Chapter 4 100 Balloon expulsion (BET) A non-sterile disposable balloon (BARD, Covington, USA) was filled with 50cc water or until the patients felt a desire to defaecate. Balloon expulsion time differs in literature. According to several studies, evacuation within 1 minute was considered as normal.28-30 The BET was performed by a nurse continence specialist in our clinic and results were scored <1 minute or >1 minute1 (Table 1). Transperineal ultrasound (TPUS) Transperineal ultrasound was performed with a standard BK Medical scanner (BK Medical ApS, Herlev, Denmark) and a transducer (BK Medical, type 2C9, 13 MHz). The patient was lying supine with the legs exed. As with the 3D-HRAM, patients were asked to use a MICROLAX® enema the night before and the morning of their appointment. Transperineal ultrasound was performed using a conventional curved array probe rested on the perineum to gain dynamic two-dimensional mid plane sagittal views. For the real time movement 50 ml echo lucent gel was introduced in the rectum. The patient was asked to squeeze, bear down and cough while views were digitally recorded. The movements during straining were categorized as relaxation, indifferent and paradoxical contraction. Evacuation of gel during straining was categorized as yes or no (Table 1). Table 1. Summary of anorectal function tests and their categorized outcomes Mean resting pressure Mean squeeze pressure Push Evacuation DRE surgeon 1. Low 2. Normal 3. High 1. Low 2. Normal 3. High 1. Relaxation 2. Indifferent 3. Paradoxical - DRE Pelvic floor physical therapist 1. Low 2. Normal 3. High 1. Low 2. Normal 3. High 1. Relaxation 2. Indifferent 3. Paradoxical - 3D-HRAM 1. Low: 0-49 mmHg 2. Normal: 50-100 mmHg 3. High: >100 mmHg 1. Low: 0-49 mmHg 2. Normal: 50-200 mmHg 3. High: >200 mmHg 1. Relaxation 2. Indifferent 3. Paradoxical - s-EMG Women 1. Low: 0-2.0 2. Normal:2.1-5.0 3. High: > 5.1 Men 1. Low: 0-3.0 2. Normal 3.1-6.0 3. High: > 6.1 Women 1. Low: 0-6.0 2. Normal: 6.1-15.0 3. High: > 15.1 Men 1. Low: 0-9.0 2. Normal: 9.1-18.0 3. High: > 18.1 1. Decrease of electrical activity (relaxation) 2. Indifferent 3. Increase of electrical activity (paradoxical) -
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