Prolonged multi-point recording of colonic manometry in the unprepared human colon: providing insight into potentially relevant pressure wave parameters

Abstract

Prolonged, multipoint, perfusion manometry of the unprepared colon provides improved spatial resolution of colonic motor patterns and confirms the diurnal and regional variations in propagating pressure waves detected in the prepared colon. The study demonstrates differences between high amplitude propagating sequences and propagating sequence parameters that may have functional significance; and also, that the rectal motor complex is a ubiquitous pan colonic motor pattern.

The Physiology of Human Defecation

“…In one study in volunteers, it was shown that out of 27 instances of perceived urge to defecate, 26 were associated with a propagated sequence, of which 62% were associated with HAPSs [121]. This study also showed that propagated sequences were more likely to result in urge during the 1 h pre-expulsive phase (as compared to the basal phase), and that sequences that propagated further were more likely to result in an urge.…”

“…Colonic motor activity shows a circadian pattern, in that it increases after awakening [117] and is higher during the day compared to the night [117][118][119][120]. Colonic activity also increases after meals (see above) [117,120,121]. Patients with constipation may lack the nocturnal suppression of colonic activity [122] and exhibit reduced colonic responses to food [122][123][124][125], as well as lacking spatio-temporal organization of colonic contractile patterns [126].…”

“…Although HAPCs can originate anywhere in the colon, they do so mostly in the proximal colon and then migrate distally for a variable distance [117,120,121,147]. The distance of propagation correlates with the proximity of the site of origin to the caecum [120,121,147]. One study found that only a third of the HAPSs reached the anus, the remainder terminating at the rectosigmoid region [117].…”

“…These typically have amplitude \50 mmHg [156], occur 40-120 times in a 24 h period [117,147,157], and propagate for distances \22.5 cm [121]. Studying the relation between frequency of PSs and constipation, some authors have found a reduced frequency in obstructed defecation [122] and slow transit constipation [155]; others have found no difference [151].…”

“…In adults, HAPCs occur, on average, 5-6 times a day (range 2-24) [116], whereas the frequency of HAPCs is significantly greater in children younger than 4 years of age [14], which likely correlates to the increased number of bowel movements in infants/toddlers. Although HAPCs can originate anywhere in the colon, they do so mostly in the proximal colon and then migrate distally for a variable distance [117,120,121,147]. The distance of propagation correlates with the proximity of the site of origin to the caecum [120,121,147].…”