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

Adil E. Bharucha, Guido Basilisco, Allison Malcolm, Tae Hee Lee, Matthew B. Hoy, S. Mark Scott, Satish S.C. Rao

Research output: Contribution to journalReview articlepeer-review


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.

Original languageEnglish (US)
Article numbere14335
JournalNeurogastroenterology and Motility
Issue number9
StatePublished - Sep 2022


  • anal sphincter
  • biofeedback therapy
  • constipation
  • high-resolution anorectal manometry

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology


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