| Study of the role of the second defecation reflex: anorectal excitatory reflex in the pathogenesis of constipation. | |
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MedLine Citation:
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PMID: 12742205 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Previous studies have shown that anal distension caused rectal contraction, an action mediated through the anorectal excitatory reflex. Anal anesthetization aborted rectal contraction and rectal evacuation was induced by excessive straining. We investigated the hypothesis that inhibition or absence of the anorectal excitatory reflex could lead to constipation. METHODS: We studied 18 patients (mean age +/- SD: 40.6 +/- 5.8 years, 14 women) with rectal inertia, 14 (41.7 +/- 6.6 years, 12 women) with puborectalis paradoxical syndrome, and 10 healthy volunteers (37.9 +/- 4.8 years, 8 women). The rectum was filled with normal saline until urge and then evacuated; residual fluid was calculated. The anal and rectal pressure response to anal balloon distension in increments of 2 mL of saline was recorded by a two-channel microtip catheter. RESULTS: In the healthy volunteers, saline was evacuated as a continuous stream without straining except occasionally at the start of evacuation; no residual fluid was encountered. Anal balloon distension effected notable rectal pressure increase. In rectal inertia patients, evacuation occurred in small fluid gushes produced with excessive straining; residual fluid of large volume was collected. Anal balloon distension up to 10 mL produced no notable rectal pressure changes. The patients with PPS failed to evacuate more than a few mL of fluid despite excessive straining; the volume of residual fluid was considerable. Anal balloon distension caused a notable rectal pressure rise. The results were reproducible. CONCLUSIONS: These results suggest that the defecation reflexes (rectoanal and anorectal) are absent in rectal inertia patients and this presumably denotes a neurogenic disorder. The anorectal reflex is active in puborectalis paradoxical syndrome, but the rectoanal reflex is not, indicating a possible myogenic defect in the puborectalis muscle. |
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Authors:
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Ahmed Shafik; Ali A Shafik; Olfat El-Sibai; Ismail Ahmed |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of the American College of Surgeons Volume: 196 ISSN: 1072-7515 ISO Abbreviation: J. Am. Coll. Surg. Publication Date: 2003 May |
Date Detail:
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Created Date: 2003-05-13 Completed Date: 2003-06-02 Revised Date: 2005-11-17 |
Medline Journal Info:
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Nlm Unique ID: 9431305 Medline TA: J Am Coll Surg Country: United States |
Other Details:
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Languages: eng Pagination: 729-34 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anal Canal / innervation* Balloon Dilatation Constipation / etiology*, physiopathology Defecation / physiology* Female Humans Male Pressure Rectum / innervation* Reflex / physiology* |
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