Anorectal Physiology and Endoanal Ultrasound
WHAT IS ANORECTAL PHYSIOLOGY AND ULTRASOUND?
The term “anorectal” refers to the anal canal and rectum. These are the parts of your bowel just inside your bottom. The physiology tests assess the strength of your pelvic muscles, sphincter and nerves whilst the ultrasound examines the structure of the pelvic floor muscles and any damage that has occurred to them.
WHEN ARE THESE TESTS PERFORMED?
These investigations are important tests of the pelvic floor structure and function. We will request them for many patients with incontinence, obstructed defaecation syndrome and prolapse. We also perform these tests in patients with other conditions affecting the bottom including anal fistulas and fissures. These tests are often combined with proctogram and transit studies.
WHAT DO THE TESTS INVOLVE?
The tests take approximately 45 minutes to perform in a private room with one of our nurse physiologists. She will start by asking you questions relating to your bowel function. Before the tests are undertaken, she will explain the procedures to you.
The nurse will ask you to remove your lower clothing and to lie on your side on a couch. For the anorectal physiology test, she will insert a very fine probe (about the thickness of a piece of spaghetti) into your bottom and ask you to relax and squeeze to measure your sphincter muscle strength. She will then insert a deflated balloon into you bottom and inflate this slowly to measure the sensation (feeling) in your rectum as this can be abnormal in many patients with pelvic floor problems. The ultrasound test is then performed, and this involves inserting a probe (about the thickness of a finger) about one inch into the bottom.
IS THERE ANY SPECIAL PREPARATION?
There is no special preparation required. We would usually suggest you try and empty your bowels and bladder before coming to hospital, but you can eat and drink normally before the tests.
ARE THE TESTS VERY EMBARRASSING OR PAINFUL?
Naturally many patients are anxious about undergoing these types of investigations. It is important to realise that pelvic floor problems are very common and we perform anorectal physiology and ultrasound tests on hundreds of patients each year. However we do understand that it can be difficult and embarrassing for many patients.
The tests are performed in a private environment where your dignity is respected. You will not feel any discomfort during the tests and there are no risks associated with the procedures.
WHAT IS THE RECOVERY LIKE AFTER THE TESTS?
The tests do not require any sedation or anaesthetic. You will be able to drive home afterwards and can return to work the same day if you wish.
WHAT HAPPENS THEN?
The nurse assessing you will explain her findings before you leave. She will compile a report for your surgeon. The tests need to be considered in relation to your clinical symptoms, examination findings and other tests.
You will receive a clinic appointment to come back and see the surgeon who referred you. He or she will then be able to advise you on the test results and the options available for treatment.
WHY IS A COLONOSCOPY PERFORMED?
Colonoscopy looks at the lining of the entire large bowel. This enables the surgeon to rule out serious problems. Polyps (small benign growths) can be removed. For the patient with incontinence it is important to rule out inflammation of the bowel, which is excluded by taking tiny samples of the bowel lining (biopsies).
WHAT PREPARATION IS REQUIRED FOR THIS TEST?
Colonoscopy needs a strong laxative taken 12- 24 hours beforehand. The medication and instructions will be given directly to you by your consultant, or sent to you in the post. Colonoscopy is usually performed with sedation. Download the pdf (link to colonoscopy pdf) for detailed information about how to prepare for your colonoscopy.
WHY HAPPENS DURING THE TEST?
You will be given an injection of light sedative which will relax you and make it easier for the consultant to carry out the colonoscopy. You will be asked to lie on your side. The surgeon will pass the colonoscope (a narrow tube with a camera and light source at the end) into your bowel through the anus and will view the lining of your bowel on a screen. He or she may take biopsies. The test will normally last around half an hour.
WHAT HAPPENS AFTER THE TEST?
The surgeon will normally discuss the results of the test with you immediately after it is performed. Biopsy results will usually take a couple of weeks to come through. You will be able to leave hospital as soon as you feel well enough, usually after about 3 hours. It is essential that you do not drive, operate machinery or sign important documents for 24 hours after taking the sedation and it is advisable to arrange for someone to stay with you overnight after the test.
WHAT ARE THE RISKS OF THIS TEST?
This is a very routine test. The most important but rare complication is that of perforation. This is when the instrument makes a hole in the bowel wall. It occurs in around 1:1000 colonoscopies. This is potentially serious and often needs an operation.