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Z Gastroenterol 2007; 45(5): 397-417
DOI: 10.1055/s-2007-963099
Leitlinien

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Empfehlungen zur Anorektalen Manometrie im Erwachsenenalter[1]

Anorectal Manometry[2] C. Pehl1 , P. Enck2 , A. Franke3 , T. Frieling4 , W. Heitland5 , A. Herold6 , H. Hinninghofen7 , M. Karaus8 , J. Keller9 , H.-J Krammer10 , M. Kreis11 , R. Kuhlbusch-Zicklam4 , H. Mönnikes12 , U. Münnich13 , T. Schiedeck14 , M. Schmidtmann12
  • 1Medizinische Klinik, Kreiskrankenhaus Vilsbiburg
  • 2Klinik für Innere Medizin VI - Psychosomatik, Universitätsklinikum Tübingen
  • 3II. Med. Klinik, Universitätsklinikum Mannheim
  • 4Medizin. Klinik II, Klinikum Krefeld
  • 5Chirurgische Klinik, Klinikum München-Bogenhausen
  • 6Enddarmzentrum Mannheim
  • 7Klinik für Innere Medizin VI, Psychosomatik, Universitätsklinikum Tübingen
  • 8Medizinische Klinik, Evangelisches Krankenhaus, Göttingen
  • 9Klinik für Innere Medizin, Israelitisches Krankenhaus, Hamburg
  • 10Praxis für Gastroenterologie und Ernährungsmedizin, Mannheim
  • 11Chirurgische Klinik, Ludwig-Maximilians-Universität (Klinikum Großhadern) München
  • 12Medizinische Klinik m.S. Hepatologie & Gastroenterologie, Universitätsklinikum Charité, Campus Virchow-Klinikum, Berlin
  • 13Medtronic GmbH, Düsseldorf/Halle
  • 14Klinik für Allgemein- und Viszeralchirurgie, Klinikum Ludwigsburg
Weitere Informationen

Publikationsverlauf

Manuskript eingetroffen: 11.3.2007

Manuskript akzeptiert: 23.3.2007

Publikationsdatum:
15. Mai 2007 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Die Gesellschaft für Neurogastroenterologie hat in Zusammenarbeit mit den Deutschen Gesellschaften für Verdauungs- und Stoffwechselkrankheiten (Kommission Proktologie), für Viszeralchirurgie (Arbeitsgruppe Colo-Proktologie) und für Koloproktologie Empfehlungen zur anorektalen Manometrie beim Erwachsenen erarbeitet. Die Empfehlungen umfassen die Abschnitte „Technische Grundlagen”, „Vor- und Nachbereitung”, „Durchführung und Auswertung”, „Reproduzierbarkeit” sowie „Indikationen”. Bei jeder anorektalen Manometrie sind als Mindestanforderung zu bestimmen: der Ruhe- und maximale Kneifdruck im Analkanal, das Vorhandensein respektive Fehlen des rektoanalen Inhibitionsreflexes, die sensorischen Schwellenwerte für Rektumdehnung (Perzeptions- und Stuhldrangschwelle) sowie eine Compliancemessung des Rektums bei einer Ballonfüllung mit 100 mL. In Abhängigkeit von spezifischen Fragestellungen oder laborspezifischen Protokollen kann zusätzlich die Analkanallänge, die Dauerkontraktionsleistung, die Schmerzschwelle bei Rektumdehnung bestimmt sowie ein Husten- oder Defäkationstest durchgeführt werden. Die Durchführung einer anorektalen Manometrie ist im Rahmen eines strukturierten Programms zur Abklärung der Stuhlinkontinenz und Obstipation indiziert. Weiter kann eine anorektale Manometrie im Einzelfall präoperativ, vor Biofeedback-Therapie sowie bei Patienten mit idiopathischem Schmerzsyndrom oder Reizdarm sinnvoll sein.

Abstract

This document contains the guidelines of the German Societies of Neurogastroenterology and Motility, Gastroenterology (committee for proctology), Abdominal Surgery (coloproctology working group), and Coloproctology for anorectal manometry in adults. Recommendations are given about technical notes, study preparation (equipment; patient), technique for performing manometry and data analysis, reproducibility, and indications. Minimum standards for anorectal manometry are measurement of resting and squeeze pressure, testing of rectoanal inhibitory reflex, determination of rectal sensation (first perception and urge), and calculation of rectal compliance. Anorectal manometry is indicated in patients with fecal incontinence and constipation in the context of a structured programme.

