CURRENT TECHNIQUES OF ASSESSING DEFECATION DYNAMICS

The pathophysiology of defecation disorders is multifactorial, An idea l test should identify the underlying cause(s) and provide guidelines for treatment, Unfortunately, there is no such single test. But severa l techniques are available that could provide comprehensive informatio n regarding the changes in defecation dynamics. Among these, anorectal manometry offers the most useful test for clinicians, Manometry may p rovide objective evidence for impaired rectal sensation, poor rectoana l coordination, weak anal sphincters or changes that support a diagnos is of obstructive defecation, Other tests such as the balloon expulsio n test may serve as screening tools for patients with constipation, In a patient with fecal incontinence, anal endosonography may localize t he sphincter defect and aid surgical reconstruction. The pudendal nerv e latency test may provide a pathophysiological basis for a weak anal sphincter. Imaging techniques such as defecography may provide useful information regarding rectal prolapse or levator ani dysfunction, Idea lly, the clinician should utilize these tests either to confirm a clin ical suspicion or to provide new information that could aid management , This review provides an update regarding the various tests that are available for assessing defecation and provides some practical guideli nes for performing manometry.