Document Detail

Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient.
MedLine Citation:
PMID:  22986439     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: High-resolution manometry (HRM) is used to measure anal pressures in clinical practice but normal values have not been available. Although rectal evacuation is assessed by the rectoanal gradient during simulated evacuation, there is substantial overlap between healthy people and defecatory disorders, and the effects of age are unknown. We evaluated the effects of age on anorectal pressures and rectal balloon expulsion in healthy women.
METHODS: Anorectal pressures (HRM), rectal sensation, and balloon expulsion time (BET) were evaluated in 62 asymptomatic women ranging in age from 21 to 80 years (median age 44 years) without risk factors for anorectal trauma. In total, 30 women were aged <50 years.
RESULTS: Age is associated with lower (r=-0.47, P<0.01) anal resting (63 (5) (≥50 years), 88 (3) (<50 years), mean (s.e.m.)) but not squeeze pressures; higher rectal pressure and rectoanal gradient during simulated evacuation (r=0.3, P<0.05); and a shorter (r=-0.4, P<0.01) rectal BET (17 (9) s (≥50 years) vs. 31 (10) s (<50 years)). Only 5 women had a prolonged (>60 s) rectal BET but 52 had higher anal than rectal pressures (i.e., negative gradient) during simulated evacuation. The gradient was more negative in younger (-41 (6) mm Hg) than older (-12 (6) mm Hg) women and negatively (r=-0.51, P<0.0001) correlated with rectal BET but only explained 16% of the variation in rectal BET.
CONCLUSIONS: These observations provide normal values for anorectal pressures by HRM. Increasing age is associated with lower anal resting pressure, a more positive rectoanal gradient during simulated evacuation, and a shorter BET in asymptomatic women. Although the rectoanal gradient is negatively correlated with rectal BET, this gradient is negative even in a majority of asymptomatic women, undermining the utility of a negative gradient for diagnosing defecatory disorders by HRM.
Jessica Noelting; Shiva K Ratuapli; Adil E Bharucha; Doris M Harvey; Karthik Ravi; Alan R Zinsmeister
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2012-09-18
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  107     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-05     Completed Date:  2012-12-07     Revised Date:  2014-04-01    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1530-6     Citation Subset:  IM    
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MeSH Terms
Age Factors
Aged, 80 and over
Aging* / physiology
Anal Canal / physiology*
Defecation* / physiology
Manometry* / methods
Middle Aged
Rectum / physiology*
Reference Values
Women's Health
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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