This work was presented in part at the 20th International Symposium on Gastrointestinal Motility, Toulouse, France, July 2005 and appears in abstract form in Neurogastroenterol Motil 2005; 17 (Suppl 2): 18.
Rectal hyposensitivity: pathophysiological mechanisms
Article first published online: 10 DEC 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
Neurogastroenterology & Motility
Volume 21, Issue 5, pages 508–e5, May 2009
How to Cite
Gladman, M. A., Aziz, Q., Scott, S. M., Williams, N. S. and Lunniss, P. J. (2009), Rectal hyposensitivity: pathophysiological mechanisms. Neurogastroenterology & Motility, 21: 508–e5. doi: 10.1111/j.1365-2982.2008.01216.x
- Issue published online: 24 APR 2009
- Article first published online: 10 DEC 2008
- Received: 6 July 2008 Accepted for publication: 7 September 2008
- abnormal visceral sensitivity;
- functional constipation;
- pathophysiological mechanisms;
- rectal hyposensitivity
Abstract Rectal hyposensitivity (RH) relates to a diminished perception of rectal distension. It may occur due to afferent nerve dysfunction and/or secondary to abnormal structural or biomechanical properties of the rectum. The aim of this study was to determine the contribution of these underlying pathophysiological mechanisms by systematically evaluating rectal diameter, compliance and afferent nerve sensitivity in patients with RH, using methodology employed in clinical practice. The study population comprised 45 (33 women; median age 48, range 25–72 years) constipated patients (Rome II criteria) with RH and 20 with normal rectal sensitivity on balloon distension and 20 healthy volunteers. Rectal diameter was measured at minimum distending pressure during isobaric distension under fluoroscopic screening. Rectal compliance was assessed during phasic isobaric distension by measuring the slope of the pressure–volume curve. Electrical stimulation of the rectal mucosa was employed to determine afferent nerve function. Values were compared to normal ranges established in healthy volunteers. The upper limits of normal for rectal diameter, compliance and electrosensitivity were 6.3 cm, 17.9 mL mmHg−1 and 21.3 mA respectively. Among patients with RH, rectal diameter, but not compliance, was increased above the normal range (megarectum) in seven patients (16%), two of whom had elevated electrosensitivity thresholds. Rectal diameter and compliance were elevated in 23 patients (51%), nine of whom had elevated electrosensitivity thresholds. The remaining 15 patients (33%) with RH had normal rectal compliance and diameter, all of whom had elevated electrosensitivity thresholds. Two-third of the patients with RH on simple balloon distension have elevated rectal compliance and/or diameter, suggesting that impaired perception of rectal distension is due to inadequate stimulation of the rectal afferent pathway. However, a proportion of such patients also appear to have impaired nerve function. In the remaining one-third of the patients, rectal diameter and compliance are normal, while electrosensitivity thresholds are elevated, suggestive of true impaired afferent nerve function. Identification of these subgroups of patients with RH may have implications regarding their management.