Schlüsselwörter

Darm - Rektummanometrie - Empfehlungen

Key words

intestine - rectal manometry - recommendations

1 Empfehlungen der Deutschen Gesellschaft für Neurogastroenterologie und Motilität, der Kommission Proktologie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten, der Deutschen Gesellschaft für Koloproktologie und der Chirurgischen Arbeitsgruppe Colo-Proktologie der Deutschen Gesellschaft für Viszeralchirurgie zur anorektalen Manometrie im Erwachsenenalter

2 Recommendations of the German Society for Neurogastroenterology and Motility, The Commission Proctology of the German Society for Digestive and Metabolic Diseases, the German Society for Coloprotology and the Surgical Working Group Coloproctology of the German Society for Visceral Surgery on Anorectal Manometry in Adults

Literatur

  • 1 Schuster M, Hookman P, Hendrix T. et al . Simultaneous manometric recording of internal and external anal sphincteric reflexes.  Bull Johns Hopkins Hosp. 1965;  116 79-88
    Google Scholar
  • 2 Schmitt T, Schönfeld A, Eckhardt V. Investigation of Esophageal Motor Function: Comparison between Perfusion and Microtransducer Manometry.  Z Gastroenterol. 2004;  42 785-944
    Google Scholar
  • 3 Rehak P. Gas-perfused catheters - a simple high fidelity recording system for esophageal manometry. XIV. ICMBE and VII ICMP, Espoo, Finnland.  1985;  Poster 8.64
    Google Scholar
  • 4 Tutuian R, Agrawal A, Mainie I. et al . Disposable balloon-based oesophageal motility catheters: comparison with solid-state transducers.  Neurogastroenterol Motil. 2005;  17 453-457
    Google Scholar
  • 5 Frieling T, Rühl A, Pehl C. et al . Hygiene im Manometrielabor: Deutsche Multicenter-Studie.  Z Gastroenterol. 2004;  42 808
    Google Scholar
  • 6 Eckardt V, Elmer T. Reliability of anal pressure measurement.  Dis Colon Rectum. 1991;  34 72-77
    Google Scholar
  • 7 Rao S, Azpiroz F, Diamant N. et al . Minimum standards of anorectal manometry.  Neurogastroenterol Mot. 2002;  14 553-559
    Google Scholar
  • 8 Barnett J L, Hasler W L, Camilleri M. American Gastroenterological Association medical position statement on anorectal testing techniques.  Gastroenterology. 1999;  116 732-760
    Google Scholar
  • 9 Prott G, Hansen R, Badcock C. et al . What ist he optimum methodology for the clinical measurement of resting anal pressure?.  Neurogastroenterol Mot. 2005;  17 595-599
    Google Scholar
  • 10 McHugh S, Diamant N. Effect of age, gender, and parity on anal canal pressures.  Dig Dis Sci. 1987;  32 726-736
    Google Scholar
  • 11 Zbar A, Kmiot W, Aslam M. et al . Use of vector volume manometry and endoanal magnetic resonance imaging of anal sphincter dysfunction.  Dis Colon Rectum. 1999;  42 1411-1418
    Google Scholar
  • 12 Hill J, Kelley M, Schlegel J. et al . Pressure profile of the rectum and anus of healthy persons.  Dis Colon Rectum. 1960;  3 203-209
    Google Scholar
  • 13 Meunier P. Tube digestif et pancreas.  Gastroenterol Clin Biol. 1991;  15 697-702
    Google Scholar
  • 14 Sun W, Read N. Anorectal function in normal human subjects: effect of gender.  Int J Colorectal Dis. 1989;  4 188-196
    Google Scholar
  • 15 Sun W, Rao S. Manometric assessment of anorectal function.  Gastroenterol Clin North Am. 2001;  30 15-33
    Google Scholar
  • 16 Epanomeritakis E, Koutsoumbi P, Tsiaoussis I. et al . Impairment of anorectal function in diabetes mellitus parallels duration of disease.  Dis Colon Rectum. 1999;  42 1394-1400
    Google Scholar
  • 17 Enck P, Eggers E, Koletzko S. et al . Spontaneous variation of anal „resting” pressure in healthy humans.  Am J Physiol. 1991;  261 G823-826
    Google Scholar
  • 18 McHugh S, Diamant N. Anal canal pressure profile: a reappraisal as determined by rapid pullthrough technique.  Gut. 1987;  28 1234-1241
    Google Scholar
  • 19 Freys S M, Fuchs K H, Fein M. et al . Inter- and intraindividual reproducibility of anorectal manometry.  Langenbeck’s Arch Surg. 1998;  383 325-329
    Google Scholar
  • 20 Pedersen I, Christiansen J. A study of the physiological variation in anal manometry.  Br J Surg. 1989;  76 69-70
    Google Scholar
  • 21 Simpson R, Kennedy M, Nguyen M. et al . Anal manometry: A comparison of techniques.  Dis Colon Rectum. 2006;  49 1033-1038
    Google Scholar
  • 22 Felt-Bersma R, Gort G, Meuwissen S. Normal values in anal manometry and rectal sensation: a problem of range.  Hepatogastroenterology. 1991;  38 444-449
