Gastrointestinal transit and prolonged ambulatory colonic motility in health and faecal incontinence

Abstract

Background-Colonic motor function has not been studied in the ambulatory setting over a prolonged period in the unprepared state. Furthermore, the disturbance of this function in patients with faecal incontinence is unknown. Aim-To study colonic function over two to three days in the ambulatory, unprepared state in health and in patients with idiopathic faecal incontinence. Methods-Six healthy women and six women with faecal incontinence and a structurally intact anal sphincter ingested a dual radioisotope meal, and had a six sensor, solid state manometric probe colonoscopically inserted into the left colon. Scanning was performed until radioisotope left the gut and pressure was recorded for a median of 44 hours. Results-Three of six patients showed abnormal gastric emptying. Patients showed no disturbance of colonic radioisotope transit. Controls had a median of 12, whereas patients had a median of 16, high amplitude propagated waves per 24 hours. In three patients urge incontinence was associated with high amplitude (up to 500 cm water) propagated waves which often reached the rectum. These high pressure waves were identical to those occuring in healthy subjects, the only diVerence being the lack of adequate sphincter response. Passive incontinence was not associated with colonic motor activity. Defaecation in all subjects was associated with identical propagated waves, and distal movement of 13% (median) of right colonic content and excretion of 32% from the left colon and rectum. The urge to defaecate was associated with either propagated waves (45%) or non-propagated contractions (55%). Rectal motor complexes were recorded in both groups of subjects, but similar rhythmic activity was also recorded in the sigmoid and descending colon. Conclusions-Normal colonic function consists of frequent high pressure propagated waves. Rhythmic activity occurs both proximal to and in the rectum. Defaecation is characterised by high pressure propagated waves associated with coordinated anal sphincter relaxation. Patients with faecal incontinence may have a widespread disturbance of gut function. Urge incontinence, an urge to defaecate, and defaecation can all be associated with identical high amplitude propagated pressure waves.

Exploring gastrointestinal variables affecting drug and formulation behavior: Methodologies, challenges and opportunities

“…the number of retrograde propagating sequences and the number of high-amplitude propagating sequences) is reduced in adults with functional constipation as compared to healthy subjects (Dinning et al, 2013). In adults with functional diarrhea, the number of high and low amplitude anterograde propagating sequences was increased, while simultaneous and retrograde activity was less frequent (Herbst et al, 1997). A similar increase in anterograde propagating sequences has been observed in patients with moderately active ulcerative colitis, but not in patients in remission (Bassotti et al, 2014).…”

“…During the first 30 minutes after the meal, the presence of simultaneous and retrograde sequences in the sigmoid colon is associated with movement of colonic contents in retrograde direction (Bazzocchi et al, 1990). After this period, the colonic contents move both in anterograde and retrograde direction until the occurrence of the high-amplitude propagating sequences, which normally move the majority of colonic contents from the proximal part (transverse) to the distal colon, inducing the sensation and, in a next step, the activation of defecation (Bazzocchi et al, 1990;Herbst et al, 1997). Anterograde and retrograde low-amplitude propagating sequences are believed to play a major role in the mixing function, which allows the colon to absorb water and nutrients and slow the progression of luminal contents (Phillips, 1984).…”

Rectal sensorimotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies

“…19 All episodes of urge incontinence were associated with propagation of HAPCs from the transverse colon to the rectum. 19 HAPCs are the major motor correlates of mass intraluminal movement, 26 and there is a clear association with both the urge to defecate 22 27 and faecal expulsion.…”

“…Numerous studies have used prolonged ambulatory manometry to investigate colonic contractile activity in normal subjects and patients with constipation, [19][20][21][22][23] but few studies have used this technique to address possible colorectal dysmotility in faecal incontinence. 19 24 Colorectal motility comprises a number of distinct phasic contractile activities, both isolated and in recognisable patterns. 25 Two components, high amplitude contractions and rectal motor complexes (RMC), have been shown to be functionally important in patients with faecal incontinence.…”

“…24 The RMC is a subconscious intrinsic motor programme comprising regular cyclical bursts of phasic pressure waves. 19 23 30-32 The function of the RMC remains unclear but is thought to represent localised segmental activity. 31 32 It now appears that the RMC, although predominant in the rectosigmoid region, is indeed manifest throughout the colon, where it has been termed the colonic motor complex.…”