Concierge colorectal physiology · London
Colorectal physiology tests, transit study, anorectal manometry, EMG and defecography — the full workup.
A full workup for chronic constipation, bowel incontinence, and pelvic floor problems. It combines a colonic transit study, anorectal manometry, endoanal ultrasound, defecography, and pudendal nerve EMG. The findings feed a joint plan across the specialists involved.
Why patients choose us
- 01
A full workup in one pathway
Transit study, anorectal manometry, endoanal ultrasound, defecography and EMG — coordinated by one consultant team rather than piecemeal.
- 02
Reported by the people who scan
The consultant colorectal / neurogastro physiologist who performs the studies also interprets them and joins the MDT.
- 03
MDT-led plan, not just a report
Findings go straight to a colorectal MDT — surgery, physiotherapy, continence nursing and radiology at the same table.
Key facts
What the panel actually measures.
Six things worth knowing before you start — what each component of the workup is and what it answers.
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Definition
One coordinated panel that covers the colon, the anorectum, and the pelvic floor together.
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Colonic transit study
Radio-opaque markers over five days measure slow-transit constipation objectively.
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Anorectal manometry
Evaluates resting and squeeze sphincter pressures and the recto-anal inhibitory reflex (RAIR).
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Endoanal ultrasound
Assesses internal and external anal sphincter integrity — the reference test after obstetric injury.
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Defecography
MR or fluoroscopic imaging visualises rectocoele, intussusception and dyssynergia in real time.
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Pudendal nerve EMG
Detects pudendal neuropathy underlying incontinence or pelvic-floor weakness.
Indicative pricing
What a private colorectal physiology workup costs in London.
Indicative ranges across our partner clinics. Bundled panels are usually cheaper than the sum of the parts.
In short
A bundled colorectal physiology panel in our network: £1,800–£3,200, with an MDT plan typically within a week.
| Test | Indicative range | Typical duration | Report turnaround |
|---|---|---|---|
| Colonic transit marker study | £350–£600 | 5 days | Same-week |
| Anorectal manometry + balloon expulsion | £450–£750 | 45 min | 48 hours |
| Endoanal ultrasound | £350–£600 | 20 min | Same-day |
| MR defecography | £850–£1,400 | 45 min | 48 hours |
| Fluoroscopic defecography | £550–£900 | 30 min | Same-day |
| Pudendal nerve EMG + latency | £450–£800 | 45 min | 48 hours |
| Full colorectal physiology panel (bundled) | £1,800–£3,200 | Half-day | 1 week |
Prices vary by clinic and by which parts of the panel are indicated for you. We come back with a firm quote within one working day.
The problem
A piecemeal workup gives a piecemeal answer.
Bowel and pelvic-floor problems rarely have one cause. When each test is done in a different place, no one is looking at the whole picture. Our panel is coordinated and MDT-reviewed by design.
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Chronic constipation not responding to laxatives?
We separate slow-transit from dyssynergic constipation — the treatment is different.
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Faecal incontinence after childbirth?
Endoanal ultrasound and manometry tell you whether the sphincter is intact or not.
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Obstructed defecation or the sense of incomplete emptying?
Defecography reveals rectocoele or intussusception a symptom-only history cannot.
The journey
From consultation to MDT plan — what happens, in order.
One coordinated pathway, one MDT-agreed plan at the end — usually within a week of the last study.
Phase 1 · Before
Consultation and transit study
Phase 2 · On the day
Half-day physiology and imaging
Phase 3 · After
MDT synthesis
- 01
Before
Colorectal / neurogastro consultation
A focused history — bowel diary, obstetric history, prior surgery, medications and red flags — decides which parts of the panel you actually need.
- 02
Before
Colonic transit marker study (5 days)
You swallow radio-opaque marker capsules; a plain abdominal film on day 5 quantifies colonic transit.
- 03
On the day
Anorectal manometry with balloon expulsion
High-resolution catheter measures sphincter pressures, RAIR and rectal sensation; a balloon expulsion test screens for dyssynergia.
- 04
On the day
Endoanal ultrasound
A short intra-anal ultrasound maps the internal and external sphincters — the definitive test for occult obstetric injury.
- 05
On the day
MR or fluoroscopic defecography
Dynamic imaging of the pelvic floor during evacuation reveals rectocoele, intussusception, enterocoele and dyssynergia.
- 06
On the day
Pudendal nerve latency (selective)
Where incontinence or neurogenic bowel is suspected, pudendal nerve terminal motor latency and EMG add the neurophysiology layer.
