Anorectal Manometry

What Is Anorectal Manometry?

Anorectal Manometry is a set of pain-free tests that allow us to evaluate your pelvic floor function. The test is administered by positioning a thin, flexible catheter into the anus that feeds through to the rectum. The variables most commonly measured are the anal sphincter resting pressure, the anal squeeze pressure as a mark of muscle strength, the Rectoanal Inhibitory Reflex, rectal sensation tone and compliance, simulated defecation, sensation, discrimination, fatigue, and paradoxical contraction.

Why Is It Needed?

Anorectal Manometry is necessary for some patients to evaluate pelvic floor function and uncover potential issues that may be causing unwanted symptoms. Symptoms that may require Anal Manometry testing include anal fissures, anal tightness, anal looseness, constipation, fecal incontinence, difficulty defecating, non-complete emptying, pain in the pelvis, pre- or post-surgical interventions, pain with or the inability to participate in receptive anal sex, and having a weak unsatisfactory orgasm.

Gay men and others who engage in receptive anal sex need to be especially conscious of the health and wellbeing of their pelvic floor to avoid issues that may arise from the combination of anal play and aging. Regular, yearly Pelvic Health Screenings are recommended as a preventative measure to ensure your pelvic health is strong and vital. Using normative data, timely manometry tests can detect changes, so preventative treatment can be instigated before symptoms are inevitable.

Questions To Consider

Many people have not given their pelvic floor muscles any thought. Some symptomatic people simply don’t know that something can be done about their issues, while others are embarrassed to discuss their issues. If you have never thought about your pelvic floor, please take a moment to ask yourself these simple questions:

  • Do you know the strength of your anal sphincter muscles?
  • Would you consider your anus too loose?
  • Would you consider your anus too tight?
  • Are you comfortable with the level of tightness or looseness?
  • Are you avoiding intimacy because of the pain due to tightness or fissures, anal laxity, or post-coital incontinence?
  • Has the feeling of control changed in your pelvis in any way?
  • Are you able to hold gas or liquid stool like you used to?
  • Have you experienced fecal smearing?


As we age, everyone will experience a weakening of the pelvic floor muscles. This can present itself in many forms: uncontrolled flatus, urinary incontinence, fecal incontinence, waning erections, weak orgasms, and more.

If symptoms such as anal pain, straining while using the toilet, anal looseness, fecal smearing or incontinence have begun, anal manometry testing will provide information that is essential for individualized treatment planning and recovery.

There are many treatment options available, depending on your diagnosis. One new treatment option for men who are experiencing anal looseness, unsatisfactory sex, fecal incontinence, and/or partner dissatisfaction is the BTL Emsella Chair. The developers of the BTL Emsella Chair have created a new method of exercising the muscles of the pelvic floor with electromagnetic energy. With this treatment option, there is no need to undress or have an anal probe inserted. 

The manufacturers have provided a protocol which tones the pelvic floor while the user simply sits fully clothed on the comfortable chair. Upon sitting, subtle, yet noticeable, electromagnetic energy is introduced into the pelvic floor, providing contractions and relaxations at a rate that simply cannot be achieved through exercise alone. Two (2) treatments a week for a total of three (3) weeks is recommended with a maintenance schedule of every six (6) months performed over 1-2 appointments.

Anorectal Manometry Preparation

There is no need for any elaborate preparation prior to the manometry test. If you have had a normal bowel movement before taking the test, you will be fine. There is no need for an enema, nor is there a need to alter your diet. Additionally, you do not need to stop taking prescribed medications because of the test. If you have any concerns, please contact someone at our office.

Anorectal Manometry Procedure

Balloon Expulsion Test

On the day of your test, you will be asked for your consent to have the test performed on you and the test will be explained again to you at that time in detail. If you decide to continue with the test, you will be asked to undress from the waist down and lie in the fetal position on your left side. A thin, well-lubricated catheter will be passed painlessly through your anus into your rectum. You will be asked to perform some easy tasks during the manometry test. The first task is to remain in quiet rest so your anal resting pressure can be recorded. 

You will then be asked to squeeze and lift the anus as if you are attempting to stop passing gas. You will be asked to do this up to three times. This tests the strength and endurance of the external anal sphincter. After that, you will be asked to try and expel the catheter twice. The action is the same as if you were trying to pass gas or stool. During the first expulsion test, the catheter will remain as it was originally inserted. During the second expulsion test, part of the catheter will be inflated mimicking the feeling of having a fuller bowel.

Rectal sensation, desire, and urgency are then evaluated by gently and painlessly inflating the rectal balloon in stages. These tests measure the rectal reservoir function and test the perception of increasing waste volume in the rectum. The test also provides valuable information about the Anorectal Inhibitory Reflex which is vital for proper bowel functioning. The final test is a Cough Reflex test, which records anal reflexive closing when exposed to sudden increases in abdominal pressure. The anal reflex protects against incontinence. 

After completing the testing, the catheter will be painlessly withdrawn and you will get dressed. The test results will be discussed with you. There is no downtime and you will not need to deviate from your normal daily plans other than blocking off time for the appointment itself.

Anal Sphincter Electromyography

Pelvic floor Electromyography is both a diagnostic and a treatment device. Electromyography (EMG) monitors the electrical activity of muscles. It allows the study of resting muscle tension, the work of muscle contraction and coordination, motor recruitment, and the identification of symmetry and asymmetry of motor patterns.

To perform the test, a small anal probe is lubricated and inserted comfortably into the anus of a patient who is lying on their side, facing a computer screen. The patient is cued to perform several simple muscle actions that include resting, squeezing and lifting, pushing, coughing, and so on. These maneuvers are displayed and recorded as line graphs on the computer to be used for future comparison.

EMG as biofeedback treatment is a proven effective tool that provides accurate, fast, and meaningful tests for patients who need to regain control of the muscles of the pelvic floor. Biofeedback training can be used to upregulate muscles for people who have issues with laxity or fecal or urinary incontinence. Biofeedback can be used to downregulate muscle activity in people who experience anal spasm, pelvic floor hypertonicity that is causing pain and/or inhibiting sexual fulfillment, or muscle tightness contributing to injuries such as anal fissures. The line graphs produced on the computer’s EMG program provide immediate knowledge of the performance of a given task allowing instant activity modification and future goal setting

Anorectal Manometry Results

The results of the Anorectal Manometry test will be considered and compared with the information from the other tests and observations made on the day of your evaluation so a complete holistic personal picture of the individual can be made and a personalized program toward recovery established


If you are a gay man or someone who engages in anal receptive sex (bottoming) and you want to check the health of your pelvic floor or if you’ve been experiencing anal laxity or tightness, or any of the aforementioned conditions, make an appointment today to come and see us. We are here to help you maintain the health and wellbeing of your pelvic floor.

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Dr. Evan Goldstein, D.O.

Dr. Evan Goldstein, D.O.

Dr. Evan Goldstein is the founder and President of Bespoke Surgical, a surgical practice for modern males and members of all other identities based in New York. He received his medical doctorate from the University of Medicine and Dentistry School of Osteopathic Medicine in 2002. Receiving the highest osteopathic education was pivotal in shaping his holistic whole-life approach towards his practice of private surgical care.

Learn More about DR. EVAN GOLDSTEIN, D.O.