Spectrum of abnormal rectoanal reflex patterns in patients with fecal incontinence

PURPOSE: Abnormalities of rectoanal inhibitory or excitatory reflex in patients with fecal incontinence are well described. A spectrum of abnormal responses, other than those already described in the literature, has been observed in some patients with fecal incontinence and forms the subject of this report. METHOD: Forty-three patients with idiopathic or traumatic fecal incontinence were studied to evaluate their reflex responses to balloon distention of the rectum, and results were compared with reflex responses of 29 control subjects with no anorectal complaints. RESULTS: Control subjects revealed normal reflex responses consisting of initial excitation followed by inhibition in the proximal anal canal and an excitatory response in the distal anal canal. Patients who were incontinent revealed five different types of reflex patterns. Eleven patients (25.5 percent) with segmental sphincter defects from obstetric injuries exhibited no distal excitation but had normal response in the proximal anal canal (Group 1). Eleven patients (25.5 percent) with idiopathic incontinence exhibited normal proximal response but an inhibitory as opposed to excitatory response in the distal anal canal (Group 2). Three patients (7 percent) with iatrogenic trauma failed to register an excitatory response in the proximal or distal anal canal but revealed a normal inhibitory reflex (Group 3). Nine patients (21 percent) with idiopathic incontinence revealed excitatory response in the entire anal canal but no inhibition (Group 4). Nine patients (21 percent) with idiopathic incontinence had a normal reflex pattern (Group 5). CONCLUSION: Excitatory and inhibitory components of rectoanal reflexes may selectively be abolished in neurogenic or traumatic insults to visceral and somatic anal sphincters, resulting in altered rectoanal reflex patterns.

[1]  N. Read,et al.  Relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence. , 1990, Gut.

[2]  P. Miner,et al.  Delayed rectal sensation with fecal incontinence. Successful treatment using anorectal manometry. , 1986, Gastroenterology.

[3]  J. Melzak,et al.  Experimental study of the reflex mechanism controlling the muscles of the pelvic floor , 1962, Diseases of the colon and rectum.

[4]  J. Bannister,et al.  External and internal anal sphincter responses to rectal distension in normal subjects and in patients with idiopathic faecal incontinence , 1989, The British journal of surgery.

[5]  W. Whitehead,et al.  External anal sphincter response to rectal distention: learned response or reflex. , 1982, Psychophysiology.

[6]  M. Swash,et al.  ELECTROPHYSIOLOGICAL STUDY OF MOTOR NERVE SUPPLY OF PELVIC FLOOR , 1981, The Lancet.

[7]  D. Bartolo,et al.  The role of partial denervation of the puborectalis in idiopathic faecal incontinence , 1983, The British journal of surgery.

[8]  N. Read,et al.  Use of anorectal manometry during rectal infusion of saline to investigate sphincter function in incontinent patients. , 1983, Gastroenterology.

[9]  N. Read,et al.  Impaired internal anal sphincter in a subgroup of patients with idiopathic fecal incontinence. , 1989, Gastroenterology.

[10]  T. Ihre.  Studies on anal function in continent and incontinent patients. , 1974, Scandinavian journal of gastroenterology. Supplement.

[11]  J. Coller.  Clinical application of anorectal manometry. , 1987, Gastroenterology clinics of North America.

[12]  F. Penninckx,et al.  The internal anal sphincter: mechanisms of control and its role in maintaining anal continence. , 1992, Bailliere's clinical gastroenterology.

[13]  D. Denny-Brown,et al.  AN INVESTIGATION OF THE NEBVOUS CONTEOL OF DEFECATION , 1935 .

[14]  M. Swash,et al.  Sphincter denervation in anorectal incontinence and rectal prolapse. , 1977, Gut.