Prolonged manometric recording of anorectal motor activity in ambulant human subjects: evidence of periodic activity.

Abstract

SUMMARY Based on short recordings, the rectum has been shown to have contractions with a frequency of five to 10 cycles per minute and slow contractions at three cycles per minute. To define anorectal motility over a prolonged period of time, we have studied 12 healthy volunteers using a fine pressure sensitive anorectal probe. A total of 240 hours of recording was obtained. We observed three types of activity in the rectum: (i) runs of powerful phasic contractions with a frequency of two to three per minute, lasting for three to 10 minutes, and recurring to an interval of 92 (1.9) minutes (mean (SEM)) during the day and 56 (1.7) minutes (mean (SEM)) at night, (ii) isolated prolonged contractions lasting for 10-20 seconds and seen mainly during waking, and (iii) clusters of contractions occurring at a frequency offive to six per minute lasting for one to two minutes and seen predominantly during the postprandial period. These clusters of contractions resembled the discrete clustered contractions seen in the ileum, whereas the more powerful and prolonged runs of contractions resembled phase III activity in the small intestine. In contrast, the anal canal showed bursts of contractions which were not temporally related. Our data show that the rectum, like the upper gastrointestinal tract, exhibits periodic motor activity; it remains to be seen whether these two biorhythms are synchronous.The interdigestive migrating motor complex (MMC) and its electrical equivalent, the myelectric complex, have been shown to migrate cyclically through the small bowel of many species, including man.`X Most studies in man, aimed at investigating the cyclical nature of gastrointestinal motility, have been confined to the upper small bowel; few have studied the ileum and proximal colon.6 Anorectal studies have largely confined themselves to the measurement of resting and squeeze pressure and the study of rectoanal reflexes. The possibility that the human anorectum exhibits periodic activity has not been investigated.Water filled catheters, water or air filled balloons, sleeve catheters and force transducers have all been used to measure contractile activity in the anorectum; conflicting results have been reported.7-'0 The rectum has been described as being quiescent

Physiopathologie de la constipation

“…Le rectum paraît également présen-ter un profil distinct de contraction, précédemment dé-crit comme «complexes moteurs rectaux» [13,14] , qui s'accroissent également après un repas.…”

Fisiopatología del estreñimiento

“…El recto también parece presentar un patrón bien diferenciado de contracciones, descritas previamente como 'complejos motores rectales' [13,14] , que también aumentan después de una comida.…”

Die Pathophysiologie der Obstipation

“…Abgesehen von den jeweiligen Kontraktionen lassen sich im Dickdarm auch diverse Schwankungen des Muskeltonus nachweisen, die ebenfalls nach dem Essen zuund während des Schlafes abnehmen [12] . Auch im Rektum scheint ein ausgeprägtes Kontraktionsmuster vorzuliegen, das früher als «Peristaltik des Rektums» bezeichnet wurde [13,14] und ebenfalls nach dem Essen zunimmt.…”