    Google Scholar
  • 23 Bannister J, Abouzekry L, Read N. Effect of aging on anorectal function.  ut. 1987;  28 353-357
    Google Scholar
  • 24 Laurberg S, Swash M. Effects of aging on the anorectal sphincters and their innervation.  Dis Colon Rectum. 1989;  32 737-742
    Google Scholar
  • 25 Poos R, Bittner R, Frank J. et al . Results of anorectal manometry for the determination of age- and sex-dependent pressure differences.  Z Gastroenterol. 1984;  22 592-597
    Google Scholar
  • 26 Schäfer R, Heyer T, Gantke B. et al . Anal endosonography and manometry: comparison in patients with defecation problems.  Dis Colon Rectum. 1997;  40 293-297
    Google Scholar
  • 27 Rao S, Hatfield R, Soffer E. et al . Manometric tests of anorectal function in healthy adults.  Am J Gastroenterol. 1999;  94 773-783
    Google Scholar
  • 28 Pehl C, Scalercio N, Schepp W. Kann die anorektale Manometrie (RM) zwischen Gesunden und Patienten mit Stuhlinkontinenz unterscheiden.  Z Gastroenterol. 2005;  43 907
    Google Scholar
  • 29 Wankling W, Brown B, Collins C. et al . Basal electrical activity in the anal canal in man.  Gut. 1968;  9 457-460
    Google Scholar
  • 30 Sangwan Y, Coller J, Schoetz D. et al . Relationship between manometric anal waves and fecal incontinence.  Dis Colon Rectum. 1995;  38 370-374
    Google Scholar
  • 31 Hancock B. The internal sphincter and anal fissure.  Br J Surg. 1977;  64 92-95
    Google Scholar
  • 32 Gibbons C, Read N. Anal hypertonia in fissures: cause or effect?.  Br J Surg. 1986;  73 443-445
    Google Scholar
  • 33 Read M, Read N, Hayes W. et al . A prospective study of the effect of hemorrhoidectomy on sphincter function and faecal continence.  Br J Surg. 1982;  69 396-398
    Google Scholar
  • 34 Loening-Baucke V, Anuras S. Effects of age and sex on anorectal manometry.  Am J Gastroenterol. 1985;  80 50-53
    Google Scholar
  • 35 Loening-Baucke V, Anuras S. Anorectal manometry in healthy elderly subjects.  J Am Geriatr Soc. 1984;  32 636-639
    Google Scholar
  • 36 Rasmussen O, Sorensen M, Tetzscher T. et al . Dynamic anal manometry: Physiological variations and pathological findings in fecal incontinence.  Gastroenterology. 1992;  103 103-113
    Google Scholar
  • 37 Taylor B M, Beart R W, Phillips S F. Longitutinal and radial variations of pressure in the human anal sphincter.  Gastroenterology. 1984;  86 693-697
    Google Scholar
  • 38 Kritasampan P, Lohsiriwat S, Leelakusolvong S. Manometric tests of anorectal function in healthy adult Thai subjects.  J Med Assoc Thai. 2004;  87 536-542
    Google Scholar
  • 39 Chiarioni G. Liquid stoll incontinence with severe urgency: anorectal function and effective biofeedback treatment.  Gut. 1993;  34 1576-1580
    Google Scholar
  • 40 Azpiroz F, Enck P, Whitehead W E. Anorectal functional testing: review of collective experience.  Am J Gastroenterol. 2002;  97 232-240
    Google Scholar
  • 41 Norton C, Hosker G, Brazzelli M. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults.  Cochrane Database Syst Rev. 2000;  (2) CD002111
    Google Scholar
  • 42 Norton C, Chelvanayagam S, Wilson-Barnett J. et al . Randomized controlled trial of biofeedback for fecal incontinence.  Gastroenterology. 2003;  125 1320-1329
    Google Scholar
  • 43 Ashraf W, Pfeiffer R, Quigley E. Anorectal manometry in the assessment of anorectal function in Parkinson’s disease: a comparison with chronic idiopathic constipation.  Movement Disorders. 1994;  9 655-663
    Google Scholar
  • 44 Marcello P, Barrett R, Coller J. et al . Fatigue rate index as a new measurement of external sphincter function.  Dis Colon Rectum. 1998;  41 336-343
    Google Scholar
  • 45 Telford K, Ali A, Lymer K. et al . Fatigability of the external anal sphincter in anal incontinence.  Dis Colon Rectum. 2004;  47 746-752
    Google Scholar
  • 46 Crowell M, Lacy B, Schettler V. et al . Subtypes of anal incontinence associated with bowel dysfunction: clinical, physiologic, and psychosocial characterization.  Dis Colon Rectum. 2004;  47 1627-1635
    Google Scholar
  • 47 Mitrani C, Chun A, Deautels S. et al . Anorectal manometric characteristics in men and women with idiopathic fecal incontinence.  J Clin Gastroenterol. 1998;  26 175-178
    Google Scholar
  • 48 Gee A, Durdey P. Urge incontinence of faeces is a marker of severe external anal sphincter dysfunction.  Br J Surg. 1995;  82 1179-1182
    Google Scholar
