Relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence

Article Abstract:

The mechanisms underlying fecal incontinence, or the inability to control defecation, are poorly understood. In normal subjects, rapid distension of the rectum (which simulates rapid propulsion of gas or liquid feces into the rectum) causes an involuntary reflexive series of muscular events: contraction of the rectum, relaxation of the internal anal sphincter, and contraction of the external anal sphincter. The latter contraction is thought to be responsible for maintaining continence. To investigate the role of impairment of this reflex sequence in the development of fecal incontinence, a study was carried out with 27 normal volunteers and with 16 patients suffering from fecal incontinence of unknown origin. The patient group also had evidence of impaired rectal sensation. Balloons were inserted into the patients' rectums, and were rapidly inflated with five different volumes of air. Contraction and relaxation of the rectum and anus were monitored, and patients reported when and if they perceived the pressure change and the nature of the sensation, such as an urge to defecate or the perception of pain. In both the normal subjects and the patients, the self-reported onset of rectal sensation correlated with external anal sphincter contraction and with rectal contraction, but was unrelated to internal anal sphincter activity. All normal subjects perceived moderate volume inflations immediately; six of the incontinent patients were unable to perceive any but the largest inflations, while the remainder of the patients had a delayed (two seconds) perception of the timing of the inflation. The lowest volumes required to elicit anal relaxation or a desire to defecate were similar in both groups. These results suggest that incontinence in patients with impaired rectal sensation may result from a delay or absence of external anal sphincter contraction during the time that the internal sphincter is relaxed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Function tests (Medicine)

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Efficacy of biofeedback training in improving faecal incontinence and anorectal physiologic function

Article Abstract:

Fecal incontinence is a condition in which the patient is unable to control the passage of stools. This condition results from a poorly-understood combination of deficits in the functioning of the anal sphincters, mechanisms governing water and electrolyte transport in the intestines, and stool consistency. Up to 80 percent of the patients reporting fecal incontinence do not have any identifiable neural or muscular defect that could account for the condition; this is referred to as idiopathic (of unknown cause) incontinence. The condition has been well characterized, but successful treatment methods have been lacking. In recent years, it has been reported that biofeedback techniques, in which the patient is given immediate feedback (e.g. via electronic devices) concerning his or her voluntary efforts to control bodily functions that are normally partially or completely involuntary, has been useful in treating idiopathic fecal incontinence. To further investigate the usefulness of biofeedback therapy, 17 patients with idiopathic fecal incontinence were randomly assigned to either a standard medical treatment group in which they were administered drugs or received medical treatment plus biofeedback. After three months, there were no differences between the two groups; 50 percent of the patients in the biofeedback plus medical treatment group improved, and 56 percent in the medical treatment alone group improved. Similar results were found at one year follow-up. Evaluation of patient rectal and anal function found no benefits that were attributed to biofeedback training. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Physiological aspects, Control, Biofeedback training, Biofeedback

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Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome

Article Abstract:

Irritable bowel syndrome (IBS) is a disturbance of normal patterns of defecation, characterized in some cases by diarrhea (diarrhea-predominant) and in others by constipation (constipation-predominant). Patients suffering from IBS are reported to show altered sensitivity to various stimuli, such as distension and pain involving the colon and rectum, although the basis of this symptomatology is not known. One treatment that has been moderately successful is hypnotherapy. It is not known by what mechanism symptomatic improvement is achieved, and published reports have in some cases have inconclusive. In order to systematically investigate the effects of hypnotherapy on IBS symptoms, a study was carried out involving 15 patients ranging in age from 22 to 46 years (14 women, one man) with IBS who received hypnotherapy, and a similar group of 15 patients who did not. IBS patients with the diarrhea-predominant form of the disease showed significant changes (normalization) of rectal sensitivity both during and after a course of hypnotherapy. A trend (not statistically significant) towards similar changes was seen in patients with the constipation-predominant form of the disorder. The hypnotherapy had no effect on pain tolerance, rectal compliance (distensibility of the rectum), or distension-induced rectal contractions. The effect of hypnotherapy on IBS symptoms seems to be mediated by alterations of visceral sensitivity, but the physiological mechanism by which this occurs remains unknown. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Health aspects, Testing, Irritable bowel syndrome, Hypnotism, Hypnosis, Hypnotic susceptibility

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