Information for Doctors
WHY ARE THESE TESTS PERFORMED?
These tests are done to look predominantly at the patient with constipation. They attempt to distinguish between those with predominantly an evacuatory problem (difficulty emptying the bowel) and those with a transit problem. We always perform these tests together as they are looking at different aspects of the same problem.
SHOULD THEY ONLY BE DONE IN PATIENTS WITH CONSTIPATION?
There has been an increasing recognition that prolapse plays a major role in many patients with faecal incontinence. Furthermore, prolapse may play a role in other problems like pelvic pain. As a consequence, these tests have become part of our standard work-up for pelvic floor patients.
HOW DO YOU KNOW IF THE PROCTOGRAPHIC FINDINGS ARE SIGNIFICANT?
There has always been much interest in the common findings of abnormalities on proctography in normal subjects. It is important to undertake the tests only in patients with symptoms and to interpret them in the light of the clinical problem. Minor abnormalities may not be significant and surgery based on what may be little more than a normal variant is likely to be unsuccessful. The key to good outcomes is regular audit, MDT meetings, data collection and a readiness to seek another opinion.