Anorektal Manometri
Özet
Anorektal manometri, anüs ve rektumdaki basınçlar ile nöral refleksleri ölçerek dışkılama fonksiyonlarını değerlendiren temel bir tanı yöntemidir. Bu işlem, üzerinde basınç sensörleri ve şişirilebilir bir balon bulunan özel bir kateter aracılığıyla gerçekleştirilir; temel amacı fekal inkontinans, konstipasyon ve defekasyon bozukluklarının fizyopatolojisini anlamaktır. Test kapsamında anal kanal istirahat basıncı, sıkma basıncı, öksürük refleksi, rektal duyarlılık ve rektoanal inhibitör refleks (RAİR) gibi kritik parametreler incelenir. Özellikle RAİR, rektal dolgunluğa yanıt olarak iç sfinkterin gevşemesini sağlar ve Hirschsprung hastalığı gibi durumların tanısında hayati önem taşır. Günümüzde yüksek çözünürlüklü manometri (HRM) teknolojisi, çok sayıda sensör sayesinde tüm anal kanalı detaylı bir şekilde görüntüleyerek daha kesin sonuçlar sunmaktadır. İşlem öncesinde hastanın proktolojik anamnezi alınmalı, Wexner skorlaması gibi objektif ölçekler kullanılmalı ve fiziki muayene ile perianal bölge titizlikle değerlendirilmelidir. Sedasyon gerektirmeyen ve yaklaşık 20-30 dakika süren bu prosedür, biofeedback tedavi süreçlerine de rehberlik ederek pelvik taban hastalıklarının yönetiminde stratejik bir rol oynar.
Anorectal manometry is a fundamental diagnostic method that evaluates defecation functions by measuring pressures and neural reflexes in the anus and rectum using a specialized catheter equipped with pressure sensors and an inflatable balloon. The procedure primarily aims to understand the pathophysiology of fecal incontinence, constipation, and defecation disorders by assessing critical parameters such as anal resting pressure, squeeze pressure, cough reflex, rectal sensation, and the recto-anal inhibitory reflex (RAIR). Notably, RAIR facilitates internal sphincter relaxation in response to rectal distension and is vital for diagnosing conditions like Hirschsprung's disease. Currently, High-Resolution Manometry (HRM) technology provides more precise results by imaging the entire anal canal in detail through multiple sensors. Prior to the 20-30 minute non-sedated procedure, a thorough proctological history, objective scales like the Wexner scoring system, and a meticulous physical examination are essential. Ultimately, this diagnostic tool plays a strategic role in managing pelvic floor diseases by guiding biofeedback therapy and providing a comprehensive analysis of sensorimotor pathways.
Referanslar
Bharucha AE. Pelvic floor: anatomy and function. Neurogastroenterol Motil. 2006 Jul; 18(7):507– 19. Doi: 10.1111/j.1365-2982.2006.00803.x.
Madoff RD, Williams JG, Caushaj PF. Fecal incontinence. N Engl J Med. 1992; 326:1002. Doi: 10.1056/NEJM199204093261507.
Mitrani C, Chun A, Desautels S, et al. Anorectal manometric characteristics in men and women with idiopathic fecal incontinence. J Clin Gastroenterol. 1998; 26:175. Doi: 10.1097/00004836-199804000-00005.
Camilleri M, Thompson WG, Fleshman JW, et al. Clinical management of intractable constipation. Ann Intern Med. 1994; 121:520. Doi: 10.7326/0003-4819-121-7-199410010-00008.
Papachrysostomou M, Smith AN. Effects of biofeedback on obstructive defecation--reconditioning of the defecation reflex? Gut. 1994; 35:252. Doi: 10.1136/gut.35.2.252.
Rao SS, Welcher KD, Pelsang RE. Effects of biofeedback therapy on anorectal function in obstructive defecation. Dig Dis Sci. 1997; 42:2197. Doi: 10.1023/a:1018846113210.
Heymen S, Jones KR, Scarlett Y, et al. Biofeedback treatment of constipation: a critical review. Dis Colon Rectum. 2003; 46:1208. Doi: 10.1007/s10350-004-6717-8.
Chiarioni G, Whitehead WE, Pezza V, et al. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006; 130:657. Doi: 10.1053/j.gastro.2005.11.014.
Rao SS, Seaton K, Miller M, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol. 2007; 5:331. Doi: 10.1016/j.cgh.2006.12.023.
Heymen S, Scarlett Y, Jones K, et al. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum. 2007; 50:428. Doi: 10.1007/s10350-006-0814-9.
Sagar PM, Pemberton JH. Anorectal and pelvic floor function. Relevance of continence, incontinence, and constipation. Gastroenterol Clin North Am. 1996; 25:163. Doi: 10.1016/s0889-8553(05)70370-8.
Shafik A, Shafik AA, El Sibai O, et al. Role of the rectosigmoidal junction in fecal continence: concept of the primary continent mechanism. Arch Surg. 2006; 141:23. Doi: 10.1001/archsurg.141.1.23.
Sun WM, Read NW, Miner PB. Relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence. Gut. 1990; 31:1056. Doi: 10.1136/gut.31.9.1056.
Fernández-Fraga X, Azpiroz F, Malagelada JR. Significance of pelvic floor muscles in anal incontinence. Gastroenterology. 2002; 123:1441. Doi: 10.1053/gast.2002.36586.
Jorge JMN, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36:77–97. Doi: 10.1007/BF02050307.
Arndorfer RC, Stef JJ, Dodds WJ, et al. Improve dinfusion system for intraluminale osophageal manometry. Gastroenterology. 1977;73:23-7.
Lee TH, Bharucha AE. How to perform and interpret a high-resolution anorectal manometry test. J Neurogastroenterol Motil. 2016 Jan 31; 22(1):46–59. Doi: 10.5056/jnm15168.
Lestar B, Penninckx F, Kerremans R. The composition of anal basal pressure. An in vivo and in vitros tudy in man. Int J Colorect Dis. 1989;4:118-22. Doi: 10.1007/BF01646870.
Loening-Baucke V, Anuras S. Effects of ageandsex on anorectalmanometry. Am J Gastroenterol. 1985;80:50-3.
Leroi AM, Berkelmans I, Denis P, et al. Anismus as a marker of sexual abuse. Consequences of abuse on anorectal motility. DigDisSci. 1995;40:1411-6. Doi: 10.1007/BF02285184.
Chiarioni G, Scattolini C, Bonfante F, et al. Liquid stool incontinence with severe urgency: anorectal function and effective biofeedback treatment. Gut. 1993;34:1576-80. Doi: 10.1136/gut.34.11.1576.
Wald A, Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy. AKN Engl J Med. 1984;310:1282-7. Doi: 10.1056/NEJM198405173102003.
Bulut T. Anorektal fizyoloji testleri ve inkontinens. Türkiye Klinikleri J Gen Surg. 2010;3:8-13.