  • 49 Denny-Brown D, Robertson, EG. An investigation of the nervous control of defaecation.  Brain. 1935;  58 256-310
    Google Scholar
  • 50 Goligher J C, Hughes E SR. Sensibility of the rectum and colon ! its role in the mechanism of anal continence.  Lancet. 1951;  I 543-548
    Google Scholar
  • 51 Duthie H L. Dynamics of the rectum and anus.  Clin Gastroenterol. 1975;  4 467-477
    Google Scholar
  • 52 De Lorijn F, Jonge W J, Wedel de T. et al . Interstitial cells of Cajal are involved in the afferent limb of the rectoanal inhibitory reflex.  Gut. 2005;  54 1107-1113
    Google Scholar
  • 53 Stebbing J F, Brading A F, Mortensen N J. Nitric oxide and the rectoanal inhibitory reflex: retrograde neuronal tracing reveals a descending nitrergic rectoanal pathway in a guinea-pig model.  Br J Surg. 1996;  83 493-498
    Google Scholar
  • 54 Fürst A, Herold A, Bruch H P. Die physiologische Relaxation des M. sphincter ani internus.  Kontinenz. 1994;  3 133-141
    Google Scholar
  • 55 Sun W, Read N, Prior A. et al . Sensory and motor responses to rectal distention vary according to rate and pattern of ballon inflation.  Gastroenterology. 1990;  99 1008-1015
    Google Scholar
  • 56 Diamant N E, Kamm M A, Wald A. et al . American Gastroenterological Association Technical review on anorectal testing techniques.  Gastroenterology. 1999;  116 735-760
    Google Scholar
  • 57 Wald A, Tunuguntla A. Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy.  N Engl J Med. 1984;  310 1282-1287
    Google Scholar
  • 58 Hinninghofen H, Enck P. Fecal incontinence: evaluation and treatment.  Gastroenterol Clin N Am. 2003;  32 685-706
    Google Scholar
  • 59 Sun W, Rao S. Manometric assesment of anorectal function.  Gastroenterol Clin N Am. 2001;  30 15-32
    Google Scholar
  • 60 Speakman C, Kamm M. Abnormal visceral autonomic innervation in neurogenic faecal incontinence.  Gut. 1993;  34 215-221
    Google Scholar
  • 61 Caruana B, Wald A, Hinds J. et al . Anorectal sensory and motor function in neurogenic fecal incontinence. Comparison between multiple sclerosis and diabetes mellitus.  Gastroenterology. 1991;  100 465-470
    Google Scholar
  • 62 Bielefeldt K, Enck P, Erckenbrecht J. Sensory and motor function in the maintenance of anal continence.  Dis Colon Rectum. 1990;  33 674-678
    Google Scholar
  • 63 Sun W, Donnelly T, Read N. Utility of a combined test of anorectal manometry, electromyography, and sensation in determining the mechanism of idiopathic faecal incontinence.  Gut. 1992;  33 807-813
    Google Scholar
  • 64 Rao S, Patel R. How useful are manometric tests of anorectal function in the management of defecation disorders?.  Am J Gastroenterol. 1997;  92 469-475
    Google Scholar
  • 65 Chiarioni G, Basotti G, Stanganini S. et al . Sensory retraining is key to biofeedback therapy for formed stool fecal incontinence.  Am J Gastroenterol. 2002;  97 109-117
    Google Scholar
  • 66 Rao S. Constipation: evaluation and treatment.  Gastroenterol Clin N Am. 2003;  32 659-683
    Google Scholar
  • 67 Farouk R, Bartolo D. The clinical contribution of integrated laboratory and ambulatory anorectal physiology assessment in faecal incontincne.  Int J Colorectal Dis. 1993;  8 60-65
    Google Scholar
  • 68 Fernandez-Fraga X, Azpiroz F, Malagelada J. Significance of pelvic floor muscles in anal incontinence.  Gastroenterology. 2002;  123 1441-1450
    Google Scholar
  • 69 Kaur G, Gardiner A, Duthie G. A new method of assessing anal sphincter integrity using inverted vectormanometry.  Dis Colon rectum. 2006;  49 1160-1166
    Google Scholar
  • 70 Braun J C, Treutner K H, Dreuw B. et al . Vectormanometry for differential diagnosis of fecal incontinence.  Dis Colon Rectum. 1994;  37 989-996
    Google Scholar
  • 71 Freys S M, Fuchs K H, Bussen D. et al . Anorectal pull-through and vector volume manometry.  Zentralbl Chir. 1996;  121 652-658
    Google Scholar
  • 72 Jorge J, Habr-Gama A. The value of sphincter asymmetry index in anal incontinence.  Int J Colorectal Dis. 2000;  15 303-310
    Google Scholar
  • 73 Willis S, Faridi A, Schelzig S. et al . Childbirth and incontinence: a prospective study on anal sphincter morphology and function before and early after vaginal delivery.  Langenbecks Arch Surg. 2002;  387 101-107
    Google Scholar
  • 74 Yang Y K, Wexner S D. Anal pressure vectography is of no apparent benefit for sphincter evaluation.  Int J Colorectal Dis. 1994;  9 92-95
    Google Scholar
