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

Abstract

Background and aims: Although external anal sphincter dysfunction is the major cause of urge faecal incontinence, approximately 50% of such patients have evidence of rectal hypersensitivity and report exaggerated stool frequency and urgency. The contribution of rectosigmoid contractile activity to the pathophysiology of this condition is unclear, and thus the relations between symptoms, rectal sensation, and rectosigmoid motor function were investigated. Methods: Fifty two consecutive patients with urge faecal incontinence, referred to a tertiary surgical centre, and 24 volunteers, underwent comprehensive anorectal physiological investigation, including prolonged rectosigmoid manometry. Patients were classified on the basis of balloon distension thresholds into those with rectal hypersensitivity (n = 27) and those with normal rectal sensation (n = 25). Automated quantitative analysis of overall rectosigmoid contractile activities and, specifically, high amplitude contractions and rectal motor complex activity was performed. Results: External anal sphincter dysfunction was similar in both patient groups. Overall, phasic activity and high amplitude contraction frequency were greater, and rectal motor complex variables significantly altered, in those with rectal hypersensitivity. Symptoms, more prevalent in the rectal hypersensitivity group, were also more often associated with rectosigmoid contractile events. For individuals, reduced compliance and increased rectal motor complex frequency were only observed in patients with rectal hypersensitivity. Conclusions: We have identified a subset of patients with urge faecal incontinence-namely, those with rectal hypersensitivity-who demonstrated increased symptoms, enhanced perception, reduced compliance, and exaggerated rectosigmoid motor activity. Comprehensive assessment of rectosigmoid sensorimotor function, in addition to evaluation of anal function, should be considered in the investigation of patients with urge faecal incontinence.

Differences in the pressures of canal anal and rectal sensitivity in patients with fecal incontinence, chronic constipation and healthy subjects

“…With respect to the manometric findings of the patients with AI: the resting pressure, ACL and SMP are diminished compared to the other groups as described by other authors (12,14,18). There is also a more impaired rectal sensation.…”

“…Other groups obtained the first sensation with 20-40 ml, urge sensation with 80-200 ml and MTV with 110-480 ml (11). Also rectal sensitivity values differ according to sex, that the urge sensation oscillates between 60-160 ml in women and 70-190 in men and MTV in 90-270 ml in women and 140-270 ml in men (12). Although expert and professional organizations recommend the use of the anorectal manometry (13), some authors question its utility since sensitivity and specificity are not superior to that found in the rectal digital examination (14,15).…”

Insights Into Normal and Disordered Bowel Habits From Bowel Diaries

“…Indeed in the multivariate model, these symptoms (i.e., rectal urgency, straining to begin and end defecation, and stool frequency) were more useful than stool form and explained 24% of the variation in the sense of incomplete evacuation. Rectal urgency is associated with rectal hypersensitivity (17,18), while the sense of incomplete evacuation may be indicative of pelvic floor dysfunction (19). Further studies are required to understand if the symptoms not evaluated here (e.g., relief of abdominal discomfort or bloating) explain the residual variance (i.e., 76%) in the sense of incomplete evacuation.…”

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction

“…Slow transit constipation can be distinguished by colonic transit studies (133,134). Diagnosis is based on symptoms, signs, examination, and any relevant diagnostic investigations…”

“…Rectal overactivity could be associated with hypersensitivity (134,135) 6.2.5 Overflow incontinence seepage of stool due to faecal impaction…”