PURPOSE: Parasympathetic afferent nerves are thought to mediate rectal filling sensations. The role of sympathetic afferent nerves in the mediation of these sensations is unclear. Sympathetic nerves have been reported to mediate nonspecific sensations in the pelvis or lower abdomen in patients with blocked parasympathetic afferent supply. It has been reported that the parasympathetic afferent nerves are stimulated by both slow ramp (cumulative) and fast phasic (intermittent) distention of the rectum, whereas the sympathetic afferent nerves are only stimulated by fast phasic distention. Therefore, it might be useful to use the two distention protocols to differentiate between a parasympathetic and sympathetic afferent deficit. METHODS: Sixty control subjects (9 males; median age, 48 (range, 20–70) years) and 100 female patients (median age, 50 (range, 18–75) years) with obstructed defecation entered the study. Rectal sensory perception was assessed with an “infinitely” compliant polyethylene bag and a computer-controlled air-injection system. This bag was inserted into the rectum and inflated with air to selected pressure levels according to two different distention protocols (fast phasic and slow ramp). The distending pressures needed to evoke rectal filling sensations, first sensation of content in the rectum, and earliest urge to defecate were noted, as was the maximum tolerable volume. RESULTS: In all control subjects, rectal filling sensations could be evoked. Twenty-one patients (21 percent) experienced no sensation at all in the pressure range between 0 and 65 mmHg during either slow ramp or fast phasic distention. The pressure thresholds for first sensation, earliest urge to defecate, and maximum tolerable volume were significantly higher in patients with obstructed defecation (P<0.001). In each subject, the pressure thresholds for first sensation, earliest urge to defecate, and maximum tolerable volume were always the same, regardless of the type of distention. CONCLUSION: Rectal sensory perception is blunted or absent in the majority of patients with obstructed defecation. The observation that this abnormality can be detected by both distention protocols suggests that the parasympathetic afferent nerves are deficient. Because none of the patients experienced a nonspecific sensation in the pelvis or lower abdomen during fast phasic distention, it might be suggested that the sympathetic afferents are also deficient. This finding implies that it is not worthwhile to use different distention protocols in patients with obstructed defecation.
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Schouten WR. Controversies in the diagnosis and treatment of constipation and obstructed defecation. Perspect Colon Rectal Surg 1996;9:71–80.
Schouten WR, Briel JW, Auwerda JJ,et al. Anismus: fact or fiction? Dis Colon Rectum 1997;40:1033–41.
Voderholzer WA, Neuhaus DA, Klauser AG, Tzavella K, Muller-Lissner SA, Schindlbeck NE. Paradoxical sphincter contraction is rarely indicative of anismus. Gut 1997;41:258–62.
Schouten WR, Gosselink MJ, Boerma MO, Ginai AZ. Rectal wall contractility in response to an evoked urge to defecate in patients with obstructed defecation. Dis Colon Rectum 1998;41:473–9.
De Medici A, Badiali D, Corazziari E,et al. Rectal sensitivity in chronic constipation. Dig Dis Sci 1989;34:747–53.
Read NW, Abouzetery L, Read MG,et al. Anorectal function in elderly patients with fecal impaction. Gastroenterology 1985;89:956–66.
Varma JS, Smith AN. Neurophysiological dysfunction in young women with intractable constipation. Gut 1988;29:963–8.
Waldron D, Bowes KL, Kingma YL,et al. Colonic and anorectal motility in young women with intractable constipation. Gastroenterology 1988;95:1388–94.
Bannister JJ, Timms JM, Barfield LJ,et al. Physiological studies in young women with chronic constipation. Int J Colorectal Dis 1986;1:175–82.
Read NW, Timms JM, Barfield LJ,et al. Impairment of defecation in young women with severe constipation. Gastroenterology 1986;90:53–60.
Roe AM, Bartolo DC, Mortensen NJ. Slow transit constipation: comparison between patients with and without previous hysterectomy. Dig Dis Sci 1988;33:1159–63.
