🚽📊 Anorectal Manometry in Children: A Parent-Friendly Guide

✅ Anorectal manometry is a safe, specialized test that helps doctors understand how the rectum and anal muscles work together.
It is most often used for chronic constipation, stool accidents, or suspected nerve/muscle coordination problems.

1) 🧾 Quick “At-a-glance” box (top of page)

✅ Test name: Anorectal Manometry
Common names: Rectal pressure test, anal sphincter function test

Plain-language summary (2–3 lines):
This test measures how well the muscles and nerves of the rectum and anus work during squeezing, pushing, and sensing stool. It helps explain why a child may be constipated or having stool accidents despite treatment.

Who it affects (typical ages):
Most often school-age children and teens, sometimes younger children with severe or long-standing symptoms.

✅ What parents should do today:

• Understand why the test is being recommended
• Reassure your child (it is not painful)
• Follow bowel clean-out or prep instructions exactly

⚠️ Red flags that need urgent/ER care (not caused by the test):

• Severe belly pain with hard, swollen abdomen
• Vomiting with constipation
• Blood in stool with a very unwell child

🟡 When to see the family doctor/clinic:

• Chronic constipation not improving
• Stool accidents despite laxatives
• Suspected Hirschsprung disease or pelvic floor dysfunction

2) 🧠 What it is (plain language)

Anorectal manometry checks how the rectum and anus work, including:

• muscle strength
• muscle relaxation
• nerve reflexes
• sensation (when the rectum feels full)

It answers questions like:

• Can my child feel stool normally?
• Do the muscles relax when they try to poop?
• Is the nerve reflex present?

What part of the body is involved? (small diagram required)

Common myths vs facts

• Myth: “It’s painful.”
  Fact: It may feel strange or uncomfortable, but it is not painful.
• Myth: “It means surgery is needed.”
  Fact: Most results guide behavioral or therapy-based treatment, not surgery.
• Myth: “It’s only for adults.”
  Fact: It is commonly used in children with severe constipation.

3) 🧩 Why it’s done (indications)

Common reasons for anorectal manometry

• Chronic constipation that doesn’t improve with treatment
• Stool accidents (fecal incontinence / soiling)
• Difficulty pushing stool out
• Suspected pelvic floor dyssynergia (muscles don’t coordinate)
• Screening for Hirschsprung disease (to check the rectoanal inhibitory reflex)

Less common but important reasons

• Nerve or spinal conditions
• Post-surgical bowel problems
• Severe withholding behavior with unclear cause

4) 👀 What parents might notice (symptoms leading to the test)

• Long history of constipation
• Very large or painful stools
• Stool accidents despite laxatives
• Child avoids using the toilet
• Straining without stool passing
• Sensation of “not feeling the urge” to poop

What’s normal vs what’s not normal

✅ Common:

• Occasional constipation
• Stool accidents during toilet training

⚠️ Concerning:

• Constipation for months–years
• Daily stool accidents in a toilet-trained child
• No response to proper laxative doses

5) 🏠 Preparing for the test (step-by-step)

✅ Good preparation makes the test quicker and more accurate.

Before the test

• Your child may need:
  • a bowel clean-out or
  • a rectal enema the day of the test
• Follow instructions exactly
• Your child can usually eat normally unless told otherwise

How to prepare your child emotionally

✅ Do this now:

• Explain that:
  • nothing sharp is used
  • the tube is thin and soft
  • the test is short (usually 20–30 minutes)
• Practice “blowing out candles” or pushing gently at home
• Reassure them you’ll be nearby

6) ⛔ What NOT to do (common mistakes)

• Don’t skip the bowel prep
• Don’t stop prescribed laxatives unless told
• Don’t scare your child with medical details
• Don’t expect the test alone to “fix” constipation

7) 🚦 When to worry: triage guidance (before/after test)

🔴 Emergency (unrelated to the test itself)

• Severe abdominal pain
• Persistent vomiting
• Distended, hard abdomen
• Fever with severe constipation

🟡 Call clinic

• Prep not working
• Child extremely anxious
• Missed instructions

🟢 Normal after test

• Mild rectal discomfort
• Temporary embarrassment
• Return to normal activities the same day

8) 🩺 How the test is done (what to expect)

Step-by-step

1. Child lies on their side
2. A thin, soft tube with a balloon is gently placed in the rectum
3. The child is asked to:
   • squeeze
   • relax
   • push like pooping
4. The balloon may be inflated to check sensation
5. Tube is removed

Sedation?

• Usually not needed
• Child must be awake to follow instructions

9) 📊 What the test measures (results explained simply)

Key measurements

• Resting anal tone
• Squeeze strength
• Push/relax coordination
• Rectal sensation
• Rectoanal inhibitory reflex (RAIR)

Common result patterns

• Normal study: look for behavioral or stool consistency issues
• Pelvic floor dyssynergia: muscles tighten instead of relax
• Reduced sensation: child doesn’t feel stool until very full
• Absent RAIR: raises concern for Hirschsprung disease (needs further testing)

10) ⏳ What happens after the test

Typical next steps

• Adjust laxative plan
• Start biofeedback therapy
• Pelvic floor physiotherapy
• Toileting routine changes

Return to school/sports

• Same day, no restrictions

11) ⚠️ Complications (rare)

• Temporary discomfort
• Anxiety
• Very rare: rectal irritation

12) 🛡️ How results help prevent future problems

• Prevents unnecessary surgery
• Targets the right therapy
• Reduces long-term stool accidents
• Improves confidence and quality of life

13) 🌟 Special situations

Children with autism or anxiety

• Extra preparation and explanation
• Allow breaks
• Child-life support if available

Children with neurologic conditions

• Helps clarify nerve involvement

Suspected Hirschsprung disease

• Screens for nerve reflex but does not replace biopsy

14) 📅 Follow-up plan

• Review results with GI specialist
• Start recommended therapy
• Monitor stool pattern and accidents
• Reassess in weeks–months

15) ❓ Parent FAQs

“Is it painful?”

No. It may feel uncomfortable but should not hurt.

“Is anesthesia needed?”

Usually no.

“Will this cure constipation?”

It helps guide the right treatment, not an instant cure.

“Can my child poop after the test?”

Yes, normally.

“Is it safe?”

Yes, it is considered very safe.

16) 🧾 Printable tools

🧾 Printable: Anorectal Manometry Prep Checklist

• Prep instructions followed
• Comfortable clothes
• Child reassured
• Toileting practice done

🧾 Printable: Result Discussion Sheet

• Main finding: __________________________
• Plan recommended: _____________________
• Next steps: ___________________________

🧾 Printable: Red Flags Sheet

⚠️ Urgent: severe abdominal pain, vomiting, distension, fever with constipation.

17) 📚 Credible sources + last updated date

Trusted references:

• Pediatric gastroenterology society resources
• Children’s hospital constipation and motility testing pages

Last reviewed/updated on: 2025-12-30
Local practices may vary.

🧡 Safety disclaimer

This guide supports—not replaces—medical care. If you are worried about your child, trust your instincts and seek urgent medical assessment.

This guide was fully developed & reviewed by Dr. Mohammad Hussein, MD, FRCPC ROYAL COLLEGE–CERTIFIED PEDIATRICIAN & PEDIATRIC GASTROENTEROLOGIST Board-certified pediatrician and pediatric gastroenterologist (Royal College of Physicians and Surgeons of Canada) with expertise in inflammatory bowel disease, eosinophilic gastrointestinal disorders, motility and functional testing, and complex nutrition across diverse international practice settings.

To book an online assessment Email Dr. Hussein’s Assistant Elizabeth Gray at: Elizabeth.Gray@pedsgimind.ca
In the email subject, please write: New Assessment Appointment with Dr. Hussein

Important: This appointment is completely online as Dr. Hussein is currently working overseas. This service is not covered by OHIP