Abstract
PURPOSE: Sensation is an essential aspect of fecal continence. We aimed to correlate manovolumetric and radiologic changes at successive levels of rectal filling sensation. METHODS: Combined anorectal manometry and proctography were performed in nine volunteers. Images, volumes, and pressures were analyzed at the start of the test, at 20 seconds before first sensation, and at first, constant, urge, and maximum tolerable sensation. RESULTS: Consecutive levels of rectal filling sensation were associated with progressive opening and dilation of the upper anal canal (up to 44 mm) and sliding down of the rectal contents (14 mm), which had already started before the first sensation. This coincided initially with a pressure decrease in the proximal anal canal (from 94 to 42 mmHg). With constant sensation and particularly with urge sensation, rectal pressure increase appeared to be responsible for further proximal anal dilation. This was accompanied by a significant increase of proximal anal pressure (up to 133 mmHg) and sharpening of the angle between the anal axis and the horizontal reference line. CONCLUSION: The proximal anal canal or its surrounding structures play an important role in the desire-to-defecate sensation. They can be activated by a progressive buildup of rectal reservoir pressure in the presence of a competent distal anal sphincter barrier.
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References
HL Duthie RC Bennet (1963) ArticleTitleThe relation of sensation in the anal canal to the functional anal sphincter Gut 4 179–182
R Miller GT Lewis DC Bartolo F Cervero NJ Mortensen (1988) ArticleTitleSensory discrimination and dynamic activity in the anorectum Br J Surg 75 1003–1007
J Melzack NH Porter (1964) ArticleTitleStudies on the reflex activity of the external sphincter ani in spinal man Paraplegia 1 277–296
JC Goligher ES Hughes (1951) ArticleTitleSensibility of the rectum and colon Lancet 1 543–547
T Ihre (1974) ArticleTitleStudies on the anal function in continent and incontinent patients Scand J Gastroenterol 9 5–64
P Arhan C Faverdin B Persoz et al. (1976) ArticleTitleRelationship between viscoelastic properties of the rectum and anal pressure in man J Appl Physiol 41 677–682
P Arhan G Devroede B Persoz C Faverdin C Dornic D Pellerin (1979) ArticleTitleResponse of the anal canal to repeated distention of the rectum Clin Invest Med 2 83–88
MJ Farthing JE Lennard-Jones (1978) ArticleTitleSensibility of rectum to distension and anorectal distension reflex in ulcerative colitis Gut 19 64–69
FM Penninckx B Lestár RP Kerremans (1989) ArticleTitleA new balloon-retaining test for evaluation of anorectal function in incontinent patients Dis Colon Rectum 32 202–205
PM Broens FM Penninckx B Lestar RP Kerremans (1994) ArticleTitleThe trigger for rectal filling sensation Int J Colorectal Dis 9 1–4
DM Preston JE Lennard-Jones BM Thomas (1984) ArticleTitleThe balloon proctogram Br J Surg 71 29–32
CJ Lahr DA Rothenberger LL Jenssen SM Goldberg (1986) ArticleTitleBalloon topography Dis Colon Rectum 29 1–5
R Kerremans (1968) ArticleTitleRadio-cinematographic examination of the rectum and the anal canal in cases of rectal constipation Acta Gastroenterol Belg 31 561–570
P Mahieu J Pringot P Bodart (1984) ArticleTitleDefecography. I. Description of a new procedure and results in normal patients Gastrointest Radiol 9 247–251
RH Lane AG Parks (1977) ArticleTitleFunction of the anal sphincters following colo-anal anastomosis Br J Surg 64 596–599
N Williams F Seow-Choen (1998) ArticleTitlePhysiological and functional outcome following ultra-low anterior resection with colon pouch anal anastomosis Br J Surg 85 1029–1035
R Annibali T Oresland L Hulten (1994) ArticleTitleDoes the level of stapled ileoanal anastomosis influence physiologic and functional outcome? Dis Colon Rectum 37 321–329
PA Goldberg MA Kamm RJ Nicholls G Morris KE Britton (1997) ArticleTitleContribution of gastrointestinal transit and pouch characteristics in determining pouch function Gut 40 790–793
P Broens F Penninckx (2002) ArticleTitleFilling sensations after restorative proctocolectomy Acta Chir Belg 102 20–23
G Winckler (1958) ArticleTitleRemarques sur la morphologie et l’innervation du muscle releveur de l’anus Arch Anat 41 77–95
F Penninckx B Lestar R Kerremans (1995) ArticleTitleManometric evaluation of incontinent patients Acta Gastroenterol Belg 58 51–59
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Broens, P., Vanbeckevoort, D., Bellon, E. et al. Combined Radiologic and Manometric Study of Rectal Filling Sensation. Dis Colon Rectum 45, 1016–1022 (2002). https://doi.org/10.1007/s10350-004-6353-3
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DOI: https://doi.org/10.1007/s10350-004-6353-3