NEW ANORECTAL PHYSIOLOGY LABORATORY ESTABLISHED
The Department, together with University Hospital, has recently established our Anorectal Physiology Laboratory that offers a new service for patients and referring physicians. Located at University Hospital, this fully-equipped facility enables our colorectal specialists to perform comprehensive anorectal physiology testing, and further distinguishes the quality of care in our colon and rectal surgery program.
Dr. Marvin L. Corman, Dr. David E. Rivadeneira, and Dr. William B. Smithy
Referring physicians are provided a complete, written, fully-interpreted report on the testing that has been performed on their patients. Upon request, a colon and rectal surgeon will also provide a consultation and recommendations.
Anorectal physiology is the study of the function of the anal sphincter mechanism, the anal canal, and the rectum. Indications for requesting physiologic tests include anal and urinary incontinence, pelvic floor descent, constipation that has not been responsive to conventional treatment, chronic anal infections, and anorectal pain. In addition, these tests may be used in the staging of anal and rectal tumors, as well as in the follow-up for cancer recurrence.
Our Anorectal Physiology Laboratory is equipped with state-of-the-art technology. It has advanced ultrasound imaging systems that are not widely available in Suffolk County. The anal manometry and pudendal nerve terminal motor latency testing, described below, is performed on the newest Medtronic Encompass diagnostic system.
The Anorectal Physiology Laboratory offers a range of diagnostic tests that provide important information about the function and anatomy of the anus and rectum. These studies typically take 5-15 minutes to complete. A description of each test follows, with attention to why the test is done, how it is accomplished, and what information is obtained:
Anal manometry measures the resting and squeeze pressures in the anal canal in instances of loss of bowel control. Anorectal reflexes and sensation are tested during the same examination. A narrow, flexible tube is inserted into the anus and rectum. Once the tube is in place, a small balloon at the tip of the tube may be expanded. This test shows how tight the anal sphincter is during rest and squeeze. It also measures the sensitivity and function of the rectum.
Pudendal Nerve Terminal Motor Latency Testing
Pudendal nerve terminal motor latency testing measures the delay between an electrical impulse and the muscle contraction. It assesses the functioning of the pudendal nerves, and is useful in evaluating patients with incontinence, constipation, and rectal prolapse. The procedure involves the placement of a gloved finger into the anus. On the glove is a stimulating electrode. Several electrical impulses are delivered and the nerve conduction is determined. Occasionally one may sense the impulse for a few seconds, but any discomfort is very mild.
Anal ultrasonography (ultrasound) evaluates the structure of the sphincter muscle and surrounding tissue. Ultrasound is a very useful tool for imaging the anatomy of the internal and external anal sphincters. It is not an x-ray, so there is no radiation exposure. A narrow wand-like probe the size of an index finger is inserted into the anal canal and the rectum. This instrument, which is attached to a computer and video screen, emits sound waves. Using sound waves produced by the probe, images are captured on the screen.
Ultrasound-guided biopsy of suspicious lesions can be performed during this testing. The patient may feel vibration from the probe during the examination, but it should not cause any physical discomfort.
With rectal ultrasound, a rigid instrument is inserted gently into the rectum. The ultrasound probe, with a deflated balloon on the end, is inserted through the scope. The balloon is then inflated and cross-sectional images of the rectum are taken. This test helps to evaluate rectal masses and aids in determining the appropriateness of various surgical alternatives.
In this procedure, a small amount of liquid called barium is inserted to coat the walls of the rectum. Barium makes the rectum more visible on x-rays that are then taken. This test evaluates how well stool is evacuated from the rectum.
Biofeedback is an important component of treating pelvic floor syndromes and urinary or fecal incontinence, thereby providing patients with specific information about the pelvic muscles. With small sensors placed on the muscles being monitored, biofeedback equipment can detect the electrical activity of these muscles. Once the sensors are in place, they are connected to a computer that changes the electrical activity of the muscles into a signal that can be seen or heard on the computer screen.
Unlike the procedures described above, electro-galvanic stimulation (EGS) is not a test, but a treatment for rectal pain. The physician inserts a probe into the rectum to stimulate the muscle that may be in spasm. The procedure takes about 1 hour. Usually three to six treatments are required. This is the one procedure done in our laboratory that is sometimes moderately uncomfortable.
For appointments, please call 631-444-7584.
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