ANAL PHYSIOLOGICAL LAB

What is Pelvic Floor Testing?
(Other Names are Urodynamics and Anal Physiology Testing)
Pelvic Floor Testing is a series of studies that gives your doctor a detailed look at the function of your bladder, urethra, rectum and anus. These tests can help your doctor evaluate any problems you may be having with storing urine, voiding (eliminating) urine, storing gas, liquid or solid stool, or eliminating stool from your body. These test also help identify the extent of cancer and if it has spread and the size and function of your sphincter muscles prior to or after physical therapy, surgery or radiation treatment.

Understanding the Pelvic Floor
The lower part of the body is supported (elevated) by one muscle the levator muscle. This muscle works in harmony with other muscles which operate the bladder (which stores urine until you are ready to release it), the urethra (the canal that carries urine from the bladder out of the body), the rectum (which stores stool or gas until you are ready to release it) and the anus (the canal that carries stool and gas from the rectum out of the body). Signals from the brain tell the sphincter (muscles around the urethra and around the anus) when to relax and the bladder or rectum when to contract to let urine or stool elimination out of the body. As it is one muscle, the levator, which supports all these structures, the entire muscle is considered in the evaluation of the pelvic floor. An analogy worth considering is, if this one muscle is a car; when one tire of the car is flat the entire car can not work effectively.

Why You Need Pelvic Floor Testing
Possible problems that you have may have with storing or voiding include the following:

• You may be incontinent (leak urine or stool)
• Your bladder or rectum may not empty completely
• You may have symptoms such as the frequent need to void or a constant, urgent need to void or severe debilitating pain with voiding
• Your urine stream may be intermittent or weak or you may have a blockage of stool or inability to evacuate stool without digital assistance or support
• You may have persistent urinary tract infections
• You may be able to evacuate only diarrhea

Preparing for the Study
Tell your doctor which medications you are taking and ask whether you should stop them before the study. You may be asked to keep a diary of your voiding habits for a few days before the study. This diary can be a helpful part of your evaluation. One (1) hour before the scheduled Urodynamics test, use the bathroom and empty your bladder. Then drink one full 6-8 ounce glass of water. Do not drink any more liquid before the test. When you arrive do not empty your bladder, wait until you are instructed to urinate on a special chair at the beginning of the test. Patients on medications for the bladder such as Ditropan or Detrol please take your regularly scheduled dose.

During Pelvic Floor Testing
The study will be done in the doctor's office unless an x-ray is required. Depending on what studies are being done, the testing may take up to one hour or more. The tests are painless so no sedating medication is required. We need your full participation with the study so please do not take any muscle relaxants or narcotics prior to testing.

Tests That May Be Done

• Urodynamics performed by a urologist.

• Uroflowmetry measures the amount and speed of urine you void from your bladder. You urinate into a funnel attached to a computer that records your urine flow over time. The amount of urine left in your bladder after you void may also be measured immediately after this test.

• Cystometry evaluates how much the bladder can hold, how strong the bladder muscle is, and how well the signals work that tells you when your bladder is full. Through a catheter, you bladder is filled with sterile water or saline solution. You are asked to report any sensations you feel and whether they are similar to symptoms you have felt at home. You may be asked to cough, stand, and walk or bear down during this test.

• Electromyogram helps evaluate the muscle contraction that control urination. Electrode patches or wires may be placed near the rectum or urethra to make the recording. You may be asked to try to tighten or relax your sphincter muscles during this test.

• Pressure Flow Study measures the pressure and flow of urine out of your bladder. It is often preformed after cystometry. You are asked to urinate while a probe in the urethra measures pressures. The maximum urethral closure pressure profile, the functional urethral length and valsalva leak point pressure are all obtained.

• Video Cystourethrography takes video pictures of urine flow through the urinary tract. It can help identify blockages or other problems. The bladder is filled with an x-ray contrast fluid; the x-ray video pictures are taken as the fluid is urinated out.

• Anal Rectal Manometry helps evaluate the muscle contraction and control of gas, stool, and liquid. It measures the maximum internal and external anal sphincter closure pressure profile and the functional sphincter length.

• Balloon Expulsion Test helps to evaluate the coordinated movement of the muscles of the pelvis. It helps to determine the function of the rectal muscles in evacuation of stool.

• Pudendal Nerve Motor Latency helps evaluate the muscle contraction that controls both continence and evacuation of stool. Electrode patches or wires may be placed near the rectum to make the recording. You may be asked to try to tighten or relax your sphincter muscles during this test.

• 3-Dimensional Transrectal Ultrasound
  This is a diagnostic and functional test which will require a one hour visit to determine the location, density and function of the sphincter muscle or the location, depth of spread and lymph node status of a rectal cancer. The muscles of the sphincter and the muscular wall of the rectum can be visualized independently. Radiation treatment, child birth or diseases such as multiple sclerosis can affect the muscles of the pelvis.

• Biofeedback/Physical Therapy
  This is a functional test which may require 2-5 sessions to make you aware of the location of the sphincter muscle to help you identify what muscle needs tightening to exercise for help in maintaining continence. The muscle of the rectum, vagina and urethra can be operated independently and require exercise to maintain function and tone as we age.

• Colonic Transit Study
  This is a colon function and evacuation test which requires one week of testing and is preformed at the radiology department. You are provided a radio opaque marker which you swallow. On day one an x-ray is taken after you take the pill. On day 2 a second x-ray is taken to see if the markers have reached the large intestine and that the small bowel transit time is normal. On day 5 a third x-ray is taken. All of the markers should be gone from the colon. If they reside in the right side of the abdomen then you have poor colonic transit. If they reside in the left side of the abdomen you may have a pelvic floor problem and can not evacuate stool normally.

Getting your Results
When the study is finished, you'll get dressed and be discharged to home. Tests results are available immediately after finishing the study and will be provided to you and your referring physician. The interpretation of the studies requires input from both a colorectal surgeon and a gynecologist. Once Dr. McConnell has reviewed the study you will receive a phone call to discuss options. These options may include other studies, surgery, or physical therapy. Your referring doctor will also be provided the information and can talk to you about the options.

The Staff of the Pelvic Floor Testing Facility

Elizabeth J. McConnell, MD, FACS
Board Certified Colon and Rectal Surgery and General Surgery Fellowship at Mayo Clinic Rochester MN

Anne Moe, PAC
From Minneapolis, MN, the newest member of our team.