Investigations

Investigations

Anorectal physiology studies provide objective assessment of the anorectal function. Manometry is a simple method for measuring internal (resting) and external (squeeze) anal sphincter tone. Endoanal ultrasonography (EAUS) provides a dynamic assessment of the thickness and structural integrity of the external and internal sphincters ( Figure 80.11 ). Dynamic standard or MRI defecography is not routine in patients with incontinence; however, in select cases they can be useful when obstructive or prolapse symptoms are mixed in with inconti nence symptoms. Harald Hirschsprung , 1830–1916, physician, The Queen Louise Hospital for Children, Copenhagen, Denmark, described congenital megacolon in 1887. James Parkinson , 1755–1824, general practitioner, Shoreditch, London, UK. G Milton Shy , 1919–1967, neurologist, National Institute of Neurological Diseases and Blindness, National Institutes of Health, Bethesda, MD, USA. Glen Drager , 1917–1967, Baylor College of Medicine, Houston, TX, USA. Sir Alan Guyatt Parks , 1920–1982, surgeon, St Mark’s Hospital and The London Hospital, London, UK.

Figure 80.11 Axial view of endoanal ultrasonography through the mid-anal canal of a female patient with faecal incontinence following vaginal delivery. The study demonstrates a defect in the internal (white arrows) and external (red arrows) anal sphincter /f_i bres in keeping with an obstetric anal sphincter injury (courtesy of Dr Alison Corr, Consul

tant Radiologist, St Mark’s Hospital, London, UK)