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. 2018 Sep 20;9:1248. doi: 10.3389/fphys.2018.01248

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Copyright © 2018 Chen, Parsons, Shokrollahi, Wan, Vincent, Yuan, Pervez, Chen, Xue, Zhang, Eshtiaghi, Armstrong, Bercik, Moayyedi, Greenwald, Ratcliffe and Huizinga.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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A high amplitude SPW associated with balloon expulsion. (A) Two SPWs appear in response to rectal balloon distention; the dark area above the anal sphincter shows the pressure in the rectum induced by the balloon. The first SPW was associated with liquid outflow. The second SPW consists of a cluster of high frequency multiple pressure waves, the last wave at 55 mmHg is followed by relaxation of the sphincter and it expels the balloon. Preceding the balloon expulsion, the SPW was associated with pain and urge. (B) 3D image of (C), the balloon distention and anal sphincter activity was removed to make the SPW better visible. (C) Close up of the second SPW as shown in (B) where its composition of multiple pressure waves is clearly visible.