Introduction
Materials and methods
Subjects
Ethics
Equipment
Study protocol
-
Rest over 60 seconds (s) - LP: mean maximum pressure (mmHg); complementary parameters: mean pressure (mmHg), functional anal canal length (cm); 3D manometric parameters: resting PV (104mmHg2.cm), highest and lowest pressure asymmetry (%).
-
Short squeeze (3 squeezes lasting 5 s separated by 30 s between them) - LP: maximum incremental pressure squeeze (mmHg); complementary parameters: mean pressure (mmHg), maximum absolute squeeze pressure (mmHg); 3D manometric parameters: short squeeze PV (104mmHg2.cm); highest and lowest pressure asymmetry (%).
-
Long (endurance) squeeze (sustained voluntary effort over 30 s) -complementary parameters: fatigue rate (mmHg), fatigue rate index (min), and capacity to sustain (%); 3D manometric parameters (104mmHg2.cm): 1/3; 2/3 and 3/3 long squeeze PV.
-
Cough (2 single coughs separated by 30 s between them) - LP: maximum pressure anal canal (mmHg), maximum pressure rectum (mmHg); complementary parameter: anorectal gradient pressure (mmHg); 3D manometric parameters: anal canal PV (104mmHg2.cm) in cough, highest and lowest pressure asymmetry of the anal canal (%).
-
Push (15 s duration, separated by 30 s between them) - LP: maximum pressure anal canal (mmHg), maximum pressure rectum (mmHg); complementary parameters: rectum-anal gradient pressure (mmHg), anal canal relaxation percent (%).
-
Recto-anal inhibitory reflex (RAIR- performed with 50mls, 30 s recovery interval) - complementary parameter: anal canal relaxation percent (%).
-
Rectal sensory test (1-5 ml/s rate manually controlled) - LP: first sensation volume (ml), desire to defecate volume (ml), maximum tolerated volume (ml).
Endurance complementary parameters
3D manometric parameters
Statistical analysis
Results
Resting manometric parameters
|
Female (25)
Mean (SD) Med IQR)
|
Male (25)
Mean (SD) Med(IQR)
|
p
| ||
---|---|---|---|---|---|
London Protocol parameter
| |||||
Mean maximum pressure (mmHg)
| 61.1 (16.3) | 59.9 [51.9;74.0] | 62.8 (14.7) | 60.9 [50.7;75.3] | 0.71 |
Complementary parameters
| |||||
Mean pressure
(mmHg)
| 38.4 (9.6) | 38.9 [30.7;46.0] | 42.1 (9.2) | 40.0 [35.4;45.1] | 0.20 |
Functional anal canal length (cm)
| 3.5 (1.0) | 3.6 [2.7;4.4] | 3.9 (0.8) | 3.9 [3.3;4.6] | 0.14 |
3D parameters
| |||||
Resting PV (10
4
mmHg
2
.cm)
| 2.4 (1.5) | 2.0 [1.1;3.3] | 2.9 (1.6) | 2.6 [1.7;3.6] | 0.31 |
Highest pressure asymmetry (%)
| 26.3 (9.8) | 23.9 [19.3;29.9] | 27.3 (9.6) | 26.8 [21.1;32.5] | 0.72 |
Lowest pressure asymmetry (%)
| 27.1 (13.0) | 25.4 [19.4;32.4] | 23.2 (10.0) | 22.6 [17.5;28.2] | 0.31 |
