MCOMPASS ANAL MANOMETRY AN OVERVIEW

ANAL MANOMETRY MEASURES PRESSURE ALLOWS INTERPRITATION SENSATION RAIR RECTAL COMPLIANCE MOTIVATION OF THE PATIENT FUNCTION OF THE PUDENDAL NERVE

WHEN TO USE ANAL MANOMETRY POOR ANAL STRENGTH FROM HISTORY OR FROM EXAMINATION WHEN THIS INFORMATION IS IMPORTANT TO THE PATIENTS CARE WHEN THE SITUATION IS CONFUSING TO THE PHYSICIAN EDUCATION FOR THE PATIENT

ANAL MANOMETRY A PRACTICLE REVIEW ANATOMY & PHYSIOLOGY OF THE RECTUM & ANUS PERFORMING A GOOD STUDY WITH THE MCOMPASS AVOIDING A POOR QUALITY STUDY READING THE MCOMPASS STUDY HOW DO I KNOW THAT I HAVE A GOOD STUDY POTENTIAL PROBLEM AREAS EXAMPLES OF WHEN TO USE THE MCOMPASS STUDY

ANATOMY: RECTUM

ANATOMY: ANAL MUSCLES INTERNAL ANAL SPHINCTER EXTERNAL ANAL SPHINCTER PELVIC DIAPHRAM

AUTOMONIC (INVOLUNTARY) NERVOUS SYSTEM PARASYMPATHETIC: CRANEAL NERVES AND SACRAL NERVES SYMPATHETIC: SPINAL NERVES

ANATOMY: NEURAL INNERVATION PELVIS, RECTUM & ANUS

NERVES TO THE ANUS & RECTUM SOMATIC (VOLUNTARY) PUDENDAL & LEVATOR ANI S 2, 3, 4 AUTOMONIC (INVOLUNTARY) SYMPATHETIC (FIGHT OR FLIGHT) L 1, 2, 3 PARASYMPATHETIC (REST) S 2, 3, 4

SOMATIC (VOLUNTARY) PUDENDAL & LEVATOR ANI NERVES S 2, 3, 4 AUTOMONIC (INVOLUNTARY) SYMPATHETIC PRESACRAL L 1, 2, 3 PARASYMPATHETIC S 2, 3, 4

PHYSIOLOGY: GASTROCOLIC REFLEX AUTONOMIC NERVOUS SYSTEM PARASYMPATHETIC NERVES VAGUS NERVE CONTROLS GUT FUNTION FROM ESOHAGUS TO APPROXIMATLEY THE MID- TRANSVERSE COLON SACRAL PARASYMPATHETIC NERVES CONTROLS GUT FUNTION FROM MID-TRANSVERSE COLON TO ANAL CANAL SYMPATHETIC NERVES CERVICAL, THORASIC, & LUMBAR PLEXUS

GASTROCOLIC REFLEX ANTICIPATION, STOMACH, SMALL INTESTINE, COLON, RECTUM, ANAL CANAL

RECTUM & ANUS RECTAL ANAL INHIBITORY REFLEX (RAIR) STOOL IN THE RECTUM DILATES THE RECTUM STIMULATES THE MUCOSA STETCHES THE PELVIC DIAPHRAM INTERNAL ANAL SPHINCTER (AUTONOMIC CONTROL) CONTRACT & RELAX 6 TIMES A MIN RELAXES EXTERNAL ANAL SPHINCTER (SOMATIC CONTROL) CONTRACTS: REFLEX & PURPOSEFUL

DEFECATION APPROPRIATE TIME RELAX EXTERNAL ANAL SPHINCTER INCREASE INTRABDOMINAL PRESSURE EVACUATE THE RECTUM

MCOMPASS ANAL MANOMETRY MEASURES PRESSURE INTERNAL ANAL SPHINCTER EXTERNAL ANAL SPHINTER RECTAL ALLOWS INTERPRITATION SENSATION RECTAL COMPLIANCE MOTIVATION OF THE PATIENT FUNCTION OF THE PUDENDAL NERVE CALCULATES RAIR RECTAL COMPLIANCE

MCOMPASS TESTING SEQUENCE 1. RESTING PRESSURE INTERNAL ANAL SPHINCTER 2. CONTRACTING PRESSURE & DURATION OF SQUEEZE EXTERNAL ANAL SPHINCTER 3. RAIR (RECTAL ANAL INHIBITORY REFLEX) PARSYMPATHETIC NERVES S2, S3, S4 4. RECTAL BALLOON INFLATION RECTAL COMPLIANCE 5. EXPULSION TEST ANISMUS 6. COUGH EFFORT

MCOMPASS ANAL MANOMETRY NORMAL VALUES RESTING PRESSURE MALE & FEMALE: 60 mmhg & GREATER MALE: 200 mmhg & GREATER CONTRACTING PRESSURE FEMALE: 150 mmhg & GREATER DURATION OF SQUEEZE 20 SECONDS RAIR: CAN VARY GREATLY 30-60cc SENSATION: CAN VARY GREATLY 1 st SENSATION: 30cc DESIRE: 60-80 cc URGE: 100-120 cc PAIN: 120-150 cc

