Proctological and pelvic floor disorders: diagnostic pathway completed within hours at Policlinico San Pietro

In the presence of pelvic floor dysfunction, the three main investigations used to define the clinical picture and identify the most appropriate treatment (rehabilitative, medical, or surgical) are:

• anorectal manometry;
• 3D transanal ultrasound with a rotating probe;
• X-ray colpocystodefecography (or perineography).

“At our hospital, these three tests can be performed within 2–3 hours, with immediate reporting, thanks to an integrated and streamlined diagnostic pathway. This allows us to accelerate the diagnostic and therapeutic process, making it as efficient and comfortable as possible, even for patients coming from other cities,” explains Dr. Calabrò.

Anorectal manometry is a functional test that evaluates sphincter function and investigates functional disorders of the anorectal tract, in particular:

• contraction of the internal and external anal sphincters;
• the rectoanal inhibitory reflex;
• rectal sensitivity, both at rest and during voluntary contraction.

This test is essential in cases of:

• prolapse;
• fecal incontinence;
• chronic constipation;
• paradoxical contraction of the puborectalis muscle.

Manometry is also used in preoperative assessment for conditions such as anal fissures, hemorrhoids, and fistulas, as well as prior to rectal resection. The test is performed using a thin catheter equipped with pressure sensors, gently inserted into the anal canal.

Three-dimensional transanal ultrasound with a rotating probe is a morphological examination that provides detailed visualization of:

• the anal canal;
• the internal and external anal sphincters;
• possible abscesses and fistulas.

3D technology enables complete volumetric reconstruction of the sphincter complex, increasing diagnostic accuracy compared to conventional two-dimensional ultrasound. It is particularly indicated for:

• identifying sphincter injuries (e.g., postpartum or post-surgical);
• assessing perianal fistulas and abscesses (location and tract);
• evaluating structural abnormalities associated with incontinence or pain.

This is a minimally invasive, well-tolerated test with high diagnostic value, also used in oncological conditions.

X-ray colpocystodefecography (or perineography) is a dynamic radiological examination that evaluates both the evacuation process and the morphology of the rectum, bladder, and anal canal. By opacifying the rectum, vagina, and bladder with contrast medium (when indicated), the test allows:

• assessment of defecatory dynamics;
• identification of morphological changes typical of rectal prolapse;
• evaluation of the extent of pelvic organ prolapse (rectocele, cystocele, enterocele);
• analysis of pelvic statics and dynamics.

Unlike purely anatomical imaging, this study provides a functional “in-motion” assessment, which is essential in cases of obstructed defecation, sensation of incomplete evacuation, or complex prolapse, in order to determine whether and which type of intervention is required.

In the presence of complex clinical conditions requiring further evaluation, the diagnostic pathway at Policlinico San Pietro may be complemented with second-level investigations:

• pelvic MRI, for detailed assessment of the rectum, anal canal, and perianal structures;
• neurophysiological testing of the perineal floor to evaluate nerve and muscle function through electromyography, evoked potentials, and pudendal nerve latency studies.

The diagnostic pathway for proctological disorders and pelvic floor dysfunctions at Policlinico San Pietro is managed by a dedicated multidisciplinary team with integrated specialist expertise. From the initial consultation through to the definition of the treatment plan, patients are guided with attention to comfort, privacy, and personalization of care.

The integration of advanced technologies, efficient organization, and clinical expertise enables a comprehensive diagnostic assessment and the implementation of targeted treatments, with the aim of concretely improving patients’ quality of life.

The diagnostic pathway for proctological disorders and pelvic floor dysfunctions at Policlinico San Pietro is a private-pay service; access requires booking an initial specialist proctological consultation.