In 12 patients suffering from chronic idiopathic anal pain, the rectosphincteric function was studied using manometric and x-ray techniques. The results of manometric investigations were compared with those obtained in 12 healthy volunteers. In all patients, the resting pressure in the anal canal was significantly higher than in control subjects. In 10 patients, defecography revealed abnormalities of the pelvic muscles. We treated the patients by using biofeedback techniques, consisting of voluntary modifications of the state of contraction of the external sphincter. In all cases, pain disappeared after a mean of eight biofeedback training sessions. When noxious manifestations had disappeared, manometry showed a significant decrease in the anal canal resting pressure. Our results indicate 1) that chronic idiopathic anal pain is associated with abnormal anorectal manometric profiles, probably resulting from a dysfunctioning of the striated external anal sphincter, and 2) that biofeedback training is an effective treatment for chronic idiopathic anal pain.

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SUMMARY1. The effects of morphine on the electrical activity of the human rectum were investigated.2. In healthy volunteers, morphine (0-04-0{16 mg/kg, i.v.) induced spike activity that could become cyclical.3. All the effects of morphine were antagonized by naloxone (0-03-4-2 mg/kg, i.v.), but not blocked by atropine (0-007-0{014 mg/kg, I.v.).4. In patients with spinal cord injury, morphine was observed to have similar excitatory effects. Spinal cord transection was complete in all patients, so that participation of supraspinal nervous structures in these effects could be ruled out. The sacral parasympathetic nervous centres could not have been involved in two patients in whom the medullary cone was also destroyed. The thoracolumbar sympathetic nervous centres were not completely destroyed in any of the patients, however, so that the possibility that these centres may have been involved cannot be entirely ruled out.5. Morphine failed to activate an aganglionic rectum in a patient with Hirschsprung's disease, indicating that it had no direct effect on smooth muscle cells. It is therefore probable that morphine may have an effect on the intrinsic innervation.

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