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

• Published in: Gut Vol. 54; no. 9; pp. 1263 - 1272
• Main Authors: Chan, C L H, Lunniss, P J, Wang, D, Williams, N S, Scott, S M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.09.2005; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adolescent; Adult; Aged; Anal Canal - physiopathology; Analysis of Variance; Anorectal Disease; ANOVA; Anxiety; Area Under Curve; area under the curve; AUC; Biological and medical sciences; Case-Control Studies; Colon; Compliance; control subjects; DDV; defecatory desire volume; Defecography; EAS; Electromyography; external anal sphincter; Fecal Incontinence - physiopathology; Fecal Incontinence - psychology; Female; Gastroenterology. Liver. Pancreas. Abdomen; HAC; HADS; HAPC; high amplitude contraction; high amplitude propagated contraction; hospital anxiety and depression scale; Humans; IAS; IBS; internal anal sphincter; Irritable bowel syndrome; Male; Manometry; maximum tolerable volume; Medical sciences; Mental depression; Middle Aged; Motility; MTV; Muscle Contraction; Muscle, Smooth - physiopathology; normal rectal sensation; Other diseases. Semiology; Pathology; PNTML; Prospective Studies; pudendal nerve terminal motor latency; rectal hypersensitivity; rectal motor complex; rectal sensorimotor dysfunction; Rectum - physiopathology; RMC; SCID; Sensation Disorders - physiopathology; Sensation Disorders - psychology; Sensory Thresholds; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; structured and clinical interview for DSM-III-R; Studies; UFI; urge faecal incontinence; Human; Manometry; Anus; Dysfunction; Hypersensitivity; Rectum; Digestive diseases; Intestinal disease; Anal incontinence; Anorectal; Anorectal disease; Anal sphincter
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gut.2005.071613

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.