Review of the indications, methods, and clinical utility of anorectal manometry and the rectal balloon expulsion test

Neurogastroenterol Motil. 2022 Sep;34(9):e14335. doi: 10.1111/nmo.14335. Epub 2022 Feb 27.


Background: Anorectal manometry (ARM) comprehensively assesses anorectal sensorimotor functions.

Purpose: This review examines the indications, techniques, interpretation, strengths, and weaknesses of high-resolution ARM (HR-ARM), 3-dimensional high-resolution anorectal manometry (3D-HR-ARM), and portable ARM, and other assessments (i.e., rectal sensation and rectal balloon expulsion test) that are performed alongside manometry. It is based on a literature search of articles related to ARM in adults. HR-ARM and 3D-HR-ARM are useful for diagnosing defecatory disorders (DD), to identify anorectal sensorimotor dysfunction and guide management in patients with fecal incontinence (FI), constipation, megacolon, and megarectum; and to screen for anorectal structural (e.g., rectal intussusception) abnormalities. The rectal balloon expulsion test is a useful, low-cost, radiation-free, outpatient assessment tool for impaired evacuation that is performed and interpreted in conjunction with ARM. The anorectal function tests should be interpreted with reference to age- and sex-matched normal values, clinical features, and results of other tests. A larger database of technique-specific normal values and newer paradigms of analyzing anorectal pressure profiles will increase the precision and diagnostic utility of HR-ARM for identifying abnormal mechanisms of defecation and continence.

Keywords: anal sphincter; biofeedback therapy; constipation; high-resolution anorectal manometry.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anal Canal*
  • Constipation
  • Defecation*
  • Humans
  • Manometry
  • Rectum