Sensory and motor responses to rectal distention vary according to rate and pattern of balloon inflation

Sun, Wei; Read, N W; Prior, Alison; Daly, Jo-Anne; Cheah, S.Kevin; Grundy, David

doi:10.1016/0016-5085(90)90620-g

Cited by 199 publications

(139 citation statements)

References 19 publications

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“…Because the response is invariably triggered with the onset of a need to defecate, we suspect that this must be centrally modulated. Additionally, much like the graded changes in RAIR (12,22), the SMR also exhibits a larger response at higher volumes of rectal distention (5). Supra spinal and parasympathetic pathways are implicated in the modulation of RAIR.…”

Section: Discussionmentioning

confidence: 98%

“…RAIR is an enteric neuronal reflex that is mediated by nitric oxide, vasoactive intestinal peptide, and adenosine triphosphate and causes relaxation of internal anal sphincter (IAS) (18). The rate and method of rectal distention (intermittent vs. ramp) affect the properties of the RAIR, and this reflex response is classically absent in Hirschsprung's disease and other conditions such as after circular rectal myotomy and after lower anterior resection (4,12,22).In addition to the aforementioned reflexes, recently, we have described the sensorimotor response (SMR) (5) that is also seen during balloon distention of the rectum. The SMR is a transient anal contraction that is usually seen overlying the initial relaxation phase of the RAIR (5).…”

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confidence: 99%

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confidence: 99%

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Investigation of anal motor characteristics of the sensorimotor response (SMR) using 3-D anorectal pressure topography

Cheeney

Troche

Attaluri

et al. 2011

American Journal of Physiology-Gastrointestinal and Liver Physi

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Desire to defecate is associated with a unique anal contractile response, the sensorimotor response (SMR). However, the precise muscle(s) involved is not known. We aimed to examine the role of external and internal anal sphincter and the puborectalis muscle in the genesis of SMR. Anorectal 3-D pressure topography was performed in 10 healthy subjects during graded rectal balloon distention using a novel high-definition manometry system consisting of a probe with 256 pressure sensors arranged circumferentially. The anal pressure changes before, during, and after the onset of SMR were measured at every millimeter along the length of anal canal and in 3-D by dividing the anal canal into 4 ϫ 2.1-mm grids. Pressures were assessed in the longitudinal and anterior-posterior axis. Anal ultrasound was performed to assess puborectalis morphology. 3-D topography demonstrated that rectal distention produced an SMR coinciding with desire to defecate and predominantly induced by contraction of puborectalis. Anal ultrasound showed that the puborectalis was located at mean distance of 3.5 cm from anal verge, which corresponded with peak pressure difference between the anterior and posterior vectors observed at 3.4 cm with 3-D topography (r ϭ 0.77). The highest absolute and percentage increases in pressure during SMR were seen in the superior-posterior portion of anal canal, reaffirming the role of puborectalis. The SMR anal pressure profile showed a peak pressure at 1.6 cm from anal verge in the anterior and posterior vectors and distinct increase in pressure only posteriorly at 3.2 cm corresponding to puborectalis. We concluded that SMR is primarily induced by the activation and contraction of the puborectalis muscle in response to a sensation of a desire to defecate. anal manometry; puborectalis IN HUMANS, BALLOON DISTENTION of the rectum normally induces the recto-anal inhibitory reflex (RAIR) (6, 11) as well as the recto-anal contractile reflex (RACR) (9, 10, 21). RAIR is an enteric neuronal reflex that is mediated by nitric oxide, vasoactive intestinal peptide, and adenosine triphosphate and causes relaxation of internal anal sphincter (IAS) (18). The rate and method of rectal distention (intermittent vs. ramp) affect the properties of the RAIR, and this reflex response is classically absent in Hirschsprung's disease and other conditions such as after circular rectal myotomy and after lower anterior resection (4,12,22).In addition to the aforementioned reflexes, recently, we have described the sensorimotor response (SMR) (5) that is also seen during balloon distention of the rectum. The SMR is a transient anal contraction that is usually seen overlying the initial relaxation phase of the RAIR (5). In healthy subjects, it coincides with the onset of a sensation for defecation (5). A recent study showed that the SMR was abnormal in patients with rectal hyposensitivity, suggesting a pathophysiological role for this response in anorectal disorders (19). However, the precise origin of the anal contractile response, in particular...

