Current and future perspectives on the utility of provocative tests of anal sphincter function: A state-of-the-art summary

Alexander O'Connor*, Caroline M. Byrne, Dipesh H. Vasant, Abhiram Sharma, Donghua Liao, Niels Klarskov, Edward S. Kiff, Karen Telford

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

BACKGROUND: The maintenance of fecal continence depends upon coordinated interactions between the pelvic floor, anorectum, and anal sphincter complex orchestrated by central and peripheral neural activities. The current techniques to objectively measure anorectal function rely on fixed diameter catheters placed inside the anal canal with a rectal balloon to obtain measurements of anal resting and squeeze function, and rectal compliance. Until recently it had not been possible to measure the distensibility of the anal canal, or in other words its ability to resist opening against an increasing pressure, which has been proposed as the main determinant of a biological sphincter's function. Anal acoustic reflectometry (AAR) and the functional lumen imaging probe (FLIP) are two novel, provocative techniques that dynamically assess the anal sphincter complex under volume-controlled distension. In doing so, both provide information on the viscoelastic properties of the anal canal and offer new insights into its function.

PURPOSE: This review details the current and potential future applications of AAR and FLIP and highlights the unanswered questions relevant to these new technologies.

Original languageEnglish
Article numbere14496
JournalNeurogastroenterology and Motility
ISSN1350-1925
DOIs
Publication statusE-pub ahead of print - 15 Nov 2022

Bibliographical note

© 2022 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.

Keywords

  • anal canal
  • continence
  • defecation
  • distensibility
  • fecal incontinence
  • proctology

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