Parameters of the rectoanal inhibitory reflex in patients with idiopathic fecal incontinence and chronic constipation

Zbar, Andrew P.; Aslam, Mohammed; Gold, D. M.; Gatzen, Christopher; Gosling, Amy; Kmiot, W. A.

doi:10.1007/bf02238249

Cited by 86 publications

(77 citation statements)

References 26 publications

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“…It is believed that the physiological significance of recto-anal evacuatory activity is mainly attributed to the autonomic recto-anal inhibitory reflex underlying the functional nature of rectal discrimination. The recto-anal inhibitory reflex consists of distension-evoked rectal reflex contraction and synchronous internal anal sphincter reflex relaxation, highlighting the importance of the propulsive capacity of the internal anal sphincter [13][14][15][16][17] . The contribution of recto-anal neurotransmission to the contractile and/or relaxant activity of the internal and external anal sphincters requires further investigation.…”

Section: Introductionmentioning

confidence: 99%

Locality-dependent descending reflex motor activity in the anal canal–cholinergic and nitrergic contributions in the rat model

et al. 2009

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Aim: Since the distal part of the intestine is targeted by a wide range of pathogens, the motility of the recto-anal region has been the object of many experimental and clinical observations. In this study, we investigated descending motor responses in the anal canal as a measure of the activation of autonomic reflex pathways underlying evacuatory recto-anal activity. Methods: The partitioned organ bath method was used to register motor responses of the anal canal as induced by balloon distension of the rectum in isolated rat recto-anal preparations. Results: Distension-induced descending responses of the anal canal comprised contractions (with distension at a distance of 15 mm), initial contractions and secondary relaxations (at 10 mm) and short contractions followed by deep relaxations (at 3−5 mm). Decreasing the distance between the distension stimulus and the anal canal resulted in a decreased contraction response and increased relaxation. Tetrodotoxin (0.1 μmol/L) inhibited these responses. Atropine (0.3 μmol/L) decreased contraction and did not change the relaxation response. N G -nitro-L-arginine (0.5 mmol/L) enhanced contraction in both the absence and presence of atropine. L-arginine (0.5 mmol/L) inhibited contraction and extended relaxation in atropine-pretreated preparations. The actions of N G -nitro-L-arginine and L-arginine were more pronounced in the aboral direction. ChAT-positive nerve fibers were observed in myenteric ganglia of the rectum and the anal canal. The density of NADPH-diaphorase-positive neurons was higher in the anal canal region. Conclusion: Our results suggest that locality-dependent activation of the descending reflex neuromuscular communications underlie evacuatory activity in the recto-anal region. This activation response involves long excitatory cholinergic and non-cholinergic pathways along the rectum and short inhibitory nitrergic pathways located predominantly in the anal canal region.

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Section: Introductionmentioning

confidence: 99%

Locality-dependent descending reflex motor activity in the anal canal–cholinergic and nitrergic contributions in the rat model

et al. 2009

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“…Rectoanal inhibitory reflex (RAIR) is considered to play an important role in the mechanism of evacuation (8,16,21) . Morphologic alterations of RAIR components have been associated to anorectal dysfunctions, including intestinal constipation and anal incontinence (15,23) . Moreover, RAIR may be abnormal in Chagas' disease (3,9) , due to the absence of relaxation of the internal anal sphincter, however, rectal contractions are occasionally observed (11) .…”

Section: Introductionmentioning

confidence: 99%

Prevalence of rectoanal inhibitory reflex in chagasic megacolon

Cavenaghi

Felicio

Ronchi

et al. 2008

Arq. Gastroenterol.

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BACKGROUND: Rectoanal inhibitory reflex is not always evident in patients with chagasic megacolon. This may be due to insufficient volumes of air used during insufflation for the manometric examination. AIMS: To identify the volume of air necessary to induce rectoanal inhibitory reflex in patients with chagasic megacolon and to observe its prevalence in these individuals. METHODS: Rectoanal inhibitory reflex in 39 patient with chagasic megacolon was studied by means of anorectal manometry using the balloon method. The balloon was insufflated using sequential volumes up to 300 mL to induce reflex. RESULTS: Rectoanal inhibitory reflex was identified in 43.6% of the patients using a mean volume of 196 mL of insufflated air (standard error = 13.5). CONCLUSION: Rectoanal inhibitory reflex can be induced in patients with chagasic megacolon when greater volumes of air are used.

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“…Zbar et al (1998) 44 atribuíram este fenômeno a diferentes respostas da musculatura esfincteriana, em diferentes níveis do canal anal, à distensão retal. Porém não são relatados estudos comparando este fenômeno entre os quadrantes em um mesmo nível.…”

Section: Grupo 1 (Mmhg) Grupo 2 (Mmhg)unclassified

“…No entanto, apesar da importância do RIRA no mecanismo da evacuação, este reflexo vem sendo pouco explorado pelos pesquisadores, sendo na maio-ria das vezes apenas analisado como presente, ausente ou inconclusivo ( 8,14,17,20,22,23,27,41,42,46). Recentemente, diversos autores (15,18,19,33,34,44,45,47) vêm estudando outros aspectos do RIRA, como a amplitude de relaxamento nos diferentes níveis do canal anal, na duração e velocidade de recuperação.…”

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Estudo de parâmetros do reflexo inibitório retoanal em multíparas, na zona de alta pressão com catéter radial

Leal

Coy

Fagundes

et al. 2006

Rev bras. colo-proctol.

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Trabalho realizado no Seviço de Colo-Proctologia -Disciplina de Moléstias do Aparelho Digestivo -UNICAMP -SÃO PAULO -BRASIL. Recebido em 09/08/2006 Aceito para publicação em 29/08/2006 INTRODUÇÃOO desenvolvimento de métodos diagnósticos tem proporcionado melhor compreensão da fisiologia anorretal e dos distúrbios da evacuação, com abordagens terapêuticas mais eficazes. Dentre estes, a manometria anorretal possibilita, além das medidas de pressão de repouso e contração voluntária, a pesquisa do reflexo inibitório retoanal (RIRA). Descrito por Gowers em 1887 16 e posteriormente confirmado por Denny-Brown e Robertson 9 em 1935, sua importância tem sido enfatizada nos mecanismos de evacuação e continência (18,33,44). Ocorrendo a distensão do reto, segue-se o relaxamento do esfíncter anal interno, permitindo contato do conteúdo retal com a porção proximal do canal anal (24). Assim, estimulam-se terminações nervosas que transmitirão a discriminação deste conteúdo, permitindo a diferenciação entre gases e fezes sólidas ou líquidas (11,25).No entanto, apesar da importância do RIRA no mecanismo da evacuação, este reflexo vem sendo pouco explorado pelos pesquisadores, sendo na maio-

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Parameters of the rectoanal inhibitory reflex in patients with idiopathic fecal incontinence and chronic constipation

Cited by 86 publications

References 26 publications

Locality-dependent descending reflex motor activity in the anal canal–cholinergic and nitrergic contributions in the rat model

Locality-dependent descending reflex motor activity in the anal canal–cholinergic and nitrergic contributions in the rat model

Prevalence of rectoanal inhibitory reflex in chagasic megacolon

Estudo de parâmetros do reflexo inibitório retoanal em multíparas, na zona de alta pressão com catéter radial

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