Diagnostic Testing for Fecal Incontinence

Olson, Craig

doi:10.1055/s-0034-1383901

Cited by 18 publications

(14 citation statements)

References 21 publications

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“…The prevalence has been estimated to be as high as 19.5%, and a pooled prevalence of 5.9% for functional faecal incontinence (defined by Rome II criteria) was shown in a recent systematic review . Literature on the pathophysiology of faecal incontinence has mostly focuses on anorectal physiology, using anal manometry, endoanal ultrasound, pudendal nerve testing, and defecography; the role of colonic or rectosigmoid motility is less studied . Patients with urge incontinence have been shown to have significantly more low and high amplitude contractions in the sigmoid and descending colon in the fasting phase .…”

Section: Clinical Significance Of the Rectosigmoid Brakementioning

confidence: 99%

The “rectosigmoid brake”: Review of an emerging neuromodulation target for colorectal functional disorders

Lin

Dinning

Milne

et al. 2017

Clin Exp Pharma Physio

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SummaryThe regulation of gastrointestinal motility encompasses several overlapping mechanisms including highly regulated and coordinated neurohormonal circuits. Various feedback mechanisms or "brakes" have been proposed. While duodenal, jejunal, and ileal brakes are well described, a putative distal colonic brake is less well defined.Despite the high prevalence of colonic motility disorders, there is little knowledge of colonic motility owing to difficulties with organ access and technical difficulties in recording detailed motor patterns along its entire length. The motility of the colon is not under voluntary control. A wide range of motor patterns is seen, with long intervals of intestinal quiescence between them. In addition, the use of traditional manometric catheters to record contractile activity of the colon has been limited by the low number of widely spaced sensors, which has resulted in the misinterpretation of colonic motor patterns. The recent advent of high-resolution (HR) manometry is revolutionising the understanding of gastrointestinal motor patterns. It has now been observed that the most common motor patterns in the colon are repetitive two to six cycles per minute (cpm) propagating events in the distal colon. These motor patterns are prominent soon after a meal, originate most frequently in the rectosigmoid region, and travel in the retrograde direction. The distal prominence and the origin of these motor patterns raise the possibility of them serving as a braking mechanism, or the "rectosigmoid brake," to limit rectal filling. This review aims to describe what is known about the "rectosigmoid brake," including its physiological and clinical significance and potential therapeutic applications. K E Y W O R D Scolon, gastrointestinal motility, gastrointestinal tract, high-resolution manometry, rectosigmoid brake | INTRODUCTIONColonic motility disorders are prevalent in the general population and can have a significant impact on quality of life.1-3 Gastrointestinal transit and the act of defaecation require a coordinated interplay between intrinsic neurohormonal circuits acting on a morphologically intact gastrointestinal tract. These are highly auto-regulated and coordinated events, optimised for ideal transit, maximum absorption, and timely elimination of waste products.Networks of gastrointestinal "brakes" have long been proposed to provide negative feedback controls on gastrointestinal motility. 4-12Duodenal and jejunal brakes are recognised responses to the arrival of nutrient-dense chyme into the upper small intestine, triggering neurohormonal circuits that impart feedback control on gastric emptying, gastric distention and satiety. 6,8 Distally, the ileal brake is capable of a potent inhibition of intestinal motility following the arrival of nutrients, with additional effects including delaying gastric emptying and promoting satiety. 7,10 Motility brakes within the colon and rectum have also been described, though they remain less well established.Published examples include withholding de...

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Section: Clinical Significance Of the Rectosigmoid Brakementioning

confidence: 99%

The “rectosigmoid brake”: Review of an emerging neuromodulation target for colorectal functional disorders

Lin

Dinning

Milne

et al. 2017

Clin Exp Pharma Physio

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“…Anorectal manometry shows mainly myogenic factors in anorectal functions [20]. There are a few reports on the neurogenic functions of EAS [4] [11] [12]. The regulatory nerve pathway of EAS is the pudendal nerve including both PMN and PSN, which are derived from spinal nerves S2-4 (major regulatory nerves: S3 and S4) [9].…”

Section: Discussionmentioning

confidence: 99%

“…involuntary defecation), reducing the postoperative quality of life (QOL) even 1 to 2 years after LAR [1] [2] [3]. Various dysfunctions as causative factors, such as sphincter muscle function, rectal retention ability, and recto-anal inhibitory reflux, have been mainly documented based on manometric studies [4] [5] [6]. Of these factors, sphincter dysfunction has been focused on as the main cause.…”

Section: Introductionmentioning

confidence: 99%

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Assessments of Pudendal Motor and Sensory Nerves in Patients with or without Fecal Incontinence after Low Anterior Resection for Lower Rectal Cancer

Tomita¹,

Sakurai²,

Fujisaki³

2020

JCT

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Background: To clarify the pudendal motor (PMN) and sensory (PSN) nerves play in preventing fecal incontinence (FI) after low anterior resection (LAR) for lower rectal cancer, the PMN and PSN functions were studied. Methods: Sixty patients were divided into groups A (n = 20, FI) and B (n = 40, continence). These were compared with group C (n = 30, control subjects). PMN latency (PMNL) (right, left, and posterior sides of the anal canal) was studied by sacral magnetic stimulation. Anal mucosal electric sensitivity (AMES) was measured at the lower, dentate line (DL), and upper zones. Results: The distance of anastomosis from anal verge (DAAV) in group A was significantly shorter than in group B (p value < 0.001). In PMNL, the conduction delay in group A was significantly longer than in groups B and C at all sides (p value < 0.001, respectively). On AMES, the sensitivity of patients in group A was significantly lower than in groups B and C at all zones (p value < 0.001, respectively). In groups A, B, and C, correlation coefficients between SMNL (posterior side) and AMES (DL zone) were 0.780, 0.858, and 0.793, respectively (p value < 0.001). Conclusion: FI after LAR with a short DAAV may lead to external anal sphincter dysfunction due to damage of both PMN and PSN.

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“…For this reason, it is one of the most commonly utilized diagnostic tests in the evaluation of pelvic fl oor function. Manometry has been described in the evaluation of patients with fecal incontinence [ 70 ], constipation [ 71 , 72 ], anal pain [ 73 ], fi ssure [ 74 ], and Hirschsprung's disease [ 75 ].…”

Section: Functional Evaluation Anal Manometrymentioning

confidence: 99%