Esophageal and Anorectal Motility
For many adults — and even for some children — daily quality of life is impacted by their ability to do one of two things: to get something into their digestive systems, or to get something out. Both processes — getting food into your stomach, and using the bathroom — involve ring-like muscles called sphincters that have to contract in the right ways at the right time to keep things moving.
When you swallow food, sphincters in your esophagus have to move that food down into your stomach. That means they have to contract and release in the right order, with just the right amount of pressure. Too little, and food doesn’t move down to the stomach as it should, or doesn’t stay there. Too much, and you can experience discomfort whenever you have a meal.
Likewise, when you have a bowel movement, sphincters at the other end of the digestive system have to move that waste out. If they don’t, you can experience anything from constipation to what’s known as fecal incontinence.
How can you know if you have such a problem? If the sphincters in your esophagus aren’t doing their job well, you could be experiencing anything from acid reflux to chest pain or trouble swallowing. If it’s anorectal, as we mentioned, you may find yourself constipated or having trouble controlling your bowel movements.
At Gastroenterology of Southern Indiana, our job is to work with your doctor to diagnose and treat problems with your digestive system — including your body’s ability to take food in for digestion and to move waste out.
Of course, there are technical medical terms we could use — esophageal and anorectal motility, to be exact. Our primary job is to test yours, so that we can help your doctor diagnose any problems and find a treatment plan to resolve those problems.
We do that using something called “manometry,” which lets us test the pressure exerted by those sphincters and see exactly where the problem lies. We can then work with your doctor to evaluate treatment options, from changing medications or biofeedback to surgery.
Your esophagus moves food to your stomach by peristalsis — a wavelike contracting and relaxing of the sphincters inside it. Its ability to do this is called “motility.” When it’s not working well, it’s called an esophageal motility disorder, and can be gastroesophageal reflux disease (GERD), dysphagia, achalasia and functional chest pain.
Heartburn is a symptom of GERD, which happens when stomach contents wash back up into the esophagus repeatedly — that’s called gastroesophageal reflux — and irritate the lining. GERD can be caused by a weak lower sphincter muscle, too-frequent random relaxation of the sphincter, or a hiatal hernia, where the stomach pushes up into the chest above the diaphragm and weakens the sphincter.
Dysphagia is ineffective swallowing, and while it has a variety of causes, the result is the same: it can cause food to back up in the esophagus, causing anything from a sensation of something being stuck, to pain or even vomiting.
Achalasia is a complete lack of peristalsis in the esophagus, coupled with the lower esophageal sphincter not relaxing to allow food to enter the stomach. Most people with achalasia have symptoms for years, including difficulty swallowing, vomiting, weight loss or atypical chest discomfort.
Pain in your chest that isn’t heartburn or cardiac pain may come from spastic contractions of the esophagus, or increased sensitivity of the nerves in the esophagus, or a combination of muscle spasm and increased sensitivity.
With techniques like esophageal manometry, we can safely and comfortably test the pressure in your esophagus to identify the problem and help treat it. Esophageal manometry is a very precise way to measure the muscle contractions that occur in your esophagus when you swallow, along with the coordination and force exerted by the muscles of your esophagus.
Here’s how it works. A very thin, flexible tube containing sensors is passed through your nose, down your esophagus and into your stomach. Don’t worry — it’s not nearly as uncomfortable as it sounds, and a topical anesthetic is applied to your nose first.
You’re asked to swallow a small amount of water, and we measure all the details of that process, then remove the manometer. It’s an outpatient procedure, and the whole process usually takes just 15 minutes or less.
At the other end of the spectrum — so to speak — there’s anorectal manometry, a test for patients with constipation or stool leakage. It’s also an outpatient procedure that involves little or no discomfort.
Just as the sphincters in your esophagus move food down to the stomach, anal and rectal sphincters move waste out. Anorectal manometry helps us determine the strength of those muscles.
The entire procedure takes an hour or less. A very small, flexible sensor is carefully placed in the rectum. You may be asked to squeeze as if you are trying to prevent anything from coming out, or to push or bear down as if you are trying to pass a bowel movement.
During the test, a small balloon attached to the catheter may be inflated briefly to assess the normal reflexes how you perceive stool sensation in your rectum. Based on the findings, InterStim neurostimulation (biofeedback therapy) may be recommended.