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Latency measurement of rectoanal reflexes

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Latency values of rectoanal reflexes may be altered in disorders of the pelvic floor. Evaluation of this relatively uninvestigated aspect of rectoanal reflexes may have diagnostic implications in patients with disorders of defecation. METHODS: We studied the latency of rectoanal inhibitory and excitatory reflexes to sequential balloon distention of the rectum with 60 ml and 120 ml of air in 14 normal controls (mean age, 41.5 (range, 19–66) years), in 14 patients with fecal incontinence (FI) (mean age, 44.2 (range, 28–72) years), and in 14 patients with slow transit constipation (STC) (mean age, 40.6 (range, 22–68) years). RESULTS: The mean latency of inhibition (FI=5.3 seconds; STC=4.6 seconds; controls=5.1 seconds) was remarkably similar for the three groups (P=0.19). The mean latency of excitation in the proximal anal canal (FI=2.8 seconds; STC =2.5 seconds; controls=2.8 seconds) was comparable in the three groups (P=0.58). The mean latency of excitation in the distal anal canal (FI=4.8 seconds; STC=2.6 seconds; controls=2.7 seconds) was prolonged in patients who were incontinent compared with the other two groups (P<0.01). CONCLUSIONS: Proximal rectoanal excitation and inhibitory reflexes, when present, have a constant latency, irrespective of the underlying condition. The different latency values for proximal and distal rectoanal excitatory reflexes in patients with FI may indicate disparate denervation damage to the external anal sphincter.

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References

  1. Denny Brown D, Robertson EG. An investigation of the nervous control of defaecation. Brain 1935;58:256–310.

    Google Scholar 

  2. Read NW, Bartolo DC, Read MG. Differences in anal function in patients with incontinence to solids and in patients with incontinence to liquids. Br J Surg 1984;71:39–42.

    PubMed  CAS  Google Scholar 

  3. Read NW, Haynes WG, Bartolo DC,et al. Use of anorectal manometry during rectal infusion of saline to investigate sphincter function in incontinent patients. Gastroenterology 1983;85:105–13.

    PubMed  CAS  Google Scholar 

  4. Read NW, Abouzekry L. Why do patients with faecal impaction have faecal incontinence? Gut 1986;27:283–7.

    PubMed  CAS  Google Scholar 

  5. Farouk R, Duthie GS, Pryde A, McGregor AB, Bartolo DC. Internal anal sphincter dysfunction in neurogenic faecal incontinence. Br J Surg 1993;80:259–61.

    PubMed  CAS  Google Scholar 

  6. Kumar D, Waldron D, Williams NS. Home assessment of anorectal motility and external sphincter EMG in idiopathic faecal incontinence [abstract]. Br J Surg 1989;76:635–6.

    Google Scholar 

  7. Sun WM, Read NW, Miner PB. Relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence. Gut 1990;31:1056–61.

    PubMed  CAS  Google Scholar 

  8. Buser WD, Miner PB Jr. Delayed rectal sensation with fecal incontinence: successful treatment using anorectal manometry. Gastroenterology 1986;91:1186–91.

    PubMed  CAS  Google Scholar 

  9. Coller JA. Clinical application of anorectal manometry. Gastroenterol Clin North Am 1987;16:17–33.

    PubMed  CAS  Google Scholar 

  10. Coller JA. Computerized anal sphincter manometry performance and analysis. In: Smith LE, ed. Practical guide to anorectal testing. New York: Igaku-Shoin, 1990:65–111.

    Google Scholar 

  11. Roberts PL. Principles of manometry. Semin Colon Rectal Surg 1992;3:64–7.

    Google Scholar 

  12. Scharli AF, Kiesewetter WB. Defecation and continence: some new concepts. Dis Colon Rectum 1970;13:81–107.

    PubMed  CAS  Google Scholar 

  13. Percy JP, Neill ME, Swash M, Parks AG. Electrophysiological study of motor nerve supply of pelvic floor. Lancet 1981;1:16–7.

    Article  PubMed  CAS  Google Scholar 

  14. Bartolo DC, Jarratt JA, Read MG, Donnelly TC, Read NW. The role of partial denervation of the puborectalis in idiopathic faecal incontinence. Br J Surg 1983;70:664–7.