- 07
After
MDT review of findings
All results are synthesised at a colorectal MDT — surgery, physiotherapy, continence nursing and radiology — and a written plan is issued.
Typical end-to-end: 2–3 weeks. Urgent cases: expedited.
What it shows
When the colorectal physiology panel is the right pathway.
The panel answers specific questions — is the colon slow, is the sphincter intact, is the pelvic floor coordinating, is the pudendal nerve working. These are the presentations we see most.
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Slow-transit constipation
Objectively confirmed by marker retention on the day-5 transit film.
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Dyssynergic defecation
Manometry and balloon expulsion identify paradoxical puborectalis contraction.
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Faecal incontinence (sphincter integrity)
Endoanal ultrasound characterises internal and external sphincter defects.
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Rectocoele / intussusception
Defecography demonstrates anatomical prolapse and intussusception during evacuation.
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Enterocoele
Small-bowel descent into the rectovaginal space, best seen on MR defecography.
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Pudendal neuropathy
Prolonged pudendal nerve terminal motor latency and denervation on EMG.
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Rectal sensation abnormality
Blunted or hypersensitive rectal balloon-distension thresholds on manometry.
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Red flag: obstetric sphincter injury (OASIS) with symptoms — urgent colorectal surgery pathway
Symptomatic OASIS is a colorectal-surgery pathway, not a physio-only route. We escalate the same day.
The tests
The eight studies in the workup, and what each one is for.
Not every patient needs every study. This is what each option on your referral actually measures.
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Colonic transit marker study
Five-day radio-opaque marker study with a plain film on day 5 — the objective measure of slow-transit constipation.
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Anorectal manometry (high-resolution)
Catheter-based measurement of resting and squeeze pressures, RAIR and rectal sensation thresholds.
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Balloon expulsion test
Simple bedside test for dyssynergic defecation — usually paired with manometry.
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Endoanal ultrasound
Intra-anal ultrasound of the internal and external anal sphincters — the reference test for obstetric injury.
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MR defecography
Dynamic pelvic-floor MR without ionising radiation — best for enterocoele and multi-compartment prolapse.
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Fluoroscopic defecography
Real-time barium evacuation study — highest temporal resolution for rectocoele and intussusception.
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Pudendal nerve EMG + latency
Neurophysiology of the pudendal nerve — added for faecal incontinence and neurogenic bowel.
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Bundled physiology panel
All indicated studies performed in a coordinated half-day, with a single MDT report at the end.
Our vetted London network
A small panel of clinics, we picked them.
Colorectal-surgery-led pelvic-floor units across central London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every unit in our network.
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Consultant colorectal surgeons and neurogastroenterologists — not generalists
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High-resolution anorectal manometry to the London / IAPWG standard
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Endoanal ultrasound performed and reported by a consultant colorectal specialist
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MDT integration with pelvic-floor physiotherapy and continence nursing
Red flags and safety
When physiology is the answer — and when it isn’t.
The panel is safe and mostly non-invasive. The important part is what needs a surgical or neurological pathway alongside — or instead of — physiology.
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Obstetric sphincter injury
A confirmed OASIS with symptoms is a colorectal-surgery pathway — we escalate the same day.
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Rectal prolapse
Full-thickness prolapse is a surgical problem; physiology helps plan the operation, not replace it.
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Full-thickness rectocoele
Large symptomatic rectocoele on defecography frequently warrants a surgical opinion.
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Neurogenic bowel
Suspected spinal or cauda-equina causes need urgent neurology, not just physiology.
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Post-radiotherapy dysfunction
Pelvic radiotherapy history changes both the differential and the tissue tolerance — flag it early.
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Chronic pelvic pain syndrome
Overlaps with pelvic-floor dysfunction; a multidisciplinary route is almost always the right one.
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Post-surgical stenosis
Anal or anastomotic stenosis is assessed and managed by the colorectal team first.
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Failed conservative therapy
Failure of biofeedback, laxatives or fibre after a proper trial is itself an indication for the full panel.
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Suspected malignancy on colonoscopy
Any bleeding, mass or high-grade dysplasia on scope takes priority — physiology is deferred.
After the workup
The treatment options the panel actually unlocks.
Physiology is only useful if it changes what happens next. Here are the options the MDT chooses between, informed by your specific findings.
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Biofeedback and pelvic-floor physiotherapy
First-line for dyssynergic defecation and many mild-to-moderate incontinence patterns.
