Patient guide · Neurogastroenterology
Anorectal manometry, high-resolution pressure testing for faecal incontinence and defecation disorders.
High-resolution manometry measures anal sphincter pressures, rectal sensation and recto-anal coordination. The gold-standard for evaluating faecal incontinence, chronic constipation with dyssynergic defecation and Hirschsprung’s disease.
Why patients choose us
- 01
The right hands
A consultant neurogastroenterologist reads your trace against the London Classification 2019 — the international standard.
- 02
High-resolution catheters
Thin, high-resolution manometry catheters — full pressure topography, not the old low-resolution set.
- 03
Onward pathway, not just a report
Biofeedback, pelvic-floor physiotherapy or a colorectal opinion arranged when the trace calls for it.
Key facts
What anorectal manometry actually measures.
The six things worth knowing before you read the rest of this guide.
In short
High-resolution manometry reported to the London Classification 2019, with a written report within 5–7 days.
-
What it is
High-resolution pressure catheter measurement of anorectal function — sphincter tone, rectal sensation and coordination.
-
London Classification 2019
Reported to the international London Classification 2019 standard — comparable across units.
-
Resting and squeeze pressures
Quantifies internal and external anal sphincter function at rest and on voluntary contraction.
-
Rectal sensation and compliance
Balloon distension tests first sensation, urge and maximum tolerable volume — plus rectal compliance.
-
Recto-anal inhibitory reflex
The RAIR — absent in Hirschsprung’s disease, a critical paediatric and adult finding.
-
Dyssynergic defecation
A common finding in chronic constipation, treatable with biofeedback rather than more laxatives.
Preparation
From enema to report — the seven steps of the test.
No sedation, no fasting. The whole appointment is around 30 minutes.
Phase 1 · Before
Prep at home
Phase 2 · At the clinic
~30 minutes
Phase 3 · After
Report + plan
- 01
Before
Bowel prep with enema
A small phosphate enema an hour or two before the appointment clears the rectum so the trace is clean.
- 02
At the clinic
Left lateral position
You lie on your left side on the couch, knees drawn up. No sedation, no fasting.
- 03
At the clinic
Thin manometry catheter
A thin high-resolution catheter is gently inserted through the anal canal into the rectum — uncomfortable but not painful.
- 04
At the clinic
Baseline pressures recorded
Resting anal pressures are recorded first, with the catheter still and the sphincter relaxed.
- 05
At the clinic
Squeeze, cough, push manoeuvres
You squeeze, cough and push on request — the pressures during each manoeuvre map coordination and strength.
- 06
At the clinic
Balloon expulsion test
A small balloon is inflated in the rectum and you attempt to expel it — the practical test for dyssynergic defecation.
- 07
After
Report within 5–7 days
Your consultant reports the trace to the London Classification 2019 and links it to a next step: biofeedback, physio, surgery or MDT.
Typical end-to-end: under two weeks. Urgent paediatric cases: same day.
What it shows
The eight findings the trace can deliver.
High-resolution manometry answers specific questions about pressures, reflexes, sensation and coordination — each one changes what happens next.
-
Resting anal pressure
The internal anal sphincter’s baseline tone — the passive continence mechanism.
-
Squeeze pressure
External anal sphincter strength — the voluntary continence mechanism.
-
Recto-anal inhibitory reflex
The reflex sphincter relaxation on rectal distension — normally present.
-
Rectal sensation thresholds
First sensation, urge and maximum tolerable volume — hyposensitive or hypersensitive rectum.
-
Dyssynergic defecation pattern
Paradoxical sphincter contraction on push — the trace signature of dyssynergia.
-
Faecal incontinence sphincter deficit
Low resting or squeeze pressures that explain incontinence and predict repair benefit.
-
Hirschsprung’s (absent RAIR)
Absent RAIR is the manometric signature of Hirschsprung’s disease.
-
Red flag: absent RAIR + neonatal constipation — urgent paediatric surgery referral
Same-day escalation to a paediatric colorectal surgeon.
Next steps
What the trace unlocks — the treatment options.
A manometric diagnosis is the door to targeted treatment — biofeedback, physio, neuromodulation or surgery.
-
Biofeedback therapy
The first-line treatment for dyssynergic defecation — retrains coordination between rectum and sphincter.
-
Pelvic-floor physiotherapy
Specialist pelvic-floor physio for weak sphincters, dyssynergia and pelvic-floor dysfunction.
-
Sacral nerve stimulation
Neuromodulation for faecal incontinence unresponsive to conservative measures.
-
Sphincter repair
Surgical repair of an obstetric sphincter injury (OASIS) or traumatic defect.
-
Bulking agents
Injectable bulking agents into the anal canal for passive faecal incontinence.
-
Loperamide + fibre supplementation
The medical mainstay for mild incontinence and stool consistency management.
-
Colorectal surgery referral
When the trace, symptoms or exam call for a colorectal opinion.
-
Neurogastro / MDT review
Complex traces, refractory constipation or overlapping pelvic-floor problems reviewed at MDT.
Our vetted London network
A small panel of clinics, we picked them.
Partners across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every clinic in our network.
-
Consultant neurogastroenterologists
-
London Classification 2019 reporting standard
-
High-resolution manometry catheters
-
Onward biofeedback, physio or colorectal pathway
Red flags
When manometry is urgent — and when another test comes first.
Nine presentations that change the pathway. Some accelerate manometry, some route to endoscopy or paediatric surgery first.
