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ANORECTAL DISEASE |
1 Centre for Academic Surgery, Barts and the London, Queen Mary’s School of Medicine and Dentistry, London, UK
2 Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
Correspondence to:
Correspondence to:
Dr S M Scott
Centre for Academic Surgery, GI Physiology Unit, 3rd Floor Alexandra Wing, Royal London Hospital, Whitechapel, London E1 1BB, UK; m.scott{at}qmul.ac.uk
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.
Abbreviations: ANOVA, analysis of variance; AUC, area under the curve; CS, control subjects; EAS, external anal sphincter; DDV, defecatory desire volume; HAC, high amplitude contraction; HADS, hospital anxiety and depression scale; HAPC, high amplitude propagated contraction; IAS, internal anal sphincter; IBS, irritable bowel syndrome; MTV, maximum tolerable volume; NS, normal rectal sensation; PNTML, pudendal nerve terminal motor latency; RH, rectal hypersensitivity; RMC, rectal motor complex; SCID, structured and clinical interview for DSM-III-R; UFI, urge faecal incontinence
Keywords: rectal sensorimotor dysfunction; urge faecal incontinence; manometry
This article has been cited by other articles:
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  C. Andrews, A. E. Bharucha, B. Seide, and A. R. Zinsmeister Rectal sensorimotor dysfunction in women with fecal incontinence Am J Physiol Gastrointest Liver Physiol, January 1, 2007; 292(1): G282 - G289. [Abstract] [Full Text] [PDF]
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