manometry while the BET may be performed immediately prior to the manometry or subsequent to the RST. The total time to conduct all three tests is 15 to 20 minutes. Manometry This test takes approximately 10 minutes. With the use of a lubricant, an anorectal manometry catheter is introduced into the anus. The catheter is advanced until the base of the balloon is above the anal canal by and the most distal sensor is below the anal verge. In order, the following maneuvers are then preformed: RST During the rectal sensory test, air is placed into the catheter balloon and slowly inflated either continuously or step-wise. The patient is asked to verbalize when they first sense the balloon, when the urge to defecate is first present and when they can no longer tolerate the balloon. BET To perform the balloon expulsion test, a catheter with a balloon on its tip is introduced into the patient's anorectum. The balloon is then distended to 50ml with water. Patients are then instructed to transfer from lying on their side to sitting on a toilet. Next, patients are asked to push out the balloon as if they are defecating. The time it takes for the expulsion of the balloon is then recorded. Analysis Resting pressure The anal resting pressure is the recorded pressure within the anus during muscle relaxation. After insertion of the catheter, a short amount of time is allowed for the muscles to relax. Afterwards, pressures are recorded over 60 seconds. The maximum resting pressure is the highest pressure reached during this time period, while the mean resting pressure is the average pressure during this time period. In healthy individuals, women, especially older women, have an average lower anal resting pressures than men. Squeeze pressure The anal squeeze pressure is the recorded pressure within the anus during a voluntary contraction of the external anal sphincter. Similar to resting pressures, squeeze pressures in healthy women are lower than healthy men. If using high-definition anorectal manometry, asymmetry in squeeze pressures can also be measured. Change of pressure during defecation During defecation, the pressure in the anorectum should increase while the external anal sphincter should relax. If the pressure difference during defecation does not increase sufficiently, it may indicate poor propulsive force. Additionally, inadequate relaxation of the sphincter during defecation is another abnormal finding. Another method to assess changes during defecation is to calculate an