Document Detail


A common pathophysiology for full thickness rectal prolapse, anterior mucosal prolapse and solitary rectal ulcer.
MedLine Citation:
PMID:  2720327     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Anorectal pressures at rest, during conscious contraction of the external sphincter, during serial distension of the rectum and during straining to inflate a balloon were measured in 56 patients (21 patients with full thickness rectal prolapse, 24 patients with anterior mucosal prolapse, 11 patients with solitary rectal ulcer) and in 30 normal subjects. Both basal and squeeze pressures were significantly lower in the three groups of patients compared with matched normal controls (P less than 0.05). During increases in intra-abdominal pressure, anal pressure remained above maximum rectal pressure (P less than 0.05) in normal controls, with the highest anal pressures being recorded in the most caudal anal channels. In contrast, anal pressures tended to be lower than rectal pressures during this manoeuvre in patients with rectal prolapse, anterior mucosal prolapse and solitary rectal ulcer, and the highest pressures were recorded in the channels nearest the rectum. During serial distension of the rectum, 64 per cent of patients with solitary rectal ulcer, 75 per cent with anterior mucosal prolapse and 76 per cent with rectal prolapse, but only 10 per cent of controls, showed repetitive rectal contractions. The highest anal pressure always remained higher than rectal pressure during rectal distension in normal subjects (P less than 0.05) but not in patients. The threshold rectal volume required to cause a desire to defaecate and the maximum tolerable volume were significantly lower (P less than 0.05) in each of the patient groups, compared with normal subjects. The similarity in the results from patients with rectal prolapse, anterior mucosal prolapse and solitary rectal ulcer support the hypothesis that they share a common pathophysiology. In each of the groups, the rectum is hypersensitive and hyper-reactive, and weakness of the anal sphincter creates the conditions for prolapse of the rectum to occur into or through the anal canal.
Authors:
W M Sun; N W Read; T C Donnelly; J J Bannister; A J Shorthouse
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The British journal of surgery     Volume:  76     ISSN:  0007-1323     ISO Abbreviation:  Br J Surg     Publication Date:  1989 Mar 
Date Detail:
Created Date:  1989-07-13     Completed Date:  1989-07-13     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  290-5     Citation Subset:  AIM; IM    
Affiliation:
Subdepartment of Human Gastrointestinal Physiology and Nutrition, University of Sheffield, Royal Hallamshire Hospital, UK.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anal Canal / physiopathology
Electrophysiology
Female
Humans
Male
Manometry
Middle Aged
Muscle Contraction
Pressure
Rectal Diseases / physiopathology*
Rectal Prolapse / physiopathology*
Rectum / physiopathology*
Sensation
Ulcer / physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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