Colorectal Assessment Tools: Creating a Plan for Your Child's Care

Colorectal patients often need to have testing completed to help the providers (doctors and specialists) make decisions and come up with the best treatment plan for the individual. The tests that are used to assess the colon are abdominal x-rays, contrast enemas, anorectal manometry (AMAN), and colonic manometry (CMAN).

X-ray

Abdominal X-rays are easy to perform and the most common tool that the CCPR team uses. A picture is taken of the patient’s belly, usually while they are lying down. Most patients will be asked to get an x-ray before every visit. The x-ray’s pictures will show how much gas and stool there is in the colon (large intestine), and where it is. The providers will use these pictures to decide if a patient is constipated or if they are stooling well. They can use an abdominal x-ray to help make decisions about medication changes or the need to complete an irrigation. 

Contrast Enema

Most colorectal patients will have a contrast enema completed at least once. These are often done the first time a patient is seen by the colorectal team and sometimes need to be repeated when a child is older or if they have had surgery.

During a contrast enema, a catheter is inserted into the rectum and a contrast solution is infused through the catheter. Some patients have something called a Malone/cecostomy and the contrast enema can be done through those rather than the rectum. While the contrast solution is going in, x-ray pictures are taken. The solution shows up white on the x-ray images and this helps the providers see the entire shape of the colon.

The contrast enema will show if the colon has become stretched out or dilated and will also show if there are any areas that are narrow making it difficult for poop to move through the colon. Contrast enemas are also helpful to have done before any bowel surgery or before starting any kind of formal bowel management program.

Anorectal Manometry (AMAN)

Anorectal manometry (AMAN) is a test that is performed by a gastroenterologist. A catheter is inserted into the rectum and a balloon is inflated. The AMAN tests how well the muscles relax when the balloon is inflated, and if they relax the way they are supposed to. The gastroenterologist will also ask the patient to try to push the balloon out, like they are trying to have a bowel movement, or squeeze their muscles as if they are holding a poop in. This can show how well the muscles in the pelvic floor are working and if there is appropriate communication with the muscles.

Colonic Manometry (CMAN)

Colonic manometry (CMAN) is another test that is performed by the gastroenterologist. A long catheter is used that has sensors spaced evenly throughout the entirety of the catheter. The catheter is inserted rectally and placed throughout the entire length of the colon. The test takes several hours to perform and is used to see how well the colon is contracting and moving during different phases.

The test begins what the colon is at rest. The patient is then asked to eat a meal and the sensors capture how the colon moves and contracts after eating. Medication is then given into the colon and again the sensors record how the colon responds to medication and whether it is contracting as it should. The CMAN can show how well the colon is working and if there are any areas that do not contract and push stool through effectively.

All of these tests are done to assist in making decisions that help ensure best outcomes for your child.