Anal Ultrasound (performed in the Saint Vincent Endoscopy GI Lab)
Anal ultrasound studies are performed to evaluate several conditions including anal cancer, anal fistulas, anal pain and fecal incontinence. An anal ultrasound probe is gently inserted into the anus, and images are taken to evaluate the anal sphincter muscles. You will need to perform two Fleet enemas 2 to 3 hours prior to your procedure appointment time.  

Pudendal Nerve Terminal Motor Latency (PNTML) Testing (performed in the Saint Vincent Endoscopy GI Lab)
PNTML testing can show if there has been damage to the nerves that lead to the anus.  This damage may be present due to excessive straining or previous childbirth. A sensor is placed onto the finger, and the nerves are found in the rectum to test how long it takes the anal sphincter muscle to respond to a small stimulus. You will need to perform two Fleet enemas 2 to 3 hours prior to your procedure appointment time.  

Anal Manometry (performed in the Saint Vincent Endoscopy GI Lab)
Anal manometry is an important tool to evaluate patients with fecal incontinence. It helps to determine the functional weakness of the internal and/or external anal sphincter. It can also help determine the presence of sensory or muscular defects. The capacity and compliance of the rectum is also measured. A small catheter is placed into your rectum to measure pressures of the anal sphincter muscles and to test your sensory ability. You will need to perform two Fleet enemas 2 to 3 hours prior to your procedure appointment time.  

Sitz Marker Studies (performed as an outpatient X-ray study)
Colonic transit time (how long it takes for waste to pass through the colon) is measured using radioopaque markers. No laxatives or enemas can be used for 48 hours before the study is started or during the study.  The Sitz marker pill is taken orally on a Sunday afternoon. Abdominal X-rays are taken one day (Monday), three days (Wednesday), and five days (Friday) after the Sitz marker is ingested to determine if and when the markers are expelled.  

Cinedefecography (performed at the Saint Vincent Radiology Department)
Cinedefecography (a defecogram) is a video X-ray study of the functional status of the anus, rectum and sigmoid colon.  It is an important part of the physiologic evaluation of patients with constipation, pelvic organ prolapse and rectal pain.  Barium paste (X-ray dye) is instilled into the rectum, and dynamic images of the anus, rectum and sigmoid colon are taken with the patient sitting on a commode. Films are made of the paste during resting, squeezing and pushing to evaluate the active emptying of the contrast from the rectum.  

Biofeedback Therapy
Biofeedback therapy involves working with a specially trained physical therapist to accurately measure, process and give feedback to individuals and the therapist to correctly contract the pelvic floor muscles. Often, the abdominal and gluteal muscles are incorrectly used in substitution for weak pelvic floor muscles.  The goal of biofeedback therapy is to produce a coordinated movement that consists of recognizing and responding to the urge for a bowel movement, then increasing intraabdominal (intrarectal) pressure while simultaneously relaxing the pelvic muscles.   

Therapy begins with education, observing a computer screen during different pelvic floor maneuvers, and then training to strengthen or relax the appropriate pelvic floor muscles.