ASCRS Ch57 - Common Tests for the Pelvic Floor

Fifty-seventh chapter of the ASCRS Textbook of Colon and Rectal Surgery, 4th edition (Thorsen AJ, Roth L). Book pages 979–994 (PDF pages 967–982 of raw/ASCRS Textbook 4th Ed.pdf, offset +12 — unchanged from Ch56, confirmed via the "© Springer Nature Switzerland AG 2022 <page>" copyright-line cross-check on both this chapter's first page (979 = 967 + 12) and the chapter boundary at PDF page 983/book page 995 (Ch58, "Evaluation of Constipation and Treatment of Abdominal Component," begins there — offset also +12, no shift at this chapter boundary). Unlike the Part V opener (Ch56), this chapter-to-chapter transition shows no jump, confirming the earlier +2 jump was specific to the Part-divider page rather than an ongoing drift.

A dedicated, technically deep survey of the pelvic floor testing battery — manometry (equipment, technique, the four-type dyssynergic defecation classification, the 2014-2018 London Protocol/ classification), rectal sensation testing, balloon expulsion testing, neurophysiologic testing (EMG, PNTML, spinal motor latency), and the full imaging armamentarium (endoanal ultrasound, static MRI, defecography, MR defecography, dynamic transperineal/transvaginal/endoanal ultrasound, and echodefecography).

Key concepts (chapter's own summary box)

• Disorders of anorectal function are common and have a significant impact on quality of life.
• Anal manometry allows assessment of anorectal motor and sensory function to delineate contributing factors leading to obstructed defecation, anal pain, and fecal incontinence.
• Ultrasound, fluoroscopic defecography, and MR defecography provide anatomic and dynamic assessment, and the impact of anatomy on function, in evaluating fecal incontinence, obstructed defecation, and pelvic organ prolapse.

Filing

• Anorectal Physiology Testing — substantially rewritten and expanded (previously built only from Sabiston Ch52 - Pelvic Floor Disorders & Constipation and ASCRS Ch03 - Anorectal Physiology's brief technique descriptions). New content: manometry catheter technology (water-perfused, solid-state, air-charged, HRAM/HDAM, including the chapter authors' own practical preference for conventional air-charged systems), full manometry technique, the four-type dyssynergic defecation classification with its important false-positive caveat, the London Protocol/classification, quantified sphincter anatomy on endoanal ultrasound, Oxford intussusception grading, echodefecography (an entirely new modality not previously in the wiki), and neurophysiologic testing detail (surface vs. needle EMG, PNTML's methodologic limitations, spinal motor latency/MEPs).

Relevance

This chapter is a pure diagnostic-technique survey rather than a therapeutic-outcomes chapter — its value to the wiki is depth of technical/mechanistic detail (e.g., precisely why continuous pull-through manometry is no longer preferred, or why up to 90% of asymptomatic people can show a "dyssynergic" pattern on push testing) rather than new clinical decision points. The most practically important single caveat is the dyssynergic-defecation false-positive rate, which materially qualifies how much weight a positive finding on push/simulated-evacuation testing should carry in isolation. The authors' own admission that HRAM/HDAM's added resolution hasn't changed their clinical decision-making, despite using the more advanced technology being available, is a useful practical data point for equipment-purchasing decisions that a from-first-principles read of the manometry literature alone might not surface.

Open items / gaps

• All content is textbook-level/secondary; 133 references total. No individual study is individually load-bearing enough for Research Priorities.md — this is a technique/consensus chapter rather than a comparative-outcomes one.
• The Oxford intussusception grading's fecal-incontinence association (worsening with grade) but lack of association with constipation has not yet been cross-referenced onto Rectal Prolapse (Procidentia) — flagged on Anorectal Physiology Testing as a future cross-reference to add.
• Chapter 58 ("Evaluation of Constipation and Treatment of Abdominal Component," Garrett KA, Ogilvie JW Jr) begins immediately at PDF page 983/book page 995 — next in the sequential ingest, offset confirmed unchanged at +12.