Squeeze manometric parameters | Female (25) Mean (SD) Med (IQR) | Male (25) |
p
| ||
---|---|---|---|---|---|
Mean (SD) | Med (IQR) | ||||
London Protocol parameters
| |||||
Maximum incremental pressure squeeze (mmHg); short squeeze
| 108.7 (42.7) | 102.5 [83.6;126.2] | 143 (50.5) | 146.3 [114.0;168.8] |
<0.05
|
Complementary parameters
| |||||
Mean pressure (mmHg); short squeeze
| 117.0 (40.6) | 107.8 [99.6;138.0] | 155.1 (39.4) | 157.2 [131.6;177.6] |
<0.01
|
Maximum absolute squeeze pressure (mmHg); short squeeze
| 169.9 (44.0) | 168.5 [142.8;183.5] | 205.7 (45.2) | 211.6 [180.0;239.6] |
<0.01
|
Fatigue rate (mmHg); long squeeze
| -74.9 (46.4) | -69.8 [-91.8; -47.5] | -60.5 (77.5) | -71.3 [-95.4; -13.8] | 0.64 |
Fatigue rate index (min); long squeeze
| 1.6 (2.2) | 0.8 [0.6;1.5] | 2.0 (4.2) | 1.0 [0.7;1.5] | 0.42 |
Capacity to sustain (%); long squeeze
| 71.60 (14.8) | 73.4 [61.0;80.0] | 79.80 (22.1) | 74.2 [66.9;93.6] | 0.24 |
3D parameters
| |||||
Short squeeze PV (104mmHg².cm)
| 21.0 (13.1) | 18.8 [13.5;23.9] | 36.2 (16.4) | 30.9 [26.0;49.9] |
<0.01
|
Highest-pressure asymmetry (%); short squeeze
| 15.8 (5.6) | 16.0 [10.6;18.1] | 14.1 (4.9) | 13.5 [10.4;17.2] | 0.27 |
Lowest pressure asymmetry (%); short squeeze
| 18.8 (9.2) | 17.2 [11.4;23.3] | 12.9 (4.5) | 12.6 [9.7;15.1] |
<0.05
|
Long squeeze PV (1/3) 104mmHg².cm
| 11.8 (7.9) | 9.9 [7.7;13.7] | 19.0 (10.5) | 15.4 [12.3;24.8] |
<0.01
|
Long squeeze PV (2/3) 104mmHg².cm
| 9.9 (7.2) | 7.7 [4.4;13.1] | 16.4 (10.5) | 12.2 [9.1;24.7]] |
<0.01
|
Long squeeze PV (3/3) 104mmHg².cm
| 11.8 (18.5) | 7.2 [4.0;11.3] | 15.1 (10.7) | 11.0 [9.1;20.5] |
<0.05
|
Cough manometric parameters | Female (25) | Male (25) |
p
| ||
---|---|---|---|---|---|
Mean (SD) | Med (IQR) | Mean (SD) | Med (IQR) | ||
London Protocol parameters
| |||||
Maximum pressure anal canal (mmHg)r
| 132 (31.6) | 134.6 [127.6;155.0] | 150.7 (28.8) | 150.2 [124.9;171.6] |
<0.05
|
Maximum pressure rectum (mmHg)
| 65.5 (23.8) | 65.0 [47.0;79.3] | 87.0 (27.3) | 82.2 [72.5;95.5] |
<0.01
|
Complementary parameters
| |||||
Anorectal gradient pressure (mmHg)
| 67.7 (22.1) | 62.6 [48.6;83.9] | 63.7 (26.8) | 63.1 [55.7;71.9] | 0.57 |
3D parameters
| |||||
Anal canal PV in cough (104mmHg².cm)
| 11.0 (4.8) | 10.6 [8.3;14.0] | 15.1 (5.2) | 15.3 [11.6;18.2] |
<0.01
|
Highest pressure asymmetry (%); anal canal
| 14.4 (5.9) | 13.9 [10.0;16.9] | 16.0 (6.7) | 14.9 [10.8;20.3] | 0.39 |
Lowest pressure asymmetry (%); anal canal
| 14.7 (4.9) | 14.9 [12.6;18.1] | 12.5 (4.0) | 11.7 [8.9;15.0] | 0.08 |
Push manometric parameters | Female (25) | Male (25) |
p
| ||
---|---|---|---|---|---|
