PATIENT ACCEPTANCE OF ANORECTAL PHYSIOLOGY DIAGNOSTICS: HOW IMPORTANT IS THE CATHETER?

IntroductionThe diameter of high-resolution anorectal manometry (HRAM) catheters vary from 2.6mm up to 10.75mm for some high-definition devices. Other catheter-based physiology assessment tools such as the Functional lumen imaging probe (FLIP) use of a probe with a starting diameter of 3mm. Anal acoustic reflectometry (AAR) however is a ‘catheter-less’ technique as it does not distort the anal canal due to the extremely thin (diameter 0.71mm) flexible probe occupying a small cross-sectional area (0.4mm2). Therefore the primary aim of this study was to explore which system patients found more acceptable.MethodsFemales with faecal incontinence (FI) symptoms attending for HRAM at a tertiary pelvic floor centre were recruited. Following HRAM, patients underwent AAR or FLIP in a randomised order. Resting and squeeze parameters were recorded for each modality and at the end of all 3 tests, patients completed a visual analogue scale independent of the researcher [(scale 0-10) 0= no pain/acceptable test, 10 = severe discomfort/an unacceptable test].ResultsTwenty females [median age 61.5 years (IQR 51.5-66yrs)] with varying sub-types of FI (mixed 45%, passive 35%, urge 20%) were recruited. Physiology parameters and VAS scores are presented in table 1. All of the respective median resting/squeeze parameters, [except for incremental squeeze pressure (HRAM)], for each modality were below laboratory normative values. Eleven patients (55%) reported equal acceptability for all 3 tests, scoring either 0/10 or 1/10 for each. Median scores for all three modalities were low (0.5/10 – 1/10).ConclusionsThis study has shown for the first time that the majority of patients found that all 3 modalities were of equal acceptability with minimal discomfort. It is acknowledged that assessment of anorectal function is crucial in those with FI however, fear of tests/investigations can be a barrier to accessing services. Further qualitative research on patients perceptions/preferences of anorectal investigations and treatments will help to provide education for health practitioners and service users, and hopefully improve the patient journey experience.