Diagnosis

Ano-rectal physiology test

Why are these tests performed?

These are very commonly performed test for people with incontinence, prolapse and obstructed defaecation syndrome. They are standard tests that tell us about the function and structure of the anal canal and lower rectum.

What preparation is needed for the tests?

You will be given instructions about when and where to come for the test. There is no particular preparation required.

What do the tests involve?

The anorectal physiology examination measures the strength of your sphincter muscle and this involves inserting a probe into the anal canal. The probe is only slightly thicker than a piece of spaghetti. The next part of the test involves passing a balloon into your rectum attached to a piece of fine tubing to assess the sensation or feeling in your bowel. Finally, the physiologist will usually perform a rectal examination.

The ultrasound part of the test looks at the structure of the anal sphincter muscles and the lower rectum. It requires the physiologist to insert the ultrasound probe into the anal canal. The probe usually has to go in no more than 5cm (2 inches). The probe is about the same thickness as a finger.

The perineal usltrasound is an ultrasound of the perineum, it is placed between the vagina and anus, and allows assessment of pelvic floor muscle movement and lower intestinal stability.

What happens after the tests?

You will usually be completely comfortable after the tests and able to drive home and/or go back to work immediately. The tests are analysed and the results will be discussed with you.

Flexible Sigmoidoscopy and Colonoscopy

Why are these tests performed?

These tests look at the bowel lining with a flexible scope inserted through the anus. A flexible sigmoidoscopy looks at the left half of the bowel whilst a colonoscopy looks at the entire large bowel. It allows us to see if there is an intraluminal disease (polyps/cancer, inflammation, other…).

What preparation is needed for the tests?

You will receive instructions about what you can eat and drink before the procedure. For a colonoscopy, you need to take medication by mouth (included in the appointment letter) to clear the bowel out. For a flexible sigmoidoscopy, the usual preparation is simply an enema (medication that is squirted up the anal canal into the rectum to encourage a bowel movement).

What do the tests involve?

If you are having a colonoscopy, you need to have sedation via an intravenous needle inserted in the back of your hand to make you drowsy and relaxed. For a flexible sigmoidoscopy, you can opt to have this done with sedation or awake. If done with you awake, you will be able to drive yourself home almost immediately after the test.

What happens after the tests?

If you have had sedation then the nursing staff will observe you for 1-2 hours after the procedure until you are fully awake. You should not drive for 24 hours, as there may be some residual effects from the sedation. We prefer that you will be accompanied after this investigation. In case of acute abdominal pain following this procedure, we advise you to go see your doctor to rule out a complication. 

Defaecating Proctogram and Transit Study

Why are these tests performed?

Proctography looks at how the structures in the pelvis move and co-ordinate when you open your bowels. It examines the cause of people’s symptoms and gives us an indication as to how best to treat you.

A transit study looks at how well the colon pushes faeces through the bowel with a measurement of the amount of time it takes for food to pass from the mouth to the anus

What preparation is needed for the tests?

A letter with the appointment will be sent to you in the post and it will include any specific instructions. If you are having a transit study, you will be sent some capsules to take by mouth a few days before you come into hospital.

What do the tests involve?

The proctogram is performed in the X-ray department. You will be given some fluid to drink which shows up on X-ray and women will be asked to insert a tampon to demonstrate what happens to the vagina during the test. Finally, the radiographer will put contrast (about 100ml or a cupful) into the rectum by inserting a short piece of tubing into the anal canal. You will then be asked to sit on a commode (a type of toilet) to try to empty the contrast from your bottom, as if going to the toilet. Whilst doing this, you are behind a curtain giving you privacy. Defecography : Dynamic examination of the bowels as they empty. The rectum is filled with a radio-opaque substance, which is then expelled into a radiolucent toilet at which time this bowel activity is filmed. This can be done with normal X-rays or with MRI, (magnetic resonance imaging).

The transit study involves nothing more than a simple X-ray of the abdomen to see how far the capsule and its content have got round the bowel.

What happens after the tests?

You will be allowed home immediately after the test and should feel completely fine afterwards. If you wish to return to work immediately then this should be possible.