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Anorectal physiology tests, the full panel - manometry, endoanal ultrasound, defecography and pudendal nerve testing.

A full workup of how the anus and rectum are working. It combines manometry, endoanal ultrasound, defecography (MR or evacuating proctogram), and pudendal nerve testing. It is the gold-standard assessment for bowel incontinence, obstructed defecation, and pelvic floor problems.

A colorectal physiology suite in a private London specialist centre

Key facts

What anorectal physiology tests are, in six lines.

A quick orientation before the detail - the shape of the panel, who reports it, and how it fits alongside colonoscopy and pelvic MRI.

  • Definition: complete workup of anorectal and pelvic-floor function.

  • Combines manometry, endoanal ultrasound, defecography and PNTML.

  • Requires specialist neurogastroenterology or colorectal centre.

  • London Classification and STARR criteria used.

  • Complements colonoscopy and pelvic MRI.

  • Multi-disciplinary approach to results.

Indicative pricing

What a private anorectal physiology panel costs in London.

Indicative ranges across our partner centres.

In short

£1,800–£3,200, with a colorectal MDT report within 10–14 days.

Study Indicative range
High-resolution anorectal manometry alone £450–£750
Endoanal ultrasound alone £400–£700
MR defecography (proctography) £800–£1,400
Fluoroscopic evacuating proctography £700–£1,200
Pudendal nerve terminal motor latency (PNTML) £350–£600
Full anorectal physiology panel (all four studies) £1,800–£3,200

Prices vary by centre, whether MR or fluoroscopic defecography is chosen, and whether PNTML is added.

The problem

Pelvic-floor symptoms are rarely one problem - the panel finds all of them.

Faecal incontinence and obstructed defecation are usually multi-factorial - a sphincter defect and dyssynergia; a rectocoele and neuropathy. The full panel is what teases the components apart.

  • Faecal incontinence?

    The panel maps sphincter integrity, pressures and nerve function - the three-way root-cause map.

  • Obstructed defecation?

    Defecography, manometry and balloon expulsion together identify rectocoele, intussusception and dyssynergia.

  • Post-obstetric or post-surgical?

    Endoanal ultrasound quantifies sphincter defect, and the panel guides the repair conversation.

What it shows

When the anorectal physiology panel is the right workup.

The panel answers a specific set of questions - is the sphincter intact, are the pressures adequate, does the rectum empty, are the nerves conducting. These are the findings it maps.

  • Sphincter integrity (endoanal US)

    Direct imaging of the internal and external anal sphincters - the anatomical answer to sphincter defect questions.

  • Sphincter pressures (manometry)

    High-resolution resting and squeeze pressures, quantifying functional sphincter strength.

  • Rectocoele on defecography

    Anterior rectal wall bulging into the vagina during evacuation - graded by size on proctography.

  • Intussusception on defecography

    Internal rectal prolapse during evacuation - a key finding in obstructed defecation syndrome.

  • Enterocoele on defecography

    Small-bowel descent into the rectovaginal space - a common driver of pelvic-floor symptoms.

  • Dyssynergic defecation

    Paradoxical puborectalis contraction on straining - the London Classification anorectal disorder.

  • Pudendal neuropathy

    Prolonged pudendal nerve terminal motor latency indicating denervation of the pelvic floor.

  • Red flag: obstetric sphincter injury (OASIS) with incontinence - urgent colorectal repair pathway

    A confirmed sphincter defect with faecal incontinence warrants urgent colorectal referral for repair planning.

The studies

The four studies inside the panel - and the extras.

What each study on your referral is actually for.

  • High-resolution anorectal manometry

    A slim catheter measures resting and squeeze pressures along the anal canal - the London Classification standard.

  • Endoanal ultrasound

    A dedicated endoanal probe images the internal and external sphincters in 360° for defect mapping.

  • MR defecography

    Dynamic pelvic MRI during evacuation - radiation-free, and images all three compartments of the pelvic floor.

  • Evacuating proctography

    Fluoroscopic study with rectal contrast - the classical dynamic assessment of rectal emptying.

  • Pudendal nerve latency (PNTML)

    St Mark’s electrode measures the conduction time along the pudendal nerve - selective, not routine.

  • Balloon expulsion test

    A simple bedside test of a patient’s ability to evacuate a rectal balloon - screens for dyssynergia.

  • Rectal sensitivity testing

    Volumetric thresholds for first sensation, urge and maximum tolerated volume - part of the manometry protocol.

  • Full anorectal physiology panel

    All four studies coordinated together - the gold-standard workup for complex pelvic-floor symptoms.

Red flags

When anorectal physiology is urgent.

Any of these findings triggers an expedited pathway - the panel is arranged as a priority alongside colorectal MDT review.

  • Obstetric sphincter injury (OASIS)

  • Chronic faecal incontinence

  • Rectal mass

  • Rectal prolapse

  • Enterocoele with obstructed defecation

  • Pudendal neuropathy

  • Post-radiotherapy dysfunction

  • Neurogenic bowel

  • Chronic pelvic pain syndrome

Safety and eligibility

A well-tolerated panel, with a few practical caveats.

Anorectal physiology is safe and well-tolerated - the practical points are prep, timing after surgery, and where the panel’s limits are.

  • Uncomfortable, rarely painful

    The catheter, probe and enema are all uncomfortable moments - the panel is well tolerated by almost everyone.

  • Bowel prep with enema

    A small evacuant enema an hour or two before the appointment - issued with written instructions.