  • 75 Perry R E, Blatchford G J, Christensen M A. et al . Manometric diagnosis of anal sphincter injuries.  Am J Surg. 1990;  159 112-116; discussion 116 - 117
    Google Scholar
  • 76 Stojkovic S, Balfour L, Burke D. et al . Role of resting pressure gradient in the investigation of idiopathic fecal incontinence.  Dis Colon Rectum. 2002;  45 668-673
    Google Scholar
  • 77 Enck P, Arping H, Engel S. et al . Effects of cisapride on ano-rectal spincter function.  Aliment Pharmacol Ther. 1989;  3 539-545
    Google Scholar
  • 78 Rogers J, Laurberg S, Misiewicz J. et al . Anorectal physiology validated: a repeatabilty study of the motor and sensory tests of anorectal function.  Br J Surg. 1989;  79 607-609
    Google Scholar
  • 79 Ryhammer A, Laurberg S, Hermann A. Test-retest repeatability of anorectal physiology tests in healthy volunteers.  Dis Colon Rectum. 1997;  40 287-292
    Google Scholar
  • 80 Bharucha A, Seide B, Fox J. et al . Day-to-day reproducibility of anorectal sensorimotor assessments in healthy subjects.  Neurogastroenterol Motil. 2004;  16 241-250
    Google Scholar
  • 81 Göke M, Donner K, Ewe K. et al . Intraindividual variability of anorectal manometry parameters.  Z Gastroenterol. 1992;  30 243-246
    Google Scholar
  • 82 Read N, Harford W, Schmulen A. et al . A clinical study of patients with fecal incontinence and diarrhea.  Gastroenterology. 1979;  76 747-756
    Google Scholar
  • 83 Schnegg J, Rey F, Armstrong D. et al . Effect of the menstrual cycle on the reproducibility of anorectal manometry.  Schweiz Med Wochenschr. 1994;  30 (124) 729-732
    Google Scholar
  • 84 Holmberg A, Graf W, Osterberg A. et al . Anorectal manovolumetry in the diagnosis of fecal incontinence.  Dis Colon Rectum. 1995;  38 502-508
    Google Scholar
  • 85 Kendall G, Thompson D, Day S. et al . Inter- and intraindividual variation in pressure-volume relations of the rectum in normal subjects and patients with the irritable bowel syndrome.  Gut. 1990;  31 1062-1068
    Google Scholar
  • 86 Cremonini F, Houghton L, Camilleri M. et al . Barostat testing of rectal sensation and compliance in humans: comparison of results across two centres and overall reproducibility.  Neurogastroenterol Motil. 2005;  17 810-820
    Google Scholar
  • 87 Felt-Bersma R, Klinkenberg-Knol E, Meuwissen S. Anorectal function investigations in incontinent and continent patients.  Dis Colon Rectum. 1990;  33 479-485
    Google Scholar
  • 88 Chan C, Scott M, Williams N. et al . Rectal hypersensitivity worsens stool frequency, urgency, and lifesytle in patients with urge incontinence.  Dis Colon Rectum. 2005;  48 134-140
    Google Scholar
  • 89 Siproudhis L, Bellissant E, Pagenault M. et al . Fecal incontinence with normal anal canal pressures: where ist he pitfall?.  Am J Gastroenterol. 1999;  94 1556-1563
    Google Scholar
  • 90 Sentovich S, Rivela L, Blatchford G. et al . Patterns of male fecal incontinence.  Dis Colon Rectum. 1995;  38 281-285
    Google Scholar
  • 91 Rex D, Lappas J. Combined anorectal manometry and defecography in 50 consecutive adults with fecal incontinence.  Dis Colon Rectum. 1992;  35 1040-1045
    Google Scholar
  • 92 Hiltunen K. Anal manometric findings in patients with anal incontinence.  Dis Colon Rectum. 1985;  28 925-928
    Google Scholar
  • 93 Penninckx F, Lestar B, Kerremans R. Manometric evaluation of incontinent patients.  Acta Gastro-Enterologica Belgica. 1995;  58 51-59
    Google Scholar
  • 94 Engel A, Kamm M, Bartram C. et al . Relationship of symptoms in faecal incontinence to specific sphincter abnormalities.  Int J Colorectal Dis. 1995;  10 152-155
    Google Scholar
  • 95 Hill J, Corson R, Brandon H. et al . History and examination in the assessment of patients with idiopathic fecal incontinence.  Dis Colon Rectum. 1994;  37 473-477
    Google Scholar
  • 96 Meunier P, Marechal J M, Mollard P. Accuracy of the manometric diagnosis of Hirschsprung’s disease.  J Pediatr Surg. 1978;  13 411-415
    Google Scholar
  • 97 Tobon F, Reid N C, Talbert J L. et al . Nonsurgical test for the diagnosis of Hirschsprung’s disease.  N Engl J Med. 1968;  278 188-193
    Google Scholar
  • 98 Rasmussen O, Christensen B, Sorensen M. et al . Rectal compliance in the assessment of patients with fecal incontinence.  Dis Colon Rectum. 1990;  33 650-653
    Google Scholar
  • 99 Meunier P. Physiologic study of the terminal digestive tract in chronic painful constipation.  Gut. 1986;  27 1018-1024
