Anal manometry allows us to determine the resting pressures, squeeze pressures, sensation, squeeze duration, maximal pressures and RAIR reflex of the sphincter mechanism. This evaluation of the sensation and reflex can rule out Hirshsprung's disease and help determine the cause of fecal incontinence.
EMG tests the nerves that stimulate the sphincter muscles. A specialized glove is used to stimulate the nerves and a measurement is made when the sphincter muscle contracts. You may notice a small pulsation like a heartbeat when this occurs. We also use a small sponge to determine if your sphincter muscles are able to relax when bearing down. This helps us to determine if the patient has a pelvic outlet dysfunction.
3-D ERUS is a state-of-the-art ultrasound technology which gives a 360 degree visualization of the sphincter muscle in real time. Parker Adventist Hospital has the first 3-D ERUS in the state of Colorado. This technology gives unsurpassed detail of tumors, abscesses and fistulas as well as the integrity of the muscle and is invaluable to diagnosing disease in patients who have significant rectal pain.
Preparing for an ERUS
You will need to perform two enemas about one hour before the test to clean the rectum. The fleet enemas can be purchased from any pharmacy. If you want, you can replace the content with warm tap water. There are no dietary restrictions.
A dynamic MRI allows us to visualize and compare the pelvic floor at rest and then at maximum push. A gel is placed inside the rectum and/or vaginal canal and a preliminary study is compared to a scan at exertion.
Biofeedback is also known as pelvic floor muscle retraining, this is a method of manipulating muscle strength by giving a visual representation of muscle activity. This will reinforce muscle retraining to ensure maximal conditioning. This technique is also useful in a condition called anismus where a muscle does not relax during defecation causing severe constipation.