COLORECTAL PHYSIOLOGICAL TESTS - USE OR ABUSE OF TECHNOLOGY

Objective: To assess the value of colorectal physiological tests in pa tients with functional disorders of defecation. Design: Prospective st udy. Setting: Academic hospital. Subjects: 308 consecutive patients. I nterventions: Routine history and physical examination, followed by co lonic transit study, anal manometry, cinedefecography, electromyograph y of the anal sphincter, and assessment of terminal motor latency of t he pudendal nerve. Main outcome measures: Number of diagnoses made aft er physiological tests compared with routine history and examination a lone. Results: Definitive diagnoses were made after history and physic al examination alone in 15/180 (8%) with physiological tests were 135/ 180 (75%), 53/80 (66%), and 20/48 (42%), respectively. Among the diagn oses made by physiological testing alone were: in patients with consti pation, paradoxical puborectalis contraction (n = 59), colonic inertia (n = 31), rectocele (n = 19),and intussuception (n = 18); in those wi th incontinence, loss of muscle fiber (n = 21), neuropathy (n = 10), a nd both (n = 15); and in those with rectal pain, neuropathy (n = 6) an d paradoxical puborectalis contraction (n = 3). The numbers of patient s that remained undiagnosed in the three groups were 45 (25%) 27 (34%) , and 28 (58%), respectively, Treatable conditions were diagnosed by p hysiological testing in 120/180 patients with constipation (67%) and 4 4 patients with incontinence (55%). Only 9 patients with rectal pain h ad treatable causes identified by physiologic testing. Conclusion: The value of colorectal physiological tests is greatest in patients who p resent with constipation or incontinence; they are of little value in those with chronic intractable rectal pain.