    Google Scholar
  • 100 Gladman M, Scott S, Chan C. et al . Rectal hyposensitivity: prevalence and clinical impact in patients with intractable constipation and fecal incontinence.  Dis Colon Rectum. 2003;  46 238-246
    Google Scholar
  • 101 Deen K, Seneviratne S, Silva de H. Anorectal physiology and transit in patients with disorders of thyroid metabolism.  J Gastroenterol Hepatol. 1999;  14 384-387
    Google Scholar
  • 102 Merkel I, Locher J, Burgio K. et al . Physiologic and psychologic characteristics of an elderly population with chronic constipation.  Am J Gastroenterol. 1993;  88 1854-1859
    Google Scholar
  • 103 Whitehead W E, Wald A, Diamant N E. et al . Functional disorders of the anus and rectum.  Gut. 1999;  45 (Suppl 2) II55-59
    Google Scholar
  • 104 Preston D M, Lennard-Jones J E. Anismus in chronic constipation.  Dig Dis Sci. 1985;  30 413-418
    Google Scholar
  • 105 Rao S, Welcher K, Leistikow J. Obstructive defecation: a failure of rectoanal coordination.  Am J Gastroenterol. 1998;  93 1042-1050
    Google Scholar
  • 106 Rao S, Mudipalli R, Stessman M. et al . Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus).  Neurogastroenterol Motil. 2004;  16 589-596
    Google Scholar
  • 107 Pelsang R, Rao S, Welcher K. FECOM: a new artificial stool for evaluating defecation.  Am J Gastroenterol. 1999;  94 183-186
    Google Scholar
  • 108 Barnes P, Lennard-Jones J. Balloon expulsion from the rectum in constipation of different types.  Gut. 1985;  26 1049-1052
    Google Scholar
  • 109 Fleshman J, Dreznik Z, Cohen E. et al . Balloon expulsion test facilitates diagnosis of pelvic floor outlet obstruction due to nonrelaxing puborectalis muscle.  Dis Colon Rectum. 1992;  35 1019-1025
    Google Scholar
  • 110 Bannister J J, Timms J M, Barfield L J. et al . Physiological studies in young women with chronic constipation.  Int J Colorectal Dis. 1986;  1 175-182
    Google Scholar
  • 111 Minguez M, Herreros B, Sanchiz V. et al . Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation.  Gastroenterology. 2004;  126 57-62
    Google Scholar
  • 112 Rao S, Sun W. Current techniques of assessing defecation dynamics.  Dig Dis. 1997;  15 (Suppl 1) 64-77
    Google Scholar
  • 113 Ritchie J. Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome.  Gut. 1973;  14 125-132
    Google Scholar
  • 114 Mertz H, Naliboff B, Munakata J. et al . Altered rectal perception is a biological marker of patients with irritable bowel syndrome.  Gastroenterology. 1995;  109 40-52. Erratum in: Gastroenterology 1997; 113: 1054
    Google Scholar
  • 115 Bouin M, Plourde V, Boivin M. et al . Rectal distention testing in patients with irritable bowel syndrome: sensitivity, specificity, and predictive values of pain sensory thresholds.  Gastroenterology. 2002;  122 1771-1777
    Google Scholar
  • 116 Kwan C, Diamant N, Mikula K. et al . Characteristics of rectal perception are altered in irritable bowel syndrome.  Pain. 2005;  113 160-171
    Google Scholar
  • 117 Zar S, Benson M, Kumar D. Rectal afferent hypersensitivity and compliance in irritable bowel syndrome: differences between diarrhoea-predominant and constipation-predominant subgroups.  Eur J Gastroenterol Hepatol. 2006;  18 151-158
    Google Scholar
  • 118 Prior A, Maxton D, Whorwell P. Anorectal manometry in irritable bowel syndrome: differences between diarrhoea and constipation predominant subjects.  Gut. 1990;  31 458-462
    Google Scholar
  • 119 Distrutti E, Salvioli B, Azpiroz F. et al . Rectal function and bowel habit in irritable bowel syndrome.  Am J Gastroenterol. 2004;  99 131-137
    Google Scholar
  • 120 Kwan C, Davis K, Mikula K. et al . Abnormal rectal motor physiology in patients with irritable bowel syndrome.  Neurogastroenterol Motil. 2004;  16 251-263
    Google Scholar
  • 121 Whitehead W, Delvaux M. Standardization of barostat procedures for testing smooth muscle tone and sensory thresholds in the gastrointestinal tract. The working team of Glaxo-Wellcome Research, UK.  Dig Dis Sci. 1997;  42 223-241
    Google Scholar
  • 122 Bradette M, Delvaux M, Staumont G. et al . Evaluation of colonic sensory thresholds in IBS patients using a barostat. Definition of optimal conditions and comparison with healthy subjects.  Dig Dis Sci. 1994;  39 449-457
    Google Scholar
