Rectal sensorimotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies
Open Access
- 1 September 2005
- Vol. 54 (9), 1263-1272
- https://doi.org/10.1136/gut.2005.071613
Abstract
Background and aims: Although external anal sphincter dysfunction is the major cause of urge faecal incontinence, approximately 50% of such patients have evidence of rectal hypersensitivity and report exaggerated stool frequency and urgency. The contribution of rectosigmoid contractile activity to the pathophysiology of this condition is unclear, and thus the relations between symptoms, rectal sensation, and rectosigmoid motor function were investigated. Methods: Fifty two consecutive patients with urge faecal incontinence, referred to a tertiary surgical centre, and 24 volunteers, underwent comprehensive anorectal physiological investigation, including prolonged rectosigmoid manometry. Patients were classified on the basis of balloon distension thresholds into those with rectal hypersensitivity (n = 27) and those with normal rectal sensation (n = 25). Automated quantitative analysis of overall rectosigmoid contractile activities and, specifically, high amplitude contractions and rectal motor complex activity was performed. Results: External anal sphincter dysfunction was similar in both patient groups. Overall, phasic activity and high amplitude contraction frequency were greater, and rectal motor complex variables significantly altered, in those with rectal hypersensitivity. Symptoms, more prevalent in the rectal hypersensitivity group, were also more often associated with rectosigmoid contractile events. For individuals, reduced compliance and increased rectal motor complex frequency were only observed in patients with rectal hypersensitivity. Conclusions: We have identified a subset of patients with urge faecal incontinence—namely, those with rectal hypersensitivity—who demonstrated increased symptoms, enhanced perception, reduced compliance, and exaggerated rectosigmoid motor activity. Comprehensive assessment of rectosigmoid sensorimotor function, in addition to evaluation of anal function, should be considered in the investigation of patients with urge faecal incontinence.Keywords
This publication has 72 references indexed in Scilit:
- Sensitisation of gastrointestinal tract afferentsGut, 2004
- The management of pelvic floor disordersAlimentary Pharmacology & Therapeutics, 2004
- Murine intestinal migrating motor complexes: longitudinal componentsNeurogastroenterology & Motility, 2003
- Principles of applied neurogastroenterology: physiology/motility-sensationGut, 1999
- Contractile activity of the human colon: lessons from 24 hour studies.Gut, 1993
- Assessment by prolonged ambulatory manometry of the effect of oral cisapride on proximal small bowel inter-digestive motilityDigestive Diseases and Sciences, 1992
- Colorectal and anal motility during defaecationThe Lancet, 1992
- Anorectal sampling: A comparison of normal and incontinent patientsBritish Journal of Surgery, 1988
- Anorectal Sensorimotor Dysfunction in Fecal Incontinence and Diabetes MellitusNew England Journal of Medicine, 1984
- FAECAL INCONTINENCE: THE UNVOICED SYMPTOMThe Lancet, 1982