-
Absent RAIR (Hirschsprung’s)
Absent recto-anal inhibitory reflex is the manometric signature of Hirschsprung’s disease — urgent paediatric surgery referral.
-
Severe faecal incontinence
Daily major incontinence with social impact — expedited pathway with sphincter assessment and continence nurse.
-
Rectal mass
A palpable rectal mass is a two-week-wait pathway — colonoscopy first, manometry later.
-
Obstetric sphincter injury (OASIS)
Third or fourth-degree obstetric tear — manometry plus endoanal ultrasound before considering repair.
-
Neurogenic incontinence
Spinal cord injury, cauda equina or multiple sclerosis — neurological input alongside the trace.
-
Post-radiotherapy incontinence
Pelvic radiotherapy commonly damages the anorectum — manometry documents the deficit and guides options.
-
Chronic constipation with alarm features
Weight loss, bleeding, anaemia or family history of colorectal cancer — endoscopy first.
-
Post-surgical stenosis
Anorectal surgery can leave a stricture — assessed with manometry and examination under anaesthesia.
-
Anal fistula with incontinence
Combined pathology — colorectal surgery input alongside the manometric assessment.
Reading your report
A manometry report can look intimidating. It isn’t.
Reported to the London Classification 2019, every report keeps to the same four parts.
Sources
- British Society of Gastroenterology (BSG). Anorectal physiology and pelvic floor guidance.
- International Anorectal Physiology Working Group. London Classification of anorectal disorders (2019).
- NICE CKS. Faecal incontinence in adults.
- American College of Gastroenterology. Clinical guideline on the evaluation of chronic constipation.
- 01 Header
Indication and history
Your details, the reason for the test, and the bowel and obstetric history that frames the trace.
- 02 Technique
Catheter, protocol and London Classification
Which high-resolution catheter was used, which manoeuvres were performed, and confirmation that reporting is to the London Classification 2019.
- 03 Findings
Pressures, RAIR, sensation and dyssynergia
Resting and squeeze pressures, RAIR presence, sensation thresholds, balloon expulsion and any dyssynergic pattern.
- 04 Impression
The conclusion: read this first
The clinical impression — normal, dyssynergic defecation, sphincter deficit, Hirschsprung’s — and the concrete next step.
Recognised by major UK insurers
Cover depends on your policy and clinic; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about anorectal manometry.
Quick answers on what the test measures, preparation, comfort, the London Classification, dyssynergic defecation and when urgent referral applies instead.
-
What does anorectal manometry actually measure?
High-resolution pressure sensors along a thin catheter measure anal sphincter pressures at rest and on squeeze, the recto-anal inhibitory reflex on rectal distension, rectal sensation thresholds, rectal compliance and the coordination pattern on attempted defecation. It is the gold-standard functional test of the anorectum.
-
Is anorectal manometry painful?
It is uncomfortable but not painful. The catheter is thin and passed gently in the left lateral position, without sedation. Most people find the balloon distension the most notable part; the whole test takes 20–30 minutes.
-
How do I prepare?
A small phosphate enema an hour or two before the appointment clears the rectum so the trace is clean. No fasting, and you can drive yourself to and from the appointment.
-
What is the London Classification 2019?
The International Anorectal Physiology Working Group’s consensus reporting standard for high-resolution anorectal manometry — it defines normal ranges, dyssynergia subtypes and the pattern for absent RAIR, so reports are comparable between units.
-
What is dyssynergic defecation?
A pattern in which the anal sphincter paradoxically contracts (or fails to relax) when you push to defecate. It is a common cause of chronic constipation and responds to biofeedback therapy rather than more laxatives — which is why the manometric diagnosis matters.
-
When would I need urgent referral instead?
Absent RAIR with neonatal constipation is Hirschsprung’s disease until proven otherwise — same-day paediatric surgery referral. A palpable rectal mass, bleeding with weight loss or anaemia goes down the two-week-wait colonoscopy pathway first.
Related tests
Looking for a different test?
-
Anorectal physiology
The broader anorectal physiology work-up — manometry, endoanal ultrasound and balloon studies.
Learn more -
Colonoscopy
Direct visualisation of the colon and rectum — the first test when alarm features are present.
Learn more -
Pelvic floor MRI
Cross-sectional imaging of the pelvic floor for prolapse, dyssynergia and structural defects.
Learn more -
All tests
Browse every test and procedure we arrange.
Learn more -
Acid Reflux
Related condition guide.
Learn more -
Crohns Disease
Related condition guide.
Learn more -
Colectomy
Related treatment option.
Learn more -
Cholecystectomy
Related treatment option.
Learn more
In practice, in London
How anorectal manometry tends to unfold when you go private
With anorectal manometry, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. On the NHS, anorectal manometry typically sits behind a triage step and a wait that can stretch from a few weeks into months. In London’s private sector, the same appointment often lands within days. That speed matters when symptoms are disrupting work, sleep, or a plan you’d already committed to — and it’s the single most common reason people call us in the first place.
In practice, a private anorectal manometry appointment in London means a named consultant, a proper hour in the room (or the equivalent on a video call), and a report you can actually read. Most of the imaging suites and endoscopy units we use sit within a mile of Harley Street or in Chelsea and Fulham, and turnaround on findings is measured in days, not weeks. For anorectal manometry specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
The value of going through a concierge for anorectal manometry isn’t access — anyone with an insurer or a credit card can get a private appointment in London. The value is knowing which consultant reads this particular presentation best, which unit turns reports around fastest, and which pathway won’t hit a dead end if the findings point somewhere unexpected.
Nearby in the library