Compliance, tone and sensitivity of the rectum in different subtypes of irritable bowel syndrome


Address for correspondence Dr A.A.M. Masclee, Department of Gastroenterology– Hepatology, Leiden University Medical Center, Building 1,C4-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands. Tel.: + 31 71 526 1846; fax: + 31 71 524 8115; e-mail:


Abstract  Irritable bowel syndrome (IBS) consists of various subtypes. It is not known whether these subtypes share a common pathophysiology. Evaluation of motor and sensory function of the rectum using a barostat may help to explore a common pathophysiological background or differences in pathophysiology in subtypes of IBS. We have evaluated compliance, tone and sensitivity of the rectum, in both fasting state and postprandially, using a computerized barostat in 15 patients with diarrhoea-predominant IBS (IBS-D), 14 patients with constipation-predominant IBS (IBS-C) and compared the results with those obtained in 12 healthy controls. Rectal compliance as calculated over the steep part of the pressure–volume curve (17–23 mmHg) was decreased in both IBS groups (IBS-D 8.0 ± 1.4 mL mmHg−1; IBS-C 5.6 ± 1.1 mL mmHg−1) compared with controls (24.7 ± 3.5 mL mmHg−1). The perception of urge was increased only in IBS-D patients, whereas pain perception was significantly increased in both IBS groups. Spontaneous adaptive relaxation was decreased in IBS-D patients. Postprandially, rectal volume decreased significantly in the controls and in IBS-D patients, but not in IBS-C patients. In conclusion, both rectal motor and sensory characteristics are different between IBS-D and IBS-C patients. Therefore, testing of rectal visceroperception, adaptive relaxation and the rectal response to a meal may help distinguish groups of patients with different subtypes of irritable bowel syndrome.