High-resolution anorectal manometry (HRAM) is a diagnostic method used to evaluate the functional state of the rectum and anal sphincter. This precise and detailed examination helps identify the causes of various anorectal disorders, such as constipation, fecal incontinence, difficulties with rectal evacuation, rectal prolapse, and other dysfunctions of the rectal and anal region. It is the most informative method for assessing anorectal function. HRAM is performed using the "Solar GI" manometry system by the medical technology manufacturer Laborie (Germany).
Indications for High-Resolution Anorectal Manometry:
For patients with constipation: To diagnose the type of defecation disorder.
In cases of incontinence (fecal leakage): To determine a decrease in anal pressure during rest and straining.
For patients undergoing reconstructive bowel surgery: To evaluate anal sphincter functionality.
Before and after biofeedback therapy treatment.
For chronic anal fissures.
In cases of unclear pelvic pain.
For children with Hirschsprung's disease.
Contraindications: HRAM is contraindicated in patients with specific anal strictures or obstructions that prevent the insertion of the instrument.
How is High-Resolution Anorectal Manometry Performed?
Before the examination, patients are given a micro-enema, and they are advised to avoid muscle relaxants and narcotic pain medications 24 hours before the procedure.
During the examination, the patient lies on their side with their knees bent at a 90° angle.
A thin, flexible catheter with sensors is inserted into the rectum. These sensors measure pressure at various points in the rectal and anal areas, recording pressure changes.
The examination includes:
• Evaluation of anorectal pressure and the length of the anal canal at rest.
• Assessment of anorectal pressure during straining.
• Assessment of anorectal pressure during simulated defecation and coughing reflex.
• Measurement of rectal sensitivity.
• Evaluation of rectal volume using air or fluid infusion.
The procedure usually lasts 30–60 minutes. It is minimally invasive and typically performed on an outpatient basis. Patients may feel mild discomfort, but the procedure is not painful. Results help the doctor select an appropriate treatment strategy, which may include physiotherapy, medications, and other interventions.
Benefits of HRAM:
The high-resolution anorectal manometry system provides detailed data visualized in color diagrams, offering insights into:
The functional length of the anal sphincter.
Resting pressure in the anal sphincter.
Maximum anal sphincter pressure.
Maximum sustained anal sphincter pressure.
Anorectal pressure during coughing reflex.
Anorectal pressure during defecation simulation.
Anorectal inhibitory reflex.
Rectal sensitivity.
Rectal volume assessed through balloon expulsion testing.