Wald A, Hinds JP, Carnara BJ. Psychological characteristics of patients with severe idiopathic constipation. Br J Surg 1989;97:932–7.
Toma TP, Zighelboim J, Phillips SF, Talley NJ. Methods for studying rectal sensitivity and compliance: in vitro studies of balloons and a barostat. Neurogastroenterol Motil 1996;8:19–28.
Whitehead WE, Delvaux M, and the Working Team. Standardization of barostat procedures for testing smooth muscle tone and sensory thresholds in the gastrointestinal tract. Dig Dis Sci 1997;42:223–41.
Jaenig W, Koltzenburg M. Receptive properties of sacral primary afferent neurons supplying the colon. J Neurophysiol 1991;65:1067–77.
Ness TJ, Gebhart GF. Colorectal distension as a noxious visceral stimulus: physiological and pharmacological characterization of pseudoaffective reflexes in the rat. Brain Res 1988;450:153–69.
Ness TJ, Gebhart GF. Characterization of neuronal responses to noxious visceral and somatic stimuli in the medial lumbosacral spinal cord of the rat. J Neurophysiol 1988;57:1867–92.
Lembo T, Munakata J, Mertz H,et al. Evidence for the hypersensitivity of lumbar splanchnic afferents in irritable bowel syndrome. Gastroenterology 1994;107:1686–96.
Ray BS, Neil CL. Abdominal visceral sensation in man. Ann Surg 1947;126:709–24.
Mertz H, Naliboff B, Munakata J, Niazi N, Mayer EA. Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology 1995;109:40–52.
MacDonagh R, Sun WM, Thomas DG, Smallwood R, Read NW. Anorectal function in patients with complete supraconal spinal cord lesions. Gut 1992;33:1532–8.
Weber J, Denis PH, Mihout B,et al. Effect of brain-stem lesion on colonic and anorectal motility: study of three patients. Dig Dis Sci 1985;30:419–25.
Sun WM, MacDonagh R, Forster D, Thomas DG, Smallwood R, Read NW. Anorectal function in patients with complete spinal transection before and after sacral posterior rhizotomy. Gastroenterology 1995;108:990–8.
Dorval D, Barbieux JP, Picon L, Alison D, Codjovi PH, Pouleau PH. Mesure simplifiee du temps de transit colique par une seule radiographie de l'abdomen et un seul type de marqueur. Gastroenterol Clin Biol 1994;18:141–4.
Luukkonen P, Mikkonen U, Jarvinen H. Abdominal rectopexy with sigmoidectomy vs. rectopexy alone: a prospective, randomized study. Int J Colorectal Dis 1992;7:219–22.
Broens PM, Penninckx FM, Lestar B, Kerremans RP. The trigger for rectal filling sensation. Int J Colorectal Dis 1994;9:1–4.
Netter FH. The Ciba collection of medical illustrations, volume 3, part II: the lower digestive tract. 6th ed. New York: Ciba Pharmaceutical Company, 1987.
Pemberton JH. Anatomy and physiology of the anus and rectum. In: Beck DE, Wexner SD. Fundamentals of anorectal surgery. 1st ed. New York: McGraw Hill; 1992.
Pemberton JH. Anatomy and physiology of the anus and rectum. In: Condon RE, ed. Shackelford's surgery of the alimentary tract. Vol. 4. 3rd ed. Philadelphia: WB Saunders, 1991.
Goligher JC, Hughes ES. Sensibility of the rectum and colon: its role in the mechanism of anal continence. Lancet 1951;1:543–8.
Gunterberg B, Kewenter J, Petersen I, Stener B. Anorectal function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves. Br J Surg 1976;63:546–54.
Nakahara S, Itoh H, Mibu R, Ikeda S, Konomi K, Masuda S. Anorectal function after high sacrectomy with bilateral resection of S2–S5 nerves: report of a case. Dis Colon Rectum 1986;29:271–4.
