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Rectoanal reflex parameters in incontinence and constipation.
Dis Colon Rectum. 2002 Jul; 45(7):928-33.DC

Abstract

PURPOSE

The transient relaxation of the internal anal sphincter in response to rectal distention is believed to play an important role in the continence mechanism. Most anorectal physiology laboratories merely report the rectoanal inhibitory reflex as being either present or absent. This study aimed to assess the parameters of the rectoanal inhibitory reflex in incontinent and constipated patients and healthy control subjects, in an attempt to analyze differences in internal anal sphincter function in these groups. We analyzed each response of the internal anal sphincter to rectal distention with progressively increasing volumes of air at a single site (proximal anal canal).

METHODS

Fifty-five constipated and 99 incontinent patients and healthy control subjects underwent manometry. Various parameters of the rectoanal inhibitory reflex were analyzed, and percentage sphincter relaxation was calculated at each volume at which rectoanal inhibitory reflex occurred.

RESULTS

There was no difference in the volume of rectal distention required to elicit sensation (P = 0.626) or the rectoanal inhibitory reflex (P = 0.371) in the three groups. There was a significant correlation between the volume required to elicit the rectoanal inhibitory reflex and that at which sensation was first felt only in the incontinent (P = 0.0001) group. Significantly greater sphincter relaxation was seen at each volume (P = 0.001) in the incontinent as compared with the constipated patients. With progressive rectoanal inhibitory reflex, consistently progressive increases in internal anal sphincter relaxation were found only in the incontinent group. This consistent relationship was not seen in the constipated patients or in healthy control subjects.

CONCLUSIONS

Assessment of various parameters of the rectoanal inhibitory reflex yielded important information regarding the continence mechanism. Altered responses of the internal anal sphincter in anorectal disorders plays a role in the associated physiologic impairment. This may have significant clinical implications with regard to sphincter-saving resections.

Authors+Show Affiliations

Academic Surgical Unit, Castle Hill Hospital, University of Hull Postgraduate Medical School, Cottingham, United Kingdom.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12130882

Citation

Kaur, Geetinder, et al. "Rectoanal Reflex Parameters in Incontinence and Constipation." Diseases of the Colon and Rectum, vol. 45, no. 7, 2002, pp. 928-33.
Kaur G, Gardiner A, Duthie GS. Rectoanal reflex parameters in incontinence and constipation. Dis Colon Rectum. 2002;45(7):928-33.
Kaur, G., Gardiner, A., & Duthie, G. S. (2002). Rectoanal reflex parameters in incontinence and constipation. Diseases of the Colon and Rectum, 45(7), 928-33.
Kaur G, Gardiner A, Duthie GS. Rectoanal Reflex Parameters in Incontinence and Constipation. Dis Colon Rectum. 2002;45(7):928-33. PubMed PMID: 12130882.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rectoanal reflex parameters in incontinence and constipation. AU - Kaur,Geetinder, AU - Gardiner,Angela, AU - Duthie,Graeme S, PY - 2002/7/20/pubmed PY - 2002/8/17/medline PY - 2002/7/20/entrez SP - 928 EP - 33 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 45 IS - 7 N2 - PURPOSE: The transient relaxation of the internal anal sphincter in response to rectal distention is believed to play an important role in the continence mechanism. Most anorectal physiology laboratories merely report the rectoanal inhibitory reflex as being either present or absent. This study aimed to assess the parameters of the rectoanal inhibitory reflex in incontinent and constipated patients and healthy control subjects, in an attempt to analyze differences in internal anal sphincter function in these groups. We analyzed each response of the internal anal sphincter to rectal distention with progressively increasing volumes of air at a single site (proximal anal canal). METHODS: Fifty-five constipated and 99 incontinent patients and healthy control subjects underwent manometry. Various parameters of the rectoanal inhibitory reflex were analyzed, and percentage sphincter relaxation was calculated at each volume at which rectoanal inhibitory reflex occurred. RESULTS: There was no difference in the volume of rectal distention required to elicit sensation (P = 0.626) or the rectoanal inhibitory reflex (P = 0.371) in the three groups. There was a significant correlation between the volume required to elicit the rectoanal inhibitory reflex and that at which sensation was first felt only in the incontinent (P = 0.0001) group. Significantly greater sphincter relaxation was seen at each volume (P = 0.001) in the incontinent as compared with the constipated patients. With progressive rectoanal inhibitory reflex, consistently progressive increases in internal anal sphincter relaxation were found only in the incontinent group. This consistent relationship was not seen in the constipated patients or in healthy control subjects. CONCLUSIONS: Assessment of various parameters of the rectoanal inhibitory reflex yielded important information regarding the continence mechanism. Altered responses of the internal anal sphincter in anorectal disorders plays a role in the associated physiologic impairment. This may have significant clinical implications with regard to sphincter-saving resections. SN - 0012-3706 UR - https://www.unboundmedicine.com/medline/citation/12130882/Rectoanal_reflex_parameters_in_incontinence_and_constipation_ L2 - http://link.springer.com/article/10.1007/s10350-004-6331-9 DB - PRIME DP - Unbound Medicine ER -