Anorectal Physiology Clinic
What is the Anorectal Physiology Clinic?
This is a specialist clinic provided by doctors and physiotherapists who manage problems related to the pelvic floor - the muscles within the pelvis. We specialise in the assessment of women who have had a third or fourth degree perineal tear as a result of childbirth, also known as an Obstetric Anal Sphincter Injury (OASI).
What is a third or fourth degree perineal tear/Obstetric Anal Sphincter Injury?
An OASI occurs when the tear during childbirth has also involved not just the skin around the vagina and the muscles surrounding it but the anus (back passage). These types of tears are much less common (three out of 100 deliveries) but the muscles that are injured play an important role in controlling your bowel movements.
Women who sustain an OASI are more likely to suffer from faecal urgency (needing to rush to the bathroom to pass stool) and faecal incontinence (not being able to control the passage of stool) than women who do not sustain an OASI.
For more information about these types of injuries, the Royal College of Obstetricians and Gynaecologists (RCOG) produce a leaflet which can be accessed via the following link:
Why have I been asked to attend the Anorectal Physiology Clinic?
You have been invited to this clinic as you have either recently had a baby and sustained an OASI or you are currently pregnant and have sustained an OASI in a previous pregnancy. You could also have been referred to our clinic if another medical doctor or physiotherapist has asked us for an assessment due to ongoing problems you may have with controlling your bowels.
How should I prepare for my appointment?
There are no special preparations required. However, it would be helpful if you could empty your bowels and bladder before arrival. It is best to make arrangements for your baby or small children to be looked after on the day of your appointment as we are unable to care for them in our department.
On the day, please arrive at least 10 minutes before your scheduled appointment. If you are running late, please call and let us know at the earliest opportunity. We will do our best to accommodate you if you are late, but we may have to reschedule your appointment.
What happens during my scanning appointment?
If you agree to be examined, you will be asked to undress from the waist down (including your underwear) and lie on your back on the examination couch. A single use covering will be provided to you. The examinations include:
1. Examination of the perineum and vagina
This involves a visual examination of the pelvic floor. The medical professional will inspect your external genitalia (perineum) to ensure that the tear has fully healed from the outside. They may also examine you internally to check the vagina has healed. If you have any concerns about your healing, please let the doctor know.
2. Anal manometry testing
This test measures the strength of the muscles around the back passage. It involves inserting a tube into the back passage. This is usually done while you are lying on your left-hand side, so the team will ask you to turn over for this test.
The tube is sterile and inserted approximately 3-4cm into your back passage using lubrication. The medical professional will ask you to relax first and then to squeeze your back passage muscles against the tube and will take measurements (usually three measurements). This test lasts for up to a minute.
3. Endo-anal ultrasound scan
This test uses inaudible sound waves (ultrasound) to assess the structure of the back passage muscles (called the internal and external anal sphincters). It involves the gentle insertion of an ultrasound probe (about the thickness of your index finger) 3-4cm into the back passage.
The probe is lubricated and covered with a single-use probe cover. This test lasts for up to 60 seconds. We will record images of these muscles as they will be used as part of your medical records.
Once the investigations are complete and you are dressed, the medical professional will discuss the findings with you and make their recommendations for management. You will also be given the opportunity to ask any further questions you may have.
What are the benefits of attending this scan?
Attending this scanning provides you with an opportunity to speak with a specialist and address any concerns you may have regarding your perineal tear, pelvic floor and any symptoms you may have developed as a result of childbirth. Performing anal manometry and endo-anal ultrasound scans are the best ways of assessing the quality of the repair and how your bowel functions after a third or fourth degree perineal tear.
If you are being assessed during your pregnancy we can offer advice and make recommendations to you and your obstetric and midwifery teams based on our investigations. This will allow you to make the most informed decision on how you choose to deliver your baby. If you are having ongoing problems with your bowel function, we can give you advice on how to manage these symptoms as well as refer you to our team of specialised pelvic floor physiotherapists.
What are the risks and side-effects of the investigations performed during scanning?
Ultrasound examination of the back passage and anal manometry testing are safe and pose no risk to you or your baby (if you are pregnant). The probe and the tube can be a little uncomfortable upon insertion, but every attempt will be made to minimise the discomfort caused to you. You can ask the doctor to stop the test at any time.
What are the alternatives to having this scan?
Attending the scan is not compulsory and if you decline the offer of an appointment we will continue to offer the best care we can without the scan. If you are pregnant with your second baby, we will have a mode of delivery conversation using your symptoms to best inform you.
If you have recently sustained an OASI and wish to be reviewed by a specialised pelvic floor physiotherapist, please contact your midwife or GP. If you are currently pregnant you can discuss your symptoms and options for birth with your obstetrician or midwife during your antenatal clinic appointments.