Analysis of Indications and Results of Anorectal Manometry in Two Tertiary Hospitals in India

The anorectum plays an important role in regulation of defecation and in maintenance of continence [1]. The most widely used test for anorectal function is anorectal manometry. It measures pressures of the anal sphincter muscles, sensation in the rectum, and neural refl exes that are needed for normal bowel movements. This test is mainly used in evaluation of constipation, fecal incontinence, anal sphincter tone, functional anorectal pain, pelvic fl oor dyssynergia and diagnosis of Hirschsprung’s Disease [2]. Parameters studied by anorectal manometry are the rectoanal inhibitory refl ex, anal resting pressure, sustained voluntary contraction of anal canal and rectal sensation [3]. Anorectal manometry is now available at multiple centres in India. However, the awareness regarding the procedure and its uses is limited. This study was done with the aim to analyse the indications for referral and results of anorectal manometry in two teaching hospitals in India. We reviewed the data of two centres in India over a period of 18 months from May 2015 to September 2016.Both the hospitals are teaching hospitals and cater to middle class population. The indications, fi ndings and results of all patients undergoing anorectal manometry at the two centres were recorded. Detailed history, clinical examination and per rectal examination was done in all patients. A clinical diagnosis based on the above was made using Rome III Criteria. The data was entered in Microsoft excel sheets and analyzed. All procedures were done and reported by a single gastroenterologist at each centre. A total of 178 patients underwent anorectal manometry during the study period. Most of the patients were males(135,75.8%).The mean age of patients was 39.4 years(range 3 months76 years).The major indications for the study includedconstipation (145,81.5%), incomplete evacuation(74, 41.6%), straining during defecation(58, 32.6%), digital evacuation(31,17.4%),fecal incontinence(11,6.17%) and to rule out Hirschsprung’s disease(4,2.24%).Very few patients (3 each, 1.68%) reported severe lower abdominal pain and regular use of enemas. The clinical diagnosis in patients presenting with anorectal disorders includedfecal incontinence (11,6.17%), functional constipation(104,58.4%), irritable bowel syndrome-constipation predominant(53,29.7%), Hirschsprung’s disease (4, 2.24%) and IBS with pain(4,2.24%). Based on the manometric evaluation, the diagnosis of these patients is mentioned in Figure 1. Anorectal manometry is an important tool for the diagnosis and management of pelvic fl oor disorders. However, the number of patients referred for evaluation was low in the study period. This could be related to lack of awareness regarding the procedure, social embarassement and unwillingness to consult doctors for the same. The main indication of referral in our study was evaluation of constipation. A study from North India has reported that the prevalence of self-reported constipation within 1 year is 24.8%. The study also reports that constipation was signifi cantly more frequent in females and non-working