Mean (SD) | Med (IQR) | Mean (SD) | Med (IQR) | ||
London Protocol parameters
| |||||
Maximum pressure anal canal (mmHg)
| 47.4 (19.0) | 43.9 [35.7;53.9] | 61.3 (26.5) | 51.3 [46.7;71.1] |
<0.05
|
Maximum pressure rectum (mmHg)
| 27.9 (20.5) | 23.9 [19.0;33.2] | 42.5 (18.5) | 34.9 [31.1;54.1] |
<0.01
|
Complementary parameters
| |||||
Rectum-anal gradient pressure (mmHg)
| -16.1 (22.5) | -17.9 [-24.2; -1.5] | -22.9 (13.2) | -20.2 [-31.4; -13.9] | 0.20 |
Anal canal relaxation percent (%)
| 6.4 (36.0) | 10.2 [-22.0;36.4] | -23.7 (54.1) | -5.7 [-48.8;10.2] |
<0.05
|
Rectal sensory thresholds parameters | Mean (SD) | Med (IQR) | p |
---|---|---|---|
London Protocol parameters | |||
First sensation volume (ml) | |||
Female | 22.9 (17.9) | 16.0[10.0;32.0] | 0.35 |
Male | 20.7 (20.4] | 12.0[6.0;22.0] | |
Desire to defaecate volume(ml) | |||
Female | 38.5 (19.7) | 34.0[23.0;48.0] | 0.77 |
Male | 39.2 (24.0) | 34.0 [20.0;50.0] | |
Maximum tolerated volume(ml) | |||
Female | 141.4 (53.1) | 132.0[106.0;164.0] | 0.57 |
Male | 133.4 (44.3) | 125.0[100.0;140.0] | |
Complementary parameters | |||
Anal canal relaxation (%) | |||
Female | 36.8 (15.8) | 33.3 [25.7;44.9] | 0.70 |
Male | 38.4 (13.9) | 39.4 [29.5;45.4] |
Discussion
3D manometric parameters
Studies comparison of healthy volunteers under perfusional high-resolution system
Manometric parameters | Present article (channel = 36) London Protocol | Deshmukh et al.19 (channel = 20) | Vierbig et al.20 (channel = 24) | Rasijeff et al.21 (channel = 10) |
---|---|---|---|---|
Resting manometric parameters | ||||
Mean maximum pressure(mmHg) | ||||
Female | n = 25 | n = 29 | n = 30 | n = 40 |
Mean(SD) | 61.1(16.3) | 64.0 | ||
Med(IQR) | 59.9[51.9;74.0] | 94.0[48.0;117.0] | ||
5th; 95th | [31.9;77.9] | [34.0;101.0] | ||
Male | n = 25 | n = 64 | n = 20 | n = 20 |
Mean (SD) | 62.8 (14.7) | 67.0 | ||
Med (IQR) | 60.9[50.7;75.3] | 88.0[33.0;132.0] | ||
5th; 95th | [43.0; 86.4] | [40.0;116.0] | ||
Mean pressure (mmHg) | ||||
Female | ||||
Mean (SD) | 38.4(9.6) | 79.8(4.0) | ||
Med IQR) | 38.9[30.7;46.0] | |||
Male | 72.20(3.0) | |||
Mean (SD) | 42.1 (9.2) | |||
Med (IQR) | 40.0[35.4;45.1] | |||
Functional anal canal length (cm) | ||||
Female | ||||
Mean(SD) | 3.5(1.0) | 3.0(0.1) | ||
Med(IQR) | 3.6[2.7;4.4] | 1.5[1.0;3.2] | ||
Male | ||||
Mean (SD) | 3.9 (0.8) | 3.3(0.1) | ||
Med (IQR) | 3.9[3.3;4.6] | 2.5[1.1;3.8] | ||
Squeeze manometric parameters | ||||
Maximum incremental pressure(mmHg) | ||||
Female | ||||
Mean(SD) | 108.7(42.7) | 105.0 | ||
Med(IQR) | 102.5[83.6;126.2] | 66.0[10.0;160.0] | ||
5th; 95th | [64.5;178.8] | [27.0;188.0] | ||
