Ultra slow wave pressure variations in the anal canal before and after lateral internal sphincterotomy

Ultra slow waves (USW's) in the anal canal are discrete pressure fluctuations with a low frequency (1-2/minute) and high amplitude (> or = 10% above or below baseline resting pressure). To investigate the nature of these USW's, anorectal manometry was performed in 20 control subjects as well as in 58 patients presenting with anal fissure or symptomatic hemorrhoids, before and 2 weeks after lateral internal sphincterotomy. USW's could be demonstrated in two control subjects and in