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. 1999 May;44(5):687–692. doi: 10.1136/gut.44.5.687

Perception of and adaptation to rectal isobaric distension in patients with faecal incontinence

L Siproudhis 1, E Bellissant 1, F Juguet 1, H Allain 1, J Bretagne 1, M Gosselin 1
PMCID: PMC1727504  PMID: 10205206

Abstract

BACKGROUND—Perception of, and adaptation of the rectum to, distension probably play an important role in the maintenance of continence, but perception studies in faecal incontinence provide controversial conclusions possibly related to methodological biases. In order to better understand perception disorders, the aim of this study was to analyse anorectal adaptation to rectal isobaric distension in subjects with incontinence. 
PATIENTS/METHODS—Between June 95 and December 97, 97 consecutive patients (nine men and 88 women, mean (SEM) age 55 (1) years) suffering from incontinence were evaluated and compared with 15healthy volunteers (four men and 11 women, mean age 48 (3) years). The patients were classified into three groups according to their perception status to rectal isobaric distensions (impaired, 22; normal, 61; enhanced, 14). Anal and rectal adaptations to increasing rectal pressure were analysed using a model of rectal isobaric distension. 
RESULTS—The four groups did not differ with respect to age, parity, or sex ratio. Magnitude of incontinence, prevalence of pelvic disorders, and sphincter defects were similar in the incontinent groups. When compared with healthy controls, anal pressure and rectal adaptation to distension were decreased in incontinent patients. When compared with incontinent patients with normal perception, patients with enhanced perception experienced similar rectal adaptation but had reduced anal pressure. In contrast, patients with impaired perception showed considerably decreased rectal adaptation but had similar anal pressure. 
CONCLUSION—Abnormal sensations during rectal distension are observed in one third of subjects suffering from incontinence. These abnormalities may reflect hyperreactivity or neuropathological damage of the rectal wall. 



Keywords: faecal; incontinence; rectum; barostat; perception; distension

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Figure 1 .

Figure 1

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Rectal pressures and anal pressures recorded at both upper and lower parts as a function of rectal pressure during phasic isobaric distensions of the rectum in healthy controls and in incontinent patients with impaired, normal, or increased rectal perceptions. 


Figure 2 .

Figure 2

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Rectal volumes as a function of rectal pressure during phasic isobaric distensions of the rectum in healthy controls and in incontinent patients with impaired, normal, or increased rectal perceptions. Rectal volumes were recorded at the end of each pressure plateau (A; maximal rectal volume), at the end of ascending pressure variation (B; volume variation during increasing pressure), and between these two points of stabilised pressure (C; volume variation at constant pressure). 


Figure 3 .

Figure 3

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Rectal perception as a function of rectal pressure during phasic isobaric distensions of the rectum in healthy controls and in incontinent patients with impaired, normal, or increased rectal perceptions. Rectal perception was quantified by a score ranging from no sensation (0) to pain (6). 


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