Is Abnormality in the Conventional Anorectal Manometry Really Abnormal?

CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Figure 1. Colored pressure topography plots of anorectal pressure during simulated defecation in left lateral decubitus position (A) and sitting position (B). High resolution anorectal manometry (HR-ARM) finding in left lateral decubitus position revealed inappropriate increase of rectal pressure (green color) and no decrease in anal sphincter pressure (yellow to red color). This finding was consistent with pelvic floor dyssynergia (A). However, when HR-ARM was done with the patient in the sitting position, rectal pressure increased (yellow to red color) in coordination with relaxation of the anal sphincter pressure (green color), which is a normal pattern of anorectal manometry (B). A 54-year-old woman, with chronic abdominal discomfort and difficulty in defecation, was admitted to the hospital. There were no abnormal findings on abdominal X-ray and colonic transit time remained within the normal values. The result by co-lonoscopic examination was normal. Bulk-forming laxatives were prescribed for a month, but symptomatic improvement was not found at all. Then, a defecography and the high resolution ano-rectal manometry (HR-ARM) of ManoScan TM system (Sierra