & Motility, 25: 230–e163. doi: 10.1111/nmo.12038
- Issue published online: 17 FEB 2013
- Article first published online: 6 NOV 2012
- Received: 25 January 2012 Accepted for publication: 1 October 2012
- high-resolution anorectal manometry;
- verbal feedback;
- voluntary anorectal function
Background Guidelines recommend instruction and motivation during anorectal manometry; however, its impact on findings has not been reported. This study assessed the effects of standard versus enhanced instruction and verbal feedback on the results of anorectal manometry.
Methods High-resolution manometry was performed by a solid-state catheter with 10 circumferential sensors at 6 mm separation across the anal canal and two rectal sensors. Measurements were acquired first with standard instruction and then with enhanced instruction and verbal feedback. On both occasions, squeeze pressure and duration during three voluntary contractions and intra-rectal pressure and recto-anal pressure gradient (RAPG) during three attempts at simulated defecation were assessed.
Key Results A total of 70 consecutive patients (54 female; age 25–82 years) referred for investigation of fecal incontinence (n = 31), constipation, and related disorders of defecation (n = 39) were studied. Enhanced instruction and verbal feedback increased maximum squeeze pressure (Δ10 ± 28.5 mmHg; P < 0.0038) and duration of contraction (Δ3 ± 4 s; P < 0.0001). During simulated defecation, it increased intra-rectal pressure (Δ12 ± 14 mmHg; P < 0.003) and RAPG (Δ11 ± 20 mmHg; P < 0.0001). Using standard diagnostic criteria, the intervention changed manometric findings from locally validated ‘pathologic’ to ‘normal’ values in 14/31 patients with incontinence and 12/39 with disorders of defecation.
Conclusions & Inferences Enhanced instruction and verbal feedback significantly improved voluntary anorectal functions and resulted in a clinically relevant change of manometric diagnosis in some patients. Effective explanation of procedures and motivation during manometry is required to ensure consistent results and to provide an accurate representation of patient ability to retain continence and evacuate stool.