MCOMPASS ANAL MANOMETRY FEMALE: NORMAL VALUES

MCOMPASS ANAL MANOMETRY MALE: NORMAL VALUES

HOW TO DO A GOOD ANAL MANOMETRY STUDY

PERFORMING A GOOD MANOMETRY RESTING PRESSURE BE STILL: NO TALKING, MOVING CONTRACTING PRESSURE ENCOURAGE THE PATIENT DURATION OF SQUEEZE ENCOURAGE THE PATIENT

PERFORMING A GOOD MANOMETRY RAIR DETERMINE THE RAIR VOLUME BEFORE STARTING THE TEST MAKE SURE THE BALLOON IS AS LOW AS IT WILL GO RECTAL COMPLIANCE THE 10cc PRIMING VOLUME IN THE RECTAL BALLOON IS THE CONSIDERED AS ZERO VOLUME IN THE COMPLIANCE TEST

RAIR & RECTAL COMPLIANCE KEEP BALLOON LOW BALLOON TOO HIGH

MCOMPASS ANAL MANOMETRY FEMALE: NORMAL VALUES

MCOMPASS ANAL MANOMETRY MALE: NORMAL VALUES

HOW TO DO A GOOD ANAL MANOMETRY STUDY

PERFORMING A GOOD MANOMETRY RESTING PRESSURE BE STILL: NO TALKING, MOVING CONTRACTING PRESSURE ENCOURAGE THE PATIENT DURATION OF SQUEEZE ENCOURAGE THE PATIENT

RAIR & RECTAL COMPLIANCE KEEP BALLOON LOW BALLOON TOO HIGH

GOOD STUDY GOOD PRESSURES

DO I HAVE A GOOD STUDY GOOD STUDY 4 CHANNELS NOT WORKING

DO I HAVE A GOOD STUDY 3 CHANNELS NOT WORKING 2 CHANNELS NOT WORKING

DO I HAVE A GOOD STUDY GOOD STUDY GOOD STUDY RECTAL PROLAPSE

DO I HAVE A GOOD STUDY FISSURE MALE SAME PATIENT 2 CHANNELS NOT FUNCTIONING ALL CHANNELS FUNCTIONING

READING THE STUDY FOLLOW THE SEQUENCE RESTING PRESSURE CONTRACTING PRESSURE DURATION OF SQUEEZE RAIR (RECTAL ANAL INHIBITORY REFLEX) RECTAL COMPLIANCE EXPULSION TEST COUGH

READING THE STUDY FOLLOW THE SEQUENCE

WHEN YOU THOUGHT NOTHING COULD GO WRONG

READING THE STUDY POTENTIAL PROBLEM AREAS RAIR RECTAL COMPLIANCE ANISMUS

RAIR CALCULATED AS NORMAL

RAIR HARD TO INTERPRET

RAIR NEGATIVE ON CALCULATION RAIR PROBABLY PRESENT

RAIR NEGATIVE ON CALCULATION RAIR PRESENT GOOD PRESSURES, FISSURE

RAIR PRESENT EAS CONTRACTS WITH RAIR

RAIR EASY TO SEE STARTS BEFORE 1 ST SENSATION

READING THE STUDY POTENTIAL PROBLEM AREAS RAIR RECTAL COMPLIANCE ANISMUS

RECTAL COMPLIANCE NORMAL MALE

RECTAL COMPLIANCE BALLOON VOLUME EXCEEDED

NORMAL FEMALE VARIATION IN RECTAL VOLUME

READING THE STUDY POTENTIAL PROBLEM AREAS RAIR RECTAL COMPLIANCE ANISMUS

ANISMUS PRESENT FEMALE WITH SPASTICITY

ANISMUS NOT PRESENT MALE WITH FISSURE

EXAMPLES OF PATIENTS POOR ANAL STRENGTH ON EXAMINATION OR HISTORY WHEN THIS INFORMATION IS IMPORTANT TO THE PATIENTS CARE WHEN THE SITUATION IS CONFUSING TO THE PHYSICIAN EDUCATION FOR THE PATIENT FECAL INCONTINENCE CONSTIPATION PRE-OP EVALUATION ANORECTAL SURGERY COLONIC SURGERY

INCONTINENT FEMALE MODERATE PRESSURES

CONSTIPATED MALE NORMAL STRENGTH

FISSURE MALE GOOD PRESSURES

FISSURE FEMALE GOOD TO BORDERLINE STRENGTH

DIVERTICULITIS FEMALE GOOD PRESSURES

DIVERTICULITIS FEMALE MODERATE PRESSURES

RECTAL CANCER FEMALE POOR PRESSURES

ULCERATIVE COLITIS MALE POOR PRESSURES

RECTAL PROLAPE FEMALE POOR PRESSURES: CASE #1

RECTAL PROLAPSE POOR PRESSURES: CASE #2

COLOSTOMY CLOSURE FEMALE GOOD PRESSURES

COLOSTOMY CLOSURE FEMALE POOR PRESSURES

RAIR BEFORE 1 ST SENSATION CONFUSING TO PHYSICIAN #1

RAIR BEFORE 1 ST SENSATION CONFUSING TO PHYSICIAN #2

MCOMPASS ANAL MANOMETRY KEITH D. MUNSON MD FACS, FASCRS