Rectal compliance: a critical reappraisal

Madoff, Robert D.; Orrom, W. J.; Rothenberger, David A.; Goldberg, Stanley M.

doi:10.1007/bf00496148

Cited by 85 publications

(47 citation statements)

References 8 publications

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“…The method avoids most sources of error associated with volume based methods. 12 At a constant current I, the potential difference (DV) between two detection electrodes and the CSA are proportionally related (CSA¼I d s À1 DV À1 ). The electrodes were 3 mm (d) apart and contained in a fluid with the conductivity s. The rectal probe, used in the present study, had two excitation electrodes (60 mm apart), providing a sinusoidal current of 0.1 mA at 10 kHz, and a pair of detection electrodes (Figure 1).…”

Section: Impedance Planimetrymentioning

confidence: 99%

“…5,17 There are, however, some methodological problems with these techniques. 12 Impedance planimetry determines rectal CSA, thereby avoiding some of the inherent sources of error with pressure-volume measurements. 18 The impedance planimetry probe used for this experiment was validated in vitro and accuracy was fair with a mean error of 7.3% (range: 0-14%).…”

Section: Electrical Stimulation Of the Dgn Vs Spinal Cord Injury J Womentioning

confidence: 99%

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Acute effect of electrical stimulation of the dorsal genital nerve on rectal capacity in patients with spinal cord injury

et al. 2012

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Background: Constipation and fecal incontinence are considerable problems for most individuals with spinal cord injury (SCI). Neurogenic bowel symptoms are caused by several factors including abnormal rectal wall properties. Stimulation of the dorsal genital nerve (DGN) can inhibit bladder contractions and because of common innervation inhibitory effects are anticipated in the rectum too. Therefore, DNG could have a future role in the treatment of neurogenic fecal incontinence. Aim: To study the effect of acute DGN stimulation on the rectal cross sectional area (CSA) in SCI patients. Methods: Seven patients with complete supraconal SCI (median age 50 years) were included. Stimulation was applied via plasterelectrodes using an amplitude of twice the genito-anal reflex threshold (pulse width: 200 ms; pulse rate: 20 Hz). A pressure controlled phasic (10, 20 and 30 cmH 2 O) rectal distension protocol was repeated four times with subjects randomized to stimulation during 1st and 3rd distension series or 2nd and 4th distension series. The rectal CSA and pressure were measured using impedance planimetry and manometry. Results: All patients completed the investigation. Median stimulation amplitude was 51 mA (range 30-64). CSA was smaller during stimulation and differences reached statistical significance at distension pressures of 20 cmH 2 O (average decrease 9%; P¼0.02) and 30 cmH 2 O (average decrease 4%; P¼0.03) above resting rectal pressure. Accordingly, rectal pressure-CSA relation was significantly reduced during stimulation at 20 (P¼0.03) and 30 cmH 2 O distension (P¼0.02). Conclusion: DGN Stimulation in patients with supraconal SCI results in an acute decrease of rectal CSA and the rectal pressure-CSA relation.

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Section: Impedance Planimetrymentioning

confidence: 99%

Section: Electrical Stimulation Of the Dgn Vs Spinal Cord Injury J Womentioning

confidence: 99%

Acute effect of electrical stimulation of the dorsal genital nerve on rectal capacity in patients with spinal cord injury

et al. 2012

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“…In older studies, rectal compliance was estimated using simultaneous measurements of rectal pressure and volume [2, 8]. Pressure-volume data may, however, be biased since elongation of the bag in the axial direction is likely to occur [7, 8]. The compliance defined as the slope of the pressure-volume curve varies throughout the colon; it is greater in the transverse colon than in the sigmoid colon [22].…”

Section: Discussionmentioning

confidence: 99%

“…This is further emphasized by the fact that the distal GI tract is tubular rather than globular. Most data obtained in vivo are based on computation of compliance from pressure and volume measurements [8]. However, the compliance parameter suffers greatly from the fact that the unloaded size of the organ is ignored and that volume may not be uniquely related to cross-sectional area in distension tests due to elongation of the bag.…”

Section: Introductionmentioning

confidence: 99%

Sensory and Biomechanical Responses to Distension of the Normal Human Rectum and Sigmoid Colon

Petersen¹,

Gao

Rössel³

et al. 2001

Digestion

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Background: Visceral pain is a major clinical problem. The aim of the present study was to compare the pain and biomechanical responses to standardized distension of the human colon. Methods: The relation between pain intensity and pressure, cross-sectional area (CSA) and tension-strain relations of the rectum and sigmoid colon were studied in 11 normal subjects following standardized distension using impedance planimetry. The bag was inflated stepwise with pressures up to 6 kPa. The subjects, who were blinded for the distension procedure, rated their pain intensity using an aggregate visual analogue score (VAS) combining the intensity of the feeling of air, urge to defecate and pain. Results: The distensions produced an initial rapid increase in CSA followed by a phase of slow increase until a steady state CSA was reached after 0.5–1 min. Several phasic contractions (observed as short-term decreases in the CSA) were recorded in the rectum from the end of the rapid phase to the end of distension at pressures from 1 to 5 kPa. The CSA in the rectum and sigmoid colon was 3,706 ± 426 mm² and 2,305 ± 426 mm² at the maximum bag pressure of 6 kPa (F = 52.4, p < 0.001). The tension-strain relation did not differ between the normal rectum and sigmoid colon. The VAS score for every modality (air, defecation and pain) revealed an increase in intensity as a function of pressure. The VAS score in the rectum and the sigmoid colon as a function of tension and strain did not show any differences. Conclusions: The biomechanical properties in the sigmoid colon and rectum were alike. For a given wall tension and circumferential strain the sensibility seems equal in the rectum and the sigmoid colon. The observed difference in perception between the two segments was related to the greater CSA in the rectum.

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“…Other methods are based on simultaneous measurements of pressure and volume during distension and have been ap plied especially in the rectum because of the easy access to this area [33], However, a major problem using measurement of vol ume is that the balloon would tend to elon gate in longitudinal direction because of the resistance to distension in radial direction. Hereby, parameters such as tension and compliance would be overestimated [34], In contrast, a possible elongation of the balloon is unimportant for the measured cross-sec tional area.…”

Section: Discussionmentioning

confidence: 99%

Impedance Planimetry: A New Approach to Biomechanical Intestinal Wall Properties

Gregersen

Djurhuus²

1991

Dig Dis

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Ths paper surveys impedance planimetry, a technique based on the measurement of electrical impedance for estimation of active and passive biomechanical wall properties of the intact intestine. The paper mainly concerns methodological aspects of the recording technique and possible sources of error. Furthermore, the historical background concerning developments of the technique and physiological results during the last two decades are described.

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Rectal compliance: a critical reappraisal

Cited by 85 publications

References 8 publications

Acute effect of electrical stimulation of the dorsal genital nerve on rectal capacity in patients with spinal cord injury

Acute effect of electrical stimulation of the dorsal genital nerve on rectal capacity in patients with spinal cord injury

Sensory and Biomechanical Responses to Distension of the Normal Human Rectum and Sigmoid Colon

Impedance Planimetry: A New Approach to Biomechanical Intestinal Wall Properties

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