  • 123 Whitehead W, Delvaux M. Standardization of barostat procedures for testing smooth muscle tone and sensory thresholds in the gastrointestinal tract. The Working Team of Glaxo-Wellcome Research, UK.  Dig Dis Sci. 1997;  42 223-241
    Google Scholar
  • 124 Rao S, Hatfield R. Paroxysmal anal hyperkinesis: a characteristic feature of proctalgia fugax.  Gut. 1996;  39 609-612
    Google Scholar
  • 125 Celik A, Katsinelos P, Read N. et al . Hereditary proctalgia fugax and constipation: report of a second family.  Gut. 1995;  36 581-584
    Google Scholar
  • 126 Grimaud J, Bouvier M, Naudy B. et al . Manometric and radiologic investigations and biofeedback treatment of chronic idiopathic anal pain.  Dis Colon Rectum. 1991;  34 690-695
    Google Scholar
  • 127 Suzuki H, Matsumoto K, Amano S. et al . Anorectal pressure and rectal compliance after low anterior resection.  Br J Surg. 1980;  67 655-657
    Google Scholar
  • 128 Horgan P, O’Connell P, Shinkwin C. et al . Effect of anterior resection on anal sphincter function.  Br J Surg. 1989;  76 783-786
    Google Scholar
  • 129 Iwai N, Hashimoto K, Yamane T. et al . Physiologic status of the anorectum following sphincter-saving resection for carcinoma of the rectum.  Dis Colon Rectum. 1982;  25 652-659
    Google Scholar
  • 130 Stelzner F. Die Hämorrhoidektomie: eine einfache Operation?.  Chirurg. 1992;  63 316
    Google Scholar
  • 131 Matsuoka H, Mavrantonis C, Wexner S. et al . Postanal repair for fecal incontinence - ist it worthwile.  Dis Colon Rectum. 2000;  43 1561-1567
    Google Scholar
  • 132 Hool G, Lieber M, Church J. Postoperative anal canal length predicts outcome in patients having sphincter repair for fecal incontinence.  Dis Colon Rectum. 1999;  42 313-318
    Google Scholar
  • 133 Sainio A, Voutilainen P, Husa A. Recovery of anal sphincter function following transabdominal repair of rectal prolapse: cause of improved continence?.  Dis Colon Rectum. 1991;  34 816-821
    Google Scholar
  • 134 Farouk R, Duthie G, Bartolo D. Recovery of the internal anal sphincter and continence after restorative proctocolectomy.  Br J Surg. 1994;  81 1065-1068
    Google Scholar
  • 135 Roman H, Michot F. Long-term outcomes of transanal rectocele repair.  Dis Colon Rectum. 2005;  48 510-517
    Google Scholar
  • 136 Stadelmaier U, Bittdorf B, Meyer M. et al . Kann die Kontinenzfunktion nach Rektumesektion prognostiziert werden?.  Chirurg. 2000;  71 932-938
    Google Scholar
  • 137 Pescatori M, Maria G, Rinallo L. Anal manometry improves the outcome of surgery for fistula-in-ano.  Dis Colon Rectum. 1989;  32 588-592
    Google Scholar
  • 138 Thornton M, Lam A, King D. Laparoscopic or transanal repair of rectocele? A retrospective matched cohort study.  Dis Colon Rectum. 2005;  48 792-798
    Google Scholar
  • 139 Lange J, Mölle B, Girona J. Chirurgische Proktologie. Heidelberg; Springer Verlag 2006
    Google Scholar
  • 140 Coller J. Clinical Application of Anorectal Manometry.  Gastroenterol Clin North Am. 1987;  16 17-33
    Google Scholar
  • 141 Miller N. Effects of learning on gastrointestinal functions.  Clinical Gastroenterology. 1977;  6 533-544
    Google Scholar
  • 142 Kohlenberg R. Operant conditioning in human anal sphinkter pressure.  Journal of Applied Behavior Analysis. 1973;  6 201-208
    Google Scholar
  • 143 Heymen S, Jones K, Ringel Y. et al . Biofeedback treatment of fecal incontinence: a critical review.  Dis Colon Rectum. 2001;  44 728-736
    Google Scholar
  • 144 Enck P, Musial F. Biofeedback in pelvic floor disorders. Pemberton J, Swash M, Henry MM The Pelvic Floor. Its function and disorders London; W. B. Saunders 2002: 393-404
    Google Scholar
  • 145 Jorge J, Habr-Gama A, Wexner S. Biofeedback therapy in the colon and rectal practice.  Applied Psychophysiology and Biofeedback. 2003;  28 47-61
    Google Scholar
  • 146 Ozturk R, Niazi S, Stessman M. et al . Long-term outcome and objective changes of anorectal function after biofeedback therapy for faecal incontinence.  Aliment Pharmacol Ther. 2004;  20 667-674
    Google Scholar
  • 147 Palsson O, Heymen S, Whitehead W. Biofeedback treatment for functional anorectal disorders: a comprehensive efficacy review.  Appl Psychophysiol Biofeedback. 2004;  29 153-174
    Google Scholar
  • 148 Enck P, Kränzle U, Schwiese J. et al . Biofeedback-Behandlung bei Stuhlinkontinenz.  Deutsche Medizinische Wochenschrift. 1988;  113 1789-1794
    Google Scholar
  • 149 MacLeod J. Management of anal incontinence by biofeedback.  Gastroenterology. 1987;  93 291-294