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Investigation of anal motor characteristics of the sensorimotor response (SMR) using 3-D anorectal pressure topography

Cheeney

Troche

Attaluri

et al. 2011

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…40 The amplitude and duration of the RAIR depend on the rate and volume of rectal distention. 41 RAIR is absent in several conditions, including dysganglionosis, postcircular myotomy, and lower anterior resections. 42 In a systematic review, the diagnostic utility of the absence of RAIR in Hirschsprung's disease, as detected by non-HRM, had a sensitivity of 91% and specificity of 94%.…”

Section: Recto-anal Inhibitory Reflexmentioning

confidence: 99%

How to Perform and Interpret a High-resolution Anorectal Manometry Test

Lee

Bharucha

2015

J Neurogastroenterol Motil

156

155

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High-resolution anorectal manometry (HR-ARM) and high-definition anorectal manometry (HD-ARM) catheters have closely spaced water-perfused or solid state circumferentially-oriented pressure sensors that provide much better spatiotemporal pressurization than non-high resolution catheters. This is a comprehensive review of HR-ARM and HD-ARM anorectal manometry catheter systems, the methods for conducting, analyzing, and interpreting HR-ARM and HD-ARM, and a comparison of HR-ARM with non-high resolution anorectal manometry. Compared to non-high resolution techniques, HR-ARM and HD-ARM studies take less time and are easier to interpret. However, HR-ARM and HD-ARM catheters are more expensive and fragile and have a shorter lifespan. Further studies are needed to refine our understanding of normal values and to rigorously evaluate the incremental clinical utility of HR-ARM or HD-ARM compared to non-high resolution manometry.

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“…We believe that the process of measuring the maximum tolerable volume may be omitted in patients following low anterior resection and anastomosis for distal rectal cancer. The maximum tolerable volume may be highly distorted in patients undergoing rectal resection in comparison with patients with normal rectum, as sensations of rectal distension differ in accordance with the patterns and rates of balloon inflation, which are dependent on examiners and laboratories [13] . We suggest that measurement of the maximum tolerable volume should not be routinely performed in patients undergoing restorative proctectomy for distal rectal cancer.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic colorectal perforation induced by anorectal manometry: Report of two cases after restorative proctectomy for distal rectal cancer

Park¹

2007

WJG

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There are no reports regarding perforation of the colorectum induced by anorectal manometry. We report two cases of colorectal perforation that occurred during manometry in the patients undergoing restorative proctectomy for distal rectal cancer. In the first patient, computed tomography showed an extraperitoneal perforation in the pelvic cavity and a rupture of the rectal wall. A localized perforation into the retroperitoneum was managed conservatively. In the second patient, a 3 cm linear colon rupture was detected above the anastomotic site. A primary closure of the perforated colon and proximal ileostomy were conducted, but the patient died 2 wk later. We hypothesize that the perforation induced by anorectal manometry may be associated with the relative weakening of the proximal bowel wall due to anastomosis, decreased compliance, and abnormal rectal sensation. We suggest that measurement of the maximum tolerable volume should not be routinely performed after restorative proctectomy for distal rectal cancer.

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Sensory and motor responses to rectal distention vary according to rate and pattern of balloon inflation

Cited by 199 publications

References 19 publications

Investigation of anal motor characteristics of the sensorimotor response (SMR) using 3-D anorectal pressure topography

Investigation of anal motor characteristics of the sensorimotor response (SMR) using 3-D anorectal pressure topography

How to Perform and Interpret a High-resolution Anorectal Manometry Test

Iatrogenic colorectal perforation induced by anorectal manometry: Report of two cases after restorative proctectomy for distal rectal cancer

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