Title: Effect of posture on anorectal manometric measurements in female patients with fecal
incontinence and rectoanal intussusception
Version: 3 Date: 04 Oct 2022
Reviewer:  Yoav Mazor
Reviewer's report:
I read with interest the authors' manuscript "Effect of posture on anorectal manometric
measurements in female patients with fecal incontinence and rectoanal intussusception". The
study is clearly and succinctly presented, including methods, results and discussion. I think this
data should be published.
Major comments:
1- Methodology: I am worried that methodology used for anorectal manometry is not accurate
enough. If I understand correctly the authors use a water perfused single port manometry system?
This system is not widely used  or published in the last decade. Results are off-range for
accepted normals, including high anal canal length (for females) and high anal squeeze pressures
(considering older female FI patients). Furthermore, establishing values in the upright position
with such a single port system might be very difficult.
Can the authors elaborate on this? Any references for the use of the system? Any normal values?
2- Clinical data: RAI is commonly associated with defecatory dysfunction. Can the authors
provide any information about coexistence of constipation, defecatory symptoms, stool form
and/or frequency and the such?
Minor comments:
1- Introduction: routine DPG is not recommended in the workup of FI, unless in selected tertiary
specialist centers. Please provide appropriate  references for this or modify statement.
2- Methods and discussion: balloon inflation in the rectum does not measure rectal capacity, but
rather rectal sensation (or more accurately perception, as the authors later state).
3- Results: IBS prevalence seems very low. How was this measured? Using Rome criteria?
Please provide more information
4- Discussion: although anal canal length was  statistically shorter in the upright position, I'm
not sure the difference is clinically significant.
Title: Effect of posture on anorectal manometric measurements in female patients with fecal
incontinence and rectoanal intussusception
Version: 3 Date: 04 Oct 2022
Reviewer:  Yoav Mazor
Reviewer's report:
I read with interest the authors' manuscript "Effect of posture on anorectal manometric
measurements in female patients with fecal incontinence and rectoanal intussusception". The
study is clearly and succinctly presented, including methods, results and discussion. I think this
data should be published.
Major comments:
1- Methodology: I am worried that methodology used for anorectal manometry is not accurate
enough. If I understand correctly the authors use a water perfused single port manometry system?
This system is not widely used  or published in the last decade. Results are off-range for
accepted normals, including high anal canal length (for females) and high anal squeeze pressures
(considering older female FI patients). Furthermore, establishing values in the upright position
with such a single port system might be very difficult.
Can the authors elaborate on this? Any references for the use of the system? Any normal values?
2- Clinical data: RAI is commonly associated with defecatory dysfunction. Can the authors
provide any information about coexistence of constipation, defecatory symptoms, stool form
and/or frequency and the such?
Minor comments:
1- Introduction: routine DPG is not recommended in the workup of FI, unless in selected tertiary
specialist centers. Please provide appropriate  references for this or modify statement.
2- Methods and discussion: balloon inflation in the rectum does not measure rectal capacity, but
rather rectal sensation (or more accurately perception, as the authors later state).
3- Results: IBS prevalence seems very low. How was this measured? Using Rome criteria?
Please provide more information
4- Discussion: although anal canal length was  statistically shorter in the upright position, I'm
not sure the difference is clinically significant.
Please review this paper.
user
Title: Effect of posture on anorectal manometric measurements in female patients with fecal
incontinence and rectoanal intussusception
Version: 3 Date: 04 Oct 2022
Reviewer:  Yoav Mazor
Reviewer's report:
I read with interest the authors' manuscript "Effect of posture on anorectal manometric
measurements in female patients with fecal incontinence and rectoanal intussusception". The
study is clearly and succinctly presented, including methods, results and discussion. I think this
data should be published.
Major comments:
1- Methodology: I am worried that methodology used for anorectal manometry is not accurate
enough. If I understand correctly the authors use a water perfused single port manometry system?
This system is not widely used  or published in the last decade. Results are off-range for
accepted normals, including high anal canal length (for females) and high anal squeeze pressures
(considering older female FI patients). Furthermore, establishing values in the upright position
with such a single port system might be very difficult.
Can the authors elaborate on this? Any references for the use of the system? Any normal values?
2- Clinical data: RAI is commonly associated with defecatory dysfunction. Can the authors
provide any information about coexistence of constipation, defecatory symptoms, stool form
and/or frequency and the such?
Minor comments:
1- Introduction: routine DPG is not recommended in the workup of FI, unless in selected tertiary
specialist centers. Please provide appropriate  references for this or modify statement.
2- Methods and discussion: balloon inflation in the rectum does not measure rectal capacity, but
rather rectal sensation (or more accurately perception, as the authors later state).
3- Results: IBS prevalence seems very low. How was this measured? Using Rome criteria?
Please provide more information
4- Discussion: although anal canal length was  statistically shorter in the upright position, I'm
not sure the difference is clinically significant.
assistant