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Sacral nerve stimulation
Neuromodulation for faecal incontinence and selected slow-transit constipation.
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Sphincter repair
Overlapping sphincteroplasty for symptomatic external sphincter defects.
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STARR for obstructed defecation
Stapled transanal rectal resection where defecography shows a symptomatic rectocoele and intussusception.
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Rectopexy for rectal intussusception
Ventral mesh or suture rectopexy for high-grade internal or external rectal prolapse.
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Loperamide and fibre for functional cases
Pharmacological and dietary optimisation where physiology is essentially normal.
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Colorectal MDT review
All complex or surgical cases go to a colorectal MDT before a treatment plan is agreed.
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Continence nurse follow-up
Structured nurse-led follow-up embeds the plan and picks up early failure.
Reading your report
A colorectal physiology report can look intimidating. It isn’t.
Whatever the findings, the synthesised MDT report keeps to the same four parts.
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.
- 01 Header
Indication and history
Presenting complaint, bowel diary, obstetric and surgical history, and the specific question each study is being asked to answer.
- 02 Technique
Which studies were performed
The exact protocol for each test — marker count, manometry catheter, ultrasound probe, defecography modality and EMG parameters.
- 03 Findings
Vessel-by-vessel — study by study
Transit numbers, resting/squeeze pressures, RAIR, sphincter integrity, prolapse grades and neurophysiology values.
- 04 Impression
The conclusion and MDT plan
Diagnosis, whether the picture is surgical, neuromodulatory or conservative, and the concrete next step agreed at MDT.
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 the colorectal physiology workup.
Quick answers on what the panel is, which tests you actually need, and how the MDT plan lands.
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What is a colorectal physiology workup?
A coordinated set of tests — colonic transit study, anorectal manometry, endoanal ultrasound, defecography and (selectively) pudendal EMG — that together explain why the bowel and pelvic floor aren’t working properly.
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Do I need every test in the panel?
No. The consultation decides which parts you need. Slow-transit constipation may only need the transit study and manometry; suspected obstetric sphincter injury needs endoanal ultrasound; obstructed defecation needs defecography.
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How is this different from anorectal manometry alone?
Anorectal manometry is one component. The colorectal physiology panel adds the colonic transit study, the pelvic-floor imaging (defecography) and, where indicated, pudendal neurophysiology — so the answer covers the whole pathway, not just the sphincter.
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Is defecography embarrassing?
It is a private, brief, professionally delivered study. The team does dozens a week and the room, gowning and staff are set up for dignity throughout. Most patients find the anticipation worse than the study itself.
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How quickly will I get results?
Individual study reports usually within 48 hours. The synthesised MDT plan — which is what actually matters — typically within a week of the last study.
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When should I see a GP or A&E urgently instead?
Rectal bleeding, unintentional weight loss, a change in bowel habit over 50, or sudden neurological symptoms (saddle anaesthesia, leg weakness) are urgent — GP the same day, or A&E for red-flag neurology.
Related tests
Looking for a specific test in the pathway?
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Anorectal manometry
The sphincter-pressure and RAIR component of the workup, in isolation.
Learn more -
Anorectal physiology
The narrower anorectal-only workup — manometry, endoanal ultrasound and balloon expulsion.
Learn more -
Colonoscopy
The mucosal look — always considered alongside physiology when bleeding or a change in bowel habit is in the picture.
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All tests
Browse every test and procedure we arrange.
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Sources and clinical review
Reviewed by Pulse Atlas Editorial Board (). Next review 2027-07-30. Reading time approximately 7 minutes.
In practice, in London
What colorectal physiology tests looks like on the ground in London
With colorectal physiology tests, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. The wait for colorectal physiology tests on the NHS depends heavily on where you live and how urgently the referral is graded. Central and West London private clinics can normally book within a week, with imaging or a procedure slot to follow shortly after. It’s worth being honest about the reason for going private: usually it’s time, not a fundamentally different test.
Once you’re in the private system for colorectal physiology tests, the pace picks up noticeably. Consultant slots run to time, imaging is usually available in the same building or a short walk away, and the report comes back typed and detailed. It’s the coordination that tends to feel different — one person on the other end of the phone, not a switchboard. For colorectal physiology tests specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Fit matters more than people expect. For colorectal physiology tests, the right consultant depends on what you actually need — a second opinion, a definitive diagnosis, a bridge into treatment, or reassurance that nothing’s being missed. We match on that, not on who has the biggest brochure. If a test isn’t the right next step, we’ll say so before you book anything.