Rectal Hyposensitivity: A Disorder of the Rectal Wall or the Afferent Pathway? An Assessment Using the Barostat

Gladman, Marc A.; Dvorkin, Lee; Lunniss, Peter J.; Williams, Norman S.; Scott, S. M.

doi:10.1111/j.1572-0241.2005.40021.x

Cited by 73 publications

(82 citation statements)

References 53 publications

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“…We and others observed an increased intrarectal BVP demonstrating an impaired sensation at least in some FI patients [8,9,10,16,36]. This impaired sensation may be the result of an anatomic or pathophysiologic (flaccid wall tension/decreased compliance) megarectum or a rectal afferent pathway disorder [37]. …”

Section: Discussionmentioning

confidence: 99%

Accuracy of Anorectal Manometry in Patients with Fecal Incontinence

et al. 2012

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Background/Aim: Patients with fecal incontinence (FI) have lower anal resting (MRP) and squeeze (MSP) pressure and an impaired sensitivity compared to healthy people. However, whether anorectal manometry (ARM) can separate precisely between health and disease is discussed controversially. The aim was to evaluate the accuracy of ARM in a huge cohort of patients and controls. Methods: ARM was obtained in 144 controls and in 559 FI patients. MRP, MSP, and balloon volume at first perception (BVP) and urge sensation (BVU) were determined. Receiver operating curve analysis was used to determine optimal cut-offs and sensitivity, specificity and accuracy calculated. Results: FI patients showed lower MRP, MSP, BVU (p < 0.001) and a higher BVP (p = 0.007). Deterioration of the ARM parameter increased with FI severity. ARM demonstrated an excellent sensitivity (91.4%) and accuracy (85.8%), but only a moderate specificity (62.5%). The sensitivity of ARM rose with FI severity. The pressure data showed higher sensitivity and accuracy than the sensory data despite comparable specificity. Conclusions: Sensitivity and accuracy of single ARM parameters is only moderate for the pressure data and poor for the sensory data. In contrast, ARM demonstrated an excellent sensitivity, a moderate specificity, and a convincing accuracy justifying its use in clinical routine.

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Section: Discussionmentioning

confidence: 99%

Accuracy of Anorectal Manometry in Patients with Fecal Incontinence

et al. 2012

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“…The advantage of the barostat procedure is that the characteristics of the rectal bag do not Coloproctology DOI 10.1007/978-3-319-10154-5_8-1 # Springer International Publishing Switzerland 2015 interfere with the measurements. Rectal volumes measured with the latex balloon are smaller than with the polyethylene balloon Gladman et al 2005).…”

Section: Rectal Compliance Capacity and Sensitivitymentioning

confidence: 98%

Physiology of the Rectum and Anus

Felt‐Bersma¹

2015

Coloproctology

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The anorectal area is a complex area where autonomic and somatic structures coordinate to maintain continence and to regulate defecation. The fecal bolus entering the rectum is perceived, and by a reflex mechanism, the internal anal sphincter relaxes and allows the content to enter the proximal anal canal, where depending on content and situation conscious relaxation or contraction of the external anal sphincter and puborectal muscle will follow.With anal endosonography or MRI, the integrity of the sphincters and pelvic floor can be established. The physiology of the anus and rectum can be tested with anal manometry. This allows measuring of the anal resting and squeeze pressure. Furthermore, relaxation during attempted defecation and the distention reflex can be observed. The process of defecation can be observed with defecography.

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“…it can accommodate increases in volume with little change in pressure [174]. This allows the rectum to distend in response to incoming fecal material, a phenomenon known as adaptive relaxation [257], which enables it to serve as a temporary storage organ (i.e. its ''reservoir'' function).…”

Section: Rectal Sensorimotor Activitymentioning

confidence: 99%