Anorectal Manometry Interpretation Report

Patient Name: [Patient full name]
MRN: [Medical record number]
DOB: [MM/DD/YYYY]
Sex: [male / female / intersex / non-binary / unspecified]
Encounter Number: [Encounter ID]

Test Date/Time: [MM/DD/YYYY HH:MM]
Report Date: [MM/DD/YYYY]
Ordering Clinician: [Name, credentials] (If unknown, insert "REQUIRED before sign-off")
Interpreting Clinician: [Name, credentials] (If unknown, insert "REQUIRED before sign-off")
Facility/Lab: [Facility or motility lab name]

Indication: [constipation/evacuation disorder / fecal incontinence / encopresis / anorectal pain / pre-operative assessment / post-operative assessment / other: specify]

Study Components Performed:

• ARM type: [HR-ARM / HD-ARM / conventional] [solid-state / water-perfused / unknown]
• Rectal sensory testing: [performed / not performed] (If not performed, state reason)
• Balloon expulsion test: [performed / not performed] (If not performed, state reason)
• Surface EMG: [performed / not performed / not available]

Clinical Context

• Primary symptom and duration: [Symptom description and time course] (If not documented, write "Not documented")
• Prior evaluation/imaging: [Prior tests and salient findings] (If none or not documented, write "None" or "Not documented")
• Pertinent surgical history: [Anorectal surgery, pelvic radiation, obstetric injury] (If none or not documented, write "None" or "Not documented")
• Neurologic conditions: [Details if applicable] (If none or not documented, write "None" or "Not documented")
• Current bowel regimen and relevant medications: [Opioids, anticholinergics, laxatives] (If none or not documented, write "None" or "Not documented")
• (Include for pediatric patients) Age and history relevant to Hirschsprung disease or anorectal malformation: [Details] (If not applicable, omit this line)

Pre-test Conditions

• Bowel preparation: [none / tap-water enema / phosphate enema / other: specify], timing: [Time relative to test]
• Medication status: [usual medications continued / medications held: specify] (Note opioids/analgesics if relevant)
• Sedation/anxiolysis: [none / agent, dose, time] (Flag if sedation may impact coordination or sensory results)
• Digital rectal exam: [performed / not performed / unknown] (If performed: stool in vault [yes / no], tone [low / normal / high], patient comprehension [adequate / limited], pain limiting exam [yes / no])

Technique

[Equipment and setup description including ARM type, transducer system, catheter configuration, patient position, lubrication/topical anesthetics if used, and whether stabilization period occurred after intubation]

Maneuvers performed:

• Resting recording: [number of epochs], [duration per epoch]
• Short squeeze trials: [number of attempts], [duration per attempt]
• Endurance squeeze: [performed / not performed], target duration [seconds], [number of attempts]
• Cough reflex: [performed / not performed], [number of attempts]
• Simulated defecation/push trials: [number of attempts], [coached / uncoached]
• RAIR testing: [performed / not performed], balloon volumes tested [list mL], method [rapid / slow]
• Rectal sensory thresholds: [performed / not performed], method [ascending phasic / ramp], medium [air / water]
• Balloon expulsion test: [performed / not performed], balloon volume [mL], position [seated on commode / left lateral / other], privacy conditions [door closed and unattended / chaperoned / other], maximum allowed time [seconds]

(For any maneuver not performed, document reason: [patient discomfort / inability to follow instructions / equipment issue / time constraints / other])

Study quality: [adequate / limited / invalid] for interpretation. [Explanation of any limiting factors: poor cooperation, pain, anxiety, catheter malposition, artifact, incomplete maneuvers, inability to assume proper position for BET]

Results

(Report raw values with units and lab-specific reference ranges if available. Do not apply normal/abnormal labels here; address in Interpretation.)