    PubMed  CAS  Google Scholar 

  15. Parks AG, Swash M, Urich H. Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 1977;18:656–65.

    PubMed  CAS  Google Scholar 

  16. Coller JA. Clinical application of anorectal manometry. Gastroenterol Clin North Am 1987;16:17–33.

    PubMed  CAS  Google Scholar 

  17. Sun WM, Read NW. Anorectal function in normal human subjects: effect of gender. Int J Colorectal Dis 1989;4:188–96.

    Article  PubMed  CAS  Google Scholar 

  18. Bannister JJ, Read NW, Donnelly TC, Sun WM. External and internal anal sphincter responses to rectal distension in normal subjects and in patients with idiopathic faecal incontinence. Br J Surg 1989;76:617–21.

    PubMed  CAS  Google Scholar 

  19. Beersiek F, Parks AG, Swash M. Pathogenesis of anorectal incontinence: a histometric study of the anal sphincter musculature. J Neurol Sci 1979;42:111–27.

    Article  PubMed  CAS  Google Scholar 

  20. Swash M, Gray A, Lubowski DZ, Nicholls RJ. Ultrastructural changes in internal anal sphincter in neurogenic fecal incontinence. Gut 1988;29:1692–8.

    PubMed  CAS  Google Scholar 

  21. Gammarota FV, Farouk R, Duthie GS, Bartolo DC. Intermittent electromechanical dissociation of the internal anal sphincter in idiopathic fecal incontinence. G Chir 1993;14:55–9.

    PubMed  CAS  Google Scholar 

  22. Lubowski DZ, Nicholls RJ, Burleigh DE, Swash M. Internal anal sphincter in neurogenic fecal incontinence. Gastroenterology 1988;95:997–1002.

    PubMed  CAS  Google Scholar 

  23. Duthie GS, Miller R, Bartolo DC. Internal anal sphincter electromyographic frequency is related to anal canal resting pressure: both are reduced in idiopathic faecal incontinence [abstract]. Gut 1990;31:A619.

    Google Scholar 

  24. Miller R, Bartolo DC, Cervero F, Mortensen NJ. Anorectal sampling: a comparison of normal and incontinent patients. Br J Surg 1988;75:44–7.

    PubMed  CAS  Google Scholar 

  25. Sun WM, Read NW, Miner PB, Kerrigan DD, Donnelly TC. The role of transient internal sphincter relaxation in faecal incontinence? Int J Colorectal Dis 1990;5:31–6.

    Article  PubMed  CAS  Google Scholar 

  26. Duthie HL, Bennett RC. The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal continence. Gut 1963;4:179–82.

    CAS  PubMed  Google Scholar 

  27. Duthie HL. Dynamics of the rectum and anus. Clin Gastroenterol 1975;4:467–77.

    PubMed  CAS  Google Scholar 

  28. Lubowski DZ, Nicholls RJ, Swash M, Jordan MJ. Neural control of internal anal sphincter function. Br J Surg 1987;74:668–70.

    PubMed  CAS  Google Scholar 

  29. Schuster MM, Hendrix TR, Mendeloff AI. The internal anal sphincter response: manometric studies on its normal physiology, neural pathways, and alteration in bowel disorders. J Clin Invest 1963;42:196–207.

    Article  PubMed  CAS  Google Scholar 

  30. Wald A. Use of biofeedback in treatment of fecal incontinence in patients with meningomyelocele. Pediatrics 1981;68:45–9.

    PubMed  CAS  Google Scholar 

  31. Wald A, Tunuguntla AK. Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. N Engl J Med 1984;310:1282–7.

    Article  PubMed  CAS  Google Scholar 

  32. Rogers J, Henry MM, Misiewicz JJ. Combined sensory and motor deficit in primary neuropathic faecal incontinence. Gut 1988;29:5–9.

    PubMed  CAS  Google Scholar 

  33. Whitehead WE, Orr WC, Engel BT, Schuster MM. External anal sphincter response to rectal distention: learned response or reflex. Psychophysiology 1982;19:57–62.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Colon and Rectal Surgery, Lahey Clinic, 41 Mall Road, 01805, Burlington, Massachusetts

    Yash P. Sangwan M.D.,  John A. Coller M.D., David J. Schoetz Jr. M.D., John J. Murray M.D. & Patricia L. Roberts M.D.

Authors
  1. Yash P. Sangwan M.D.
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  2. John A. Coller M.D.
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  3. David J. Schoetz Jr. M.D.
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  4. John J. Murray M.D.
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  5. Patricia L. Roberts M.D.
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Additional information

Read in part at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994.

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Sangwan, Y.P., Coller, J.A., Schoetz, D.J. et al. Latency measurement of rectoanal reflexes. Dis Colon Rectum 38, 1281–1285 (1995). https://doi.org/10.1007/BF02049153

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  • DOI: https://doi.org/10.1007/BF02049153

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