Colonic manometry

The digestive system is a hollow tube from the mouth to the anus (where poo leaves the bottom). The walls of the tube contain muscles and nerves that squeeze food rhythmically through the system. If the muscles and/or nerves are not working properly, food cannot pass through the digestive system.

Manometry is a way of measuring how well the muscles and nerves in the digestive system are working. Colonic manometry looks specifically at the muscles and nerves in the colon (large intestine).

You will need to come to the ward a few days before the test so that your child can have some bowel cleansing medicine to clear their large intestine. Your child will need to follow a special diet during the days that the medicine is being taken. We will give you a diet sheet.

The pre-admission nurse may also ask you to increase medications at home before admission to hospital.

If your child normally uses a trans anal irrigation system such as Peristeen®, or has an antegrade colonic enema (ACE), please bring the equipment with you to hospital, as it can be used to help empty your child’s bowel.

If your child has any medical problems, particularly allergies, please tell the doctor about these. Please also bring in any medicines your child is currently taking and show these to the doctor.

The person bringing your child to the test should have ‘parental responsibility’ for them. This is someone who has legal rights, responsibilities, duties, power and authority to make decisions for a child. If the person bringing your child does not have parental responsibility, we may have to cancel the test.

The doctors will explain about the test in more detail, discuss any worries you may have and ask you to sign a consent form giving permission for your child to have the test.

At the start of the hospital admission, the nurse will put a thin tube (cannula) into a vein in your child’s arm.

A nurse will apply some local anaesthetic cream first so that the skin is numb. Your child may like to have a cold numbing spray before the needle instead of the cream.

We will do blood tests during your child’s hospital stay to measure the salts and minerals in their blood.

We insert the catheter used in colonic manometry whilst your child is under general anaesthetic (‘asleep’). They will need to stop eating and drinking a few hours before they are given anaesthetic. We will tell you the exact time they need to stop eating or drinking the night before the manometry.

It is important your child keeps drinking until this time to make sure they’re well hydrated. We recommend waking your child in the night to give them a drink.

The colonic manometry will take place in the Gastroenterology Investigation Suite. A nurse will stay with your child throughout the test. You can also stay with your child throughout the test they will be still a bit sleepy from the anaesthetic but will wake as the test progresses.

First, the doctor will perform a colonoscopy whilst your child is under general anaesthetic. The doctor will use an endoscope (a long flexible camera with a light on the end) to insert a catheter (a flexible plastic tube) into your child’s large intestine via their bottom. Once the catheter is in the correct place, very small metal clips are used to keep it in place. The end outside is taped to your child’s bottom.

When your child has fully recovered from the anaesthetic, the end of the catheter is attached to a machine which measures how well the muscles and nerves are working. During the test an x-ray will be taken of your child’s tummy to confirm the position of the catheter. Your child will be given a meal as part of the test.

About an hour later, a medicine (laxative) will be put into the catheter to stimulate the large bowel and test how it contracts (squeezes). A second dose of this medicine will be given about one hour after this. The test can take up to five hours, but your child can watch TV, play with a tablet or phone, or read throughout.

There is a very small risk that the endoscope or catheter could damage your child’s rectum (where poo is held before it leaves the body) and large intestine. However, this is very unlikely as the catheter is flexible and the doctors and nurses are very experienced.

The doctor or nurse will remove the catheter from your child’s bottom and your child will come back to the ward.

Once your child has eaten something and has passed urine (had a wee), the cannula will be removed. If no other tests are planned and there are no complications, they will be able to go home.

Unless you have been advised otherwise, your child can start eating and drinking and restart any medications that were stopped for the test.[JG1]

[JG1]Rephrased- is this accurate?

Most children usually recover quickly from a general anaesthetic. Some children may get side effects, but these are usually mild. Common side effects include:

• headaches
• feeling sick or being sick (vomiting)
• a sore throat

These can usually be treated effectively with medicines.

Other side effects include:

• tiredness
• dizziness
• disturbed sleep patterns for a few days

These effects generally just need time to wear off.

Your child may also have some tummy pain. This can be due to the air used to inflate the intestine during the endoscopy or from the laxative given during the procedure. You can help ease this by encouraging them to walk around, gently rubbing their tummy or by them having a warm bath. They may also need to use the toilet urgently.

There may be blood spots from the bottom if biopsies (small samples of tissue) were taken from the intestinal wall or from the removal of the clips securing the catheter.

The nurse will tell you if a clip was unable to be removed inside the bowel during the procedure. If this happens, most are passed out in your child’s poo in about three to five days. You probably will not see the clip if it passes and you do not need to keep the clip, just flush it away with your child’s poo. However, if your child is due to have a Magnetic Resonance Imaging (MRI) scan, please let the team know during the metal check beforehand.

You should call your GP or your local hospital if your child:

• becomes generally unwell
• refuses to eat or drink
• is sick
• is unusually sleepy or it is difficult to wake them up.

Out of hours call 111. In an emergency call 999 or go straight to your nearest Accident and Emergency (A&E) department.

We will discuss the results at your child’s next outpatient appointment. The analysis of this test is complicated so it can take some time to get the results. If we need to start your child on a new treatment before the appointment, we will contact both you and your child’s GP.

You can contact the Gastroenterology Investigation Unit (GUI) on 020 7405 9200 ext 0212/ 7916.

We are open Tuesday to Friday 8am-6pm.

If your call is not answered, please leave a message and a member of the team will return your call on the unit’s next working day.