By F.C. Oglesby
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Extra resources for An Examination of a Decision Procedure
2) The anal canal pressure both at rest and during voluntary contraction of the pelvic floor can be measured by this method and it is also possible by withdrawing the probe from the rectum to the outside to obtain a pressure profile of the anal canal and thus to determine the functional length. Manometry is best carried out with the patient in the left lateral position. The probe is inserted through the anal canal into the rectum and rectal pressure recorded. It is then withdrawn 1 cm at a time, recording the pressure with the patient at rest and during maximal voluntary contraction of the pelvic floor at each point during withdrawal.
Rectal biopsy through a rigid sigmoidoscope. again. A barium enema examination might force a perforation at the biopsy site or worsen the consequences of an established perforation, so should not be performed within 10 days of a biopsy. Flexible Endoscopy The size of the specimen obtained using a flexible sigmoidoscope or colonoscope is much smaller and it is therefore not possible to orientate it as it is with a 32 Examination specimen obtained by rigid sigmoidoscopy. Specimens can, however, be obtained from different sites along the large bowel, enabling the extent and distribution of inflammatory bowel disease to be determined and increasing the chance of detecting severe dyspl~ia.
RECTOSPHINCTERIC REFLEX. The rectosphincteric reflex is absent in Hirschsprung's disease, in which no fall in anal pressure occurs during rectal distension. It is often absent in patients with abnormally low resting anal canal pressure, where perhaps any fallon rectal distension is too small to detect. 46 Special Investigations Electromyography Electromyography can be useful in locating normally functioning pelvic floor muscle which has become disrupted by trauma or is distorted by congenital abnormality.