    Google Scholar
  • 150 Cerulli M, Nikoomanesh P, Schuster M. Progress in biofeedback conditioning for fecal incontinence.  Gastroenterology. 1979;  76 742-746
    Google Scholar
  • 151 Buser W, Miner P. Delayed rectal sensation with fecal incontinence.  Gastroenterology. 1986;  91 1186-1191
    Google Scholar
  • 152 Bleijenberg G, Kuijpers H. Treatment of spastic pelvic floor syndrom with biofeedback.  Dis Colon Rectum. 1989;  30 108-111
    Google Scholar
  • 153 Engel B, Nikoomanesh P, Schuster M. Operant conditioning of rectosphincteric responses in the treatment of fecal incontinence.  New Engl J Med. 1974;  290 646-649
    Google Scholar
  • 154 Latimer P, Campbell D, Kasperkii J. A component analysis of biofeedback in the treatment of fecal incontinence.  Biofeedback and Self-Regulation. 1984;  9 311-324
    Google Scholar
  • 155 Rühl A, Gantke B, Enck P. Biofeedbacktraining in faecal incontinence. Demling L, Frühmorgen P Nonneoplastic diseases of the anorectum Lancaster; Kluwer 1992: 37-44
    Google Scholar
  • 156 Enck P. Biofeedback training in disordered defecation - a critical review.  Dig Dis Sci. 1993;  38 1953-1960
    Google Scholar
  • 157 Solomon M, Pager C, Rex J. et al . Randomized, controlled trial of biofeedback with anal manometry, transanal ultrasound, or pelvic floor retraining with digital guidance alone in the treatment of mild to moderate fecal incontinence.  Dis Colon Rectum. 2003;  46 703-710
    Google Scholar
  • 158 Heymen S, Pikarsky A, Weiss E. et al . A prospective randomised trial comparing four biofeedback techniques for patients with faecal incontince.  Colorectal Dis. 2000;  2 88-92
    Google Scholar
  • 159 Ilnyckyj A, Fachnie E, Tougas G. A randomized-controlled trial comparing an educational intervention alone vs education and biofeedback in the management of fecal incontinence in women.  Neurogastroenterol Motil. 2005;  17 58-63
    Google Scholar
  • 160 Dobben A, Terra M, Berghmans B. et al . Functional changes after physiotherapy in fecal incontinence.  Int J Colorectal Dis. 2005;  22 1-7
    Google Scholar
  • 161 Whitehead W. Biofeedback treatment of gastrointestinal disorders.  Biofeedback Self Regul. 1992;  17 59-76
    Google Scholar
  • 162 van Tets W, Kujipers J, Bleijenberg G. Biofeedback treatment is ineffective in neurogenic fecal incontinence.  Dis Colon Rectum. 1996;  39 992-994
    Google Scholar
  • 163 Loening-Baucke V. Efficacy of biofeedback training in improving faecal incontinence and anorectal physiologic function.  Gut. 1990;  31 1395-1402
    Google Scholar
  • 164 Koutsomanis D, Lennard-Jones J, Roy A. et al . Controlled randomised trial of visual biofeedback versus muscle training without a visual display for intractable constipation.  Gut. 1995;  37 95-99
    Google Scholar
  • 165 Sunic-Omejc M, Mihanovic M, Bilic A. et al . Efficiency of biofeedback therapy for chronic constipation in children.  Coll Antropol. 2002;  26 (Suppl) 93-101
    Google Scholar
  • 166 Chiotakakou-Faliakou E, Kamm M, Roy A. et al . Biofeedback provides long-term benefit for patients with intractable, slow and normal transit constipation.  Gut. 1998;  42 517-521
    Google Scholar
  • 167 Emmanuel A, Kamm M. Response to a behavioural treatment, biofeedback, in constipated patients is associated with improved gut transit and autonomic innervation.  Gut. 2001;  49 214-219
    Google Scholar
  • 168 Chiarioni G, Salandini L, Whitehead W. Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation.  Gastroenterology. 2005;  129 86-97
    Google Scholar

1 Empfehlungen der Deutschen Gesellschaft für Neurogastroenterologie und Motilität, der Kommission Proktologie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten, der Deutschen Gesellschaft für Koloproktologie und der Chirurgischen Arbeitsgruppe Colo-Proktologie der Deutschen Gesellschaft für Viszeralchirurgie zur anorektalen Manometrie im Erwachsenenalter

2 Recommendations of the German Society for Neurogastroenterology and Motility, The Commission Proctology of the German Society for Digestive and Metabolic Diseases, the German Society for Coloprotology and the Surgical Working Group Coloproctology of the German Society for Visceral Surgery on Anorectal Manometry in Adults

Dr. Christian Pehl

Medizinische Klinik, Kreiskrankenhaus Vilsbiburg

Krankenhausstr. 2

84137 Vilsbiburg

Telefon: ++49/87 41/60 31 53

Fax: ++49/87 41/60 32 04

eMail: christian.pehl@kkh-vilsbiburg.de