Physiologic and radiographic testing in patients with pelvic floor disorders and pelvic organ prolapse

“Specialized anorectal testing can help to delineate the pathophysiology of pelvic floor and anorectal dysfunction. These tests can define functional or structural abnormalities and help to select treatment modalities, especially in cases where initial or secondary interventions have failed or were ineffective.”

Pelvic floor disorders are common conditions that affect mainly the female population, especially the elderly. Anorectal physiology and imaging tests are important ways to assess anal sphincter function and structure of the pelvic floor. Those tests are part of the workup for patients with incontinence, defecatory disorders, and pelvic organ prolapse.

These tests can define functional or structural abnormalities and guide the treatment, especially in cases where initial or secondary interventions have failed or were ineffective. In this article, the most commonly utilized methods to evaluate anorectal dysfunction are discussed.

These tests include 

• Anorectal Manometry -Assess internal and external anal sphincter muscle function. 
• Balloon expulsion test -Additional evaluation for patients with symptoms of obstructed defecation.
• EMG of the pelvic floor- Judgment of the Motor Unit Potentials (MUP).
• Pudendal Nerve Terminal Motor Latency (PNTML)- Function of the nerve supplying the pelvic floor. 
• Endoanal ultrasound- Evaluation of sphincter muscles and other anorectal structures.
• Colonic Transit time- Evaluation of the pattern of evacuation. 
• Cinedefecography- Evaluation of the dynamic of evacuation after filling the rectum with a barium paste.
• (MRI)  Defecography- Functional judgment of pelvic floor and the internal organs and their mobility.

Specialized anorectal testing can help to delineate the pathophysiology of pelvic floor and anorectal dysfunction. These tests can define functional or structural abnormalities and help to select treatment modalities, especially in cases where initial or secondary interventions have failed or were ineffective.