  • Radiation only in fluoroscopic proctography

    MR defecography is radiation-free; fluoroscopic evacuating proctography uses a small dose of ionising radiation.

  • Not routinely done in pregnancy

    The panel is normally deferred until after delivery unless clinically urgent - MR proctography is preferred if imaging is essential.

  • Recent anal surgery

    Endoanal ultrasound and manometry are usually delayed six weeks after sphincter repair or fistula surgery.

  • Active perianal sepsis

    Endoanal probes are avoided during active abscess or florid fistula disease - treated first, imaged later.

  • Anticoagulation

    The panel itself is not a bleeding-risk procedure - bring a full medication list so the team can plan.

  • Continence-nurse continuity

    A named continence nurse guides you through prep, the studies and follow-up - one voice, not a queue.

  • Bring prior imaging and obstetric records

    Previous ultrasound, MRI and delivery notes materially sharpen interpretation of the panel.

Reading your report

An anorectal physiology report can look intimidating. It isn’t.

Whatever the finding, the report keeps to the same four parts.

A consultant colorectal surgeon and gastroenterologist reviewing anorectal physiology tracings on a clinical workstation

A quiet reminder

The report is written for your doctor, not for you - and that’s normal.

If you would like us to talk you through it before your follow-up, just ask.

  1. 01 Header

    Indication and obstetric / surgical history

    Your details, the reason for the panel, and the obstetric or surgical history that shapes interpretation.

  2. 02 Technique

    Studies performed and protocol

    Which of the four studies were performed, the manometry protocol used and the imaging technique for defecography.

  3. 03 Findings

    Manometry, ultrasound, defecography, PNTML

    Study-by-study description: London Classification manometry, sphincter defect mapping, defecography measurements and PNTML values.

  4. 04 Impression

    The conclusion: read this first

    The pattern - sphincter defect, dyssynergia, rectocoele, intussusception, neuropathy - and the concrete next step.

Next steps

What the panel unlocks - the treatment options.

The panel’s value is the pathway it unlocks. These are the treatment options a completed workup makes possible.

  • Pelvic-floor physiotherapy

    Specialist physiotherapy - often the first-line treatment for many pelvic-floor patterns.

  • Biofeedback therapy

    Instrumented retraining of sphincter function and coordination - evidence-based for dyssynergia and incontinence.

  • Sacral nerve stimulation

    Implanted neuromodulator for refractory faecal incontinence - a trial phase precedes any permanent implant.

  • Sphincter repair

    Surgical overlap repair for identified sphincter defects - the pathway after confirmed OASIS.

  • STARR (stapled transanal resection of the rectum)

    Stapled procedure for obstructed defecation with intussusception and rectocoele meeting STARR criteria.

  • Rectopexy for intussusception

    Laparoscopic or robotic ventral rectopexy for symptomatic internal or external rectal prolapse.

  • Colorectal MDT review

    The full panel is reviewed at colorectal MDT before any surgical decision.

  • Follow-up with continence nurse

    A named continence nurse coordinates conservative treatment, biofeedback and onward review.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Frequently asked

Everything we get asked about anorectal physiology tests.

Quick answers on cost, referrals, what the panel diagnoses, and how it differs from manometry alone.

  • What do anorectal physiology tests show?

    The complete anorectal physiology panel maps both structure and function of the anal sphincters, rectum and pelvic floor. Manometry measures pressures, endoanal ultrasound images sphincter integrity, defecography shows what happens during evacuation, and pudendal nerve testing measures nerve conduction.

  • How is this different from anorectal manometry alone?

    Manometry alone measures pressures. The full physiology panel adds endoanal ultrasound (anatomy), defecography (dynamic evacuation) and pudendal nerve latency (neurology). For complex faecal incontinence, obstructed defecation or planning surgery, the full panel is the gold standard.

  • How much does the full anorectal physiology panel cost privately?

    The full panel - manometry, endoanal ultrasound, defecography and PNTML - is typically £1,800–£3,200.

  • Do I need a referral?

    Most specialist centres require a colorectal or gastroenterology referral.

  • Is the panel painful?

    It is uncomfortable at moments - the catheter, the endoanal probe, the enema - but not painful for almost everyone. The studies are well tolerated and no sedation is needed.

  • What conditions does the panel diagnose?

    Faecal incontinence, obstructed defecation syndrome, rectocoele, intussusception, enterocoele, dyssynergic defecation, pudendal neuropathy, obstetric sphincter injury (OASIS) and post-radiotherapy anorectal dysfunction.

Sources

What this guide is built on.

Published 2026-07-30. Next review 2027-07-30. Approximate reading time 8 minutes.

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In practice, in London

The honest picture around anorectal physiology tests in London

With anorectal physiology tests, the London question is usually about report turnaround and the radiologist reading it - not whether the scan is available. On the NHS, anorectal physiology tests 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.

The mechanics are straightforward: a consultant appointment, any tests done at a nearby CQC-registered site, and a written report back within a few days. London’s density of private diagnostics - Marylebone, the City, Chelsea, Canary Wharf - means most patients can find something that fits around work without a cross-town trek. For anorectal physiology tests specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.

We’re careful about what a private pathway for anorectal physiology tests can and can’t promise. It can compress a wait, put you in front of a subspecialist quickly, and get a proper report in your hands within a week. It can’t rewrite what the imaging or the bloods say. Setting that expectation up front tends to make the whole experience less stressful.