Rectal visceral sensitivity in healthy volunteers: influences of gender, age and methods

The barostat is a device that maintains a constant pressure within an air-filled polyethylene bag by means of a feedback mechanism. The system measures variations in rectal tone by recording changes in the intrarectal pressure and volume. Different procedures, such as ramp distension or intermittent distension, are used to test visceral sensitivity and rectal wall compliance. It is not quite clear which method is preferable and how the barostat measurements compare with those of the conventional latex balloon. In 28 healthy volunteers (11 males, mean age 36, range 22-67 years) rectal distension was performed in two ways: 1 Pressure-controlled distension, by both intermittent and ramp methods, with measurement on the Visual Analogue Scale (VAS, 0-5) at 8, 12, 16, 20, 24, 28, 32 and 36 mmHg. Hysteresis (comparing area under the curve during deflation and inflation with ramp pressure distension) and compliance were calculated. 2 Volume-controlled distension, with registration of first sensation, urge to defecate and maximal tolerated distension. This procedure was compared to conventional water-filled latex balloon distension. No differences were found between intermittent and ramp distension comparing VAS scores at the same pressures. Gender or age did not affect the VAS score. Males had larger volumes at the same pressures than females. Females had larger hysteresis than males. Older females had larger hysteresis than younger females. The pressure volume curves were S-shaped. Compliance at maximal tolerated distension (V/p) and maximal dynamic compliance (Delta V/Delta p) was higher in males than females. The polyethylene bag had higher MTV and MTP compared to the latex balloon. In conclusion, no differences were found in volumes, compliance or VAS between the intermittent and the ramp pressure-controlled inflation, indicating potential for simplification of the procedure. Males had larger rectal volumes and compliances; females had more pronounced hysteresis. A systemic difference was found between distension with the water-filled latex balloon and with the air-filled polyethylene bag. This should be taken into account when interpreting results.