Male | ||||
Mean (SD) | 143(50.5) | 177.0 | ||
Med (IQR) | 146.3[114.0;168.8] | 90.0[32.0;150.0] | ||
5th; 95th | [64.7;216.2] | [36.0;305.0] | ||
Maximum absolute squeeze pressure(mmHg) | ||||
Female | ||||
Mean(SD) | 169.9 (44.0) | 170.7(8.0) | ||
Med(IQR) | 168.5[142.8;183.5] | 147.0[83.0;259.0] | ||
Male | ||||
Mean (SD) | 205.7(45.2) | 229.50(17.0) | ||
Med (IQR) | 211.6[180.0;239.6] | 165.0[90.0;377.0] | ||
Cough manometric parameters | ||||
Maximum incremental pressure(mmHg) | ||||
Female | ||||
Mean(SD) | 79.0 | |||
Med(IQR) | ||||
5th; 95th | [28.0;136.0] | |||
Male | ||||
Mean (SD) | 91.0 | |||
Med (IQR) | ||||
5th; 95th | [29.0;152.0] | |||
Push manometric parameters | ||||
Maximum pressure anal canal(mmHg) | ||||
Female | ||||
Mean(SD) | 47.4 (19.0) | |||
Med(IQR) | 43.9[35.7;53.9] | 63.0[18.0-100.0] | ||
Male | ||||
Mean (SD) | 61.3 (26.5) | |||
Med(IQR) | 51.3[46.7;71.1] | 82.0[36.0-170.0] | ||
Maximum pressure rectum(mmHg) | ||||
Female | ||||
Mean(SD) | 27.9(20.5) | |||
Med(IQR) | 23.9[19.0;33.2] | 54.0[26.0-117.0] | ||
Male | ||||
Mean (SD) | 42.5 (18.5) | |||
Med (IQR) | 34.9 [31.1;54.1] | 70.0[34.0-133.0] | ||
Rectum-anal gradient pressure(mmHg) | ||||
Female | ||||
Mean(SD) | -16.1(22.5) | |||
Med(IQR) | -17.9[-24.2; -1.5] | 6.0[-39.0;51.0] | ||
Male | ||||
Mean (SD) | -22.9 (13.2) | |||
Med (IQR) | -20.2[-31.4; -13.9] | -6.0[-78.0;66.0] | ||
Anal canal relaxation (%) | ||||
Female | ||||
Mean(SD) | 6.4 (36.0) | |||
Med(IQR) | 10.2[-22.0;36.4] | 42.0[-24.0;80.0] | ||
Male | ||||
Mean (SD) | -23.7(54.1) | |||
Med (IQR) | -5.7[-48.8;10.2] | 16.0[-38.0;53.0] | ||
Rectal sensory thresholds parameters and RAIR | ||||
First sensation volume(ml) | ||||
Female | ||||
Mean(SD) | 22.9(17.9) | 31.0(1.2) | ||
Med(IQR) | 16.0 [10.0;32.0] | 30.0 [10.0;80.0] | ||
Male | ||||
Mean(SD) | 20.70(20.40] | 43.0(4.8) | ||
Med(IQR) | 12.0[6.0;22.0] | 40.0[10.0;170] | ||
Desire to defaecate volume(ml) | ||||
Female | ||||
Mean(SD) | 38.5(19.70) | 100.0(7.0) | ||
Med(IQR) | 34.0[23.0;48.0] | 90.0[50.0;170.0] | ||
Male | ||||
Mean(SD) | 39.20(24.0) | 102.0(9.4) | ||
Med(IQR) | 34.0 [20.0;50.0] | 105.0[40.0;250.0] | ||
Maximum tolerated volume(ml) | ||||
Female | ||||
Mean(SD) | 141.4(53.10) | 162.0(10.9) | ||
Med(IQR) | 132.0[106.0;164.0] | 140.0[80.0;270.0] | ||
Male | ||||
Mean(SD) | 133.4(44.3) | 167.0(9.8) | ||
Med(IQR) | 125.0[100.0;140.0] | 160.0[80.0;310] | ||
Anal canal relaxation (%) | ||||
Female | ||||
Mean(SD) | 36.8 (15.8) | |||
Med(IQR) | 33.3 [25.7;44.9] | 44.0[17.0;80.0] | ||
Male | ||||
Mean(SD) | 38.4 (13.9) | |||
Med(IQR) | 39.4 [29.5;45.4] | 49.5[0.0;87.0] |