Gosselink MJ, Hop WC, Schouten WR. Rectal compliance in females with obstructed defecation. Dis Colon Rectum 2001;44:971–7.
Scaglia M, Fasth S, Hallgren T, Nordgren S, Oresland T, Hultén L. Abdominal rectopexy for rectal prolapse: influence of surgical technique on functional outcome. Dis Colon Rectum 1994;37:805–13.
Holmström B, Brodén G, Dolk A. Results of the Ripstein operation in the treatment of rectal prolapse and internal rectal procidentia. Dis Colon Rectum 1986;29:845–8.
Delemarre JB, Goozen HG, Kruyt RH, Soebhag R, Geesternaus AM. The effect of posterior rectopexy on fecal continence: a prospective study. Dis Colon Rectum 1991;34:311–6.
Mc Cue JL, Thomsen JP. Clinical and functional results of abdominal rectopexy for complete rectal prolapse. Br J Surg 1991;78:921–3.
Mann CV, Hoffman C. Complete rectal prolapse: the anatomical and functional results of treatment by an extended abdominal rectopexy. Br J Surg 1988;75:34–7.
Speakman CT, Madden MV, Nicholls RJ, Kamm MA. Lateral ligament division during rectopexy causes constipation but prevents recurrences: results of a prospective, randomized study. Br J Surg 1991;78:1431–3.
Sayfan J, Pinho M, Alexander-Williams J, Keighley MR. Sutured posterior abdominal rectopexy with sigmoidectomy compared with Marlex rectopexy for rectal prolapse. Br J Surg 1990;77:143–5.
Penfold JC, Hawley PR. Experiences of Ivalon-sponge implant for complete rectal prolapse at St Marks's Hospital. Br J Surg 1972;59:846–8.
van Dam JH, Gosselink MJ, Drogendijk AC, Hop WC, Schouten WR. Changes in bowel function after hysterectomy. Dis Colon Rectum 1997;40:1342–7.
Gurnari M, Mazziotti F, Corazziari E,et al. Chronic constipation after gynaecological surgery: a retrospective study. Br J Gastroenterol 1988;20:183–6.
Vierhout ME, Schreuder HW, Veen HF. Severe slow-transit constipation following radical hysterectomy. Gynecol Oncol 1993;51:401–3.
Smith AN, Varma JS, Binnie NR, Papachrysosfomou M. Disordered colorectal motility in intractable constipation following hysterectomy. Br J Surg 1990;77:1361–6.
Long DM Jr, Bernstein WC. Sexual dysfunction as a complication of abdominoperineal resection of the rectum in the male: an anatomic and physiologic study. Dis Colon Rectum 1959;2:540–8.
Varma JS. Autonomic influences on colorectal motility and pelvic surgery. World J Surg 1992;16:811–9.
Chin PT. Levels of brain stem and diencephalon controlling micturition reflex. J Neurophysiol 1955;18:583–95.
Fukuda H, Fukai K, Okada H. Effects of vesical distension on parasympathetic outflow to the colon of dogs. Kawasaki Med J 1983;9:1–10.
Hammer HF, Phillips SF, Camilleri M, Hanson RB. Rectal tone, distensibility, and perception: reproducibility and response to different distensions. Am J Physiol 1998;274:G584–90.
Sun WM, Read NW, Prior A, Daly J, Cheah SK, Grundy D. The sensory and motor responses to rectal distension vary according to the rate and pattern of balloon inflation. Gastroenterology 1990;99:1008–13.
Plourde V, Lembo T, Shui Z,et al. Effects of the somatostatin analogue octreotide on rectal afferent nerves in humans. Am J Physiol 1993;265:G742–5.
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Gosselink, M.J., Schouten, W.R. Rectal sensory perception in females with obstructed defecation. Dis Colon Rectum 44, 1337–1344 (2001). https://doi.org/10.1007/BF02234795
- Obstructed defecation
- Rectal sensory perception
- Distension protocol