Samuel N. Marcus M.D., Ph.D.



Anorectal Manometry

Anorectal manometry is a test we can use here in our office in order to assess the muscle tone and pressures, sensation and neural reflexes of the anal sphincter. This test is used for patients who are suffering from rectal incontinence (the inability to control bowel movements, which leads to embarrassing anal leakage) or severe constipation (the inability to have a bowel movement even when you have the urge).

Healthy bowel movements are dependent on very specialized muscles in the anal sphincter and colon. These muscles help to control the movement of fecal matter through the bowels. In a healthy colon and rectum, anal muscles tighten when fecal matter moves into the bowels to prevent it from perpetually leaking. On the flip side, when you when you feel the urge to have a bowel movement, your rectal muscles will begin to relax – paradoxically, they relax even more when you’re bearing down – so the fecal matter can exit the colon in a controlled fashion.

The results of the anorectal manometry procedure will help Dr. Marcus determine the best course of treatment for your particular issue. In some cases, exercises and/or biofeedback physical therapy can be sufficient to retrain pelvic floor and rectal muscles to correct sphincter dysfunction. In other cases, more invasive treatment may be required.

What happens during the test?

Before the test, you will be asked to fast for at least two hours, and we’ll ask that you cleanse the lower colon by performing two enemas, no more than two hours before the test time. This will ensure the lower colon is clean for the procedure. Anorectal manometry is a safe and pain-free procedure and there is very minimal risk involved.

The total anorectal manometry procedure takes about 30 minutes from start to finish. There are two parts of the test: Anal sphincter electromyography (EMG) and the balloon expulsion test.

  • Anal sphincter electromyography (EMG): For this test, Dr. Marcus will insert a small plug electrode into the anal canal. He will then ask you to either squeeze, relax or bear down at different times, during which the electrode will transmit readings back to the computer. This part of the test will either confirm that the sphincter muscles are doing what they should, when they should – or it may indicate discrepancies – for example, muscles that contract when they should relax, or sphincter muscles that remain relaxed (often the case with rectal tears) when they should contract.
  • Balloon expulsion test. For the second part of the test, Dr. Marcus will insert a small, deflated balloon into the rectum and then he’ll gently inflate the balloon with water. If you have a latex allergy, please let our office know so we use a latex-free balloon for your procedure. Once the balloon is inflated, patients are asked to go to the restroom and expel the balloon. The length of time it takes for your body to expel the balloon is recorded. Anything longer than a normal expulsion time indicates some type of dysfunction in the anorectal muscles.

When both parts of the procedure are complete, you will get dressed and the doctor will discuss his findings with you. Since no sedation is required for this procedure, you can drive yourself home and return immediately to your normal activities.

Are you suffering from rectal incontinence or severe/chronic constipation? The sooner you are diagnosed the sooner you can be treated. Contact Dr. Marcus to schedule a consultation or to learn more about our practice. (650) 603-5436.