Parameter	Value	Units	Details	Reference Range
Anal resting pressure	[Numeric]	mmHg	[Averaging method]	[Range]
Anal squeeze pressure	[Peak increment or absolute peak]	mmHg	[Number of attempts; best/average used]	[Range]
Endurance squeeze	[Duration maintained]	seconds	Fatigue pattern: [none / gradual decline / abrupt drop]	[Range]
Cough response	[present / absent / indeterminate]	—	[Reflex anal contraction observed: yes / no]	—
Push—rectal pressure change	[Numeric]	mmHg	Attempt # used for analysis	[Range]
Push—anal pressure change	[Numeric]	mmHg	Attempt # used for analysis	[Range]
Push—coordination pattern	[appropriate relaxation / paradoxical contraction / failure to relax / indeterminate]	—	Multiple attempts consistent: [yes / no]	—
RAIR	[present / absent / indeterminate]	—	Minimum volume tested: [mL]; volume elicited: [mL]	—
First constant sensation	[Numeric]	mL	Method: [phasic / ramp]; medium: [air / water]	[Range]
Desire to defecate	[Numeric]	mL	Method: [phasic / ramp]; medium: [air / water]	[Range]
Maximum tolerated volume	[Numeric]	mL	Method: [phasic / ramp]; medium: [air / water]	[Range]
Balloon expulsion test	[Expulsion time / not expelled]	seconds	Volume: [mL]; desire to defecate reported: [yes / no]	[Range]

Qualitative observations (pelvic floor coordination):

• Rectal propulsion: [adequate / inadequate / indeterminate]
• Anal relaxation: [appropriate / paradoxical contraction / failure to relax / indeterminate]
• Attempt variability: [Summary of consistency across attempts; attempt used for analysis]

(Note: Push results are effort- and instruction-sensitive.)

Interpretation

Rectoanal Inhibitory Reflex (RAIR)

RAIR [present / absent / indeterminate] with [adequate / inadequate] provocation volumes. [If absent, list plausible non-aganglionic explanations if relevant—megarectum, fecal loading, post-surgical states—and state recommended further evaluation. Do not diagnose Hirschsprung disease based on RAIR alone.]

Anal Tone and Contractility

Resting tone: [hypotensive / normal / hypertensive] per lab norms. Squeeze: [hypocontractile / normal] per lab norms. [Comment on endurance/fatigue if clinically relevant.]

Rectoanal Coordination

Dyssynergia: [present / absent / indeterminate]. Propulsion: [adequate / inadequate / indeterminate]. [Note whether findings are supported by BET or defecography if available.]

Rectal Sensation

Sensory profile: [hyposensitivity / normal / hypersensitivity] per lab norms. [If markedly abnormal or clinically discordant, note if confirmatory testing is warranted.]

Synthesis: [Integrative summary stating what the study most likely explains in the clinical context and recommended next action. For constipation indications, explicitly state whether findings are consistent with a defecatory disorder and whether evidence is strong (supported by abnormal BET) or limited.]

Impression

• (If study limited/invalid, list first) [Study quality limitation and impact on interpretation confidence]
• [Primary finding]: [Supporting evidence] ([Confidence level / limitations])
• [Secondary finding]: [Supporting evidence] ([Confidence level / limitations])
• [Additional findings as applicable]

(Order findings by clinical importance. Use format: finding label, supporting evidence, confidence/limitations.)

Recommendations

• [Specific recommendation tied to findings] (Include rationale linked to above findings)
• [Additional recommendations as indicated]
• Follow-up: [Return to ordering clinician / Motility clinic follow-up in specified timeframe]

(Tie all recommendations to specific findings. For dyssynergia: recommend pelvic floor biofeedback therapy and bowel habit optimization. For inadequate propulsion without dyssynergia: note limited biofeedback evidence; consider colonic transit study. For absent RAIR: recommend age-appropriate evaluation to exclude aganglionosis. For abnormal sensation: consider sensory retraining within biofeedback programs.)

Communication and Sign-off

• Results communicated to: [patient / guardian / referring clinician: name] on [MM/DD/YYYY] via [in-person / phone / secure message]
• Critical findings: [yes / no] (If yes, notification pathway: [details])
• Follow-up plan: [Refer to ordering clinician / Motility clinic follow-up in specified timeframe]

Interpreter Signature: [Name, credentials]
Date/Time: [MM/DD/YYYY HH:MM]