Performing, Analyzing, and Interpreting HRAM and HDAM Recordings

Anorectal manometry is one of the most widely performed tests for the assessment of anal sphincter function and anorectal coordination. Nowadays high resolution (HRAM) and high definition anorectal manometry (HDAM) are available, instead of the water-perfused system. The ability to visualize the anorectum as a dynamic structure during test maneuvers should intuitively allow for a better appreciation of the normal physiology and hopefully enhance our understanding of the pathophysiology of defecatory dysfunctions. Even if the anorectal manometry protocols can vary by centers, the procedure must include an assessment of rectoanal pressure and anal canal length at rest, cough reflex test, rectoanal pressures during squeeze, simulated evacuation, and rectal sensation. Although it is becoming an increasingly widespread examination, at present the normality values for different examined parameters, shared between different centers, are not available, and it would therefore be desirable to define the parameters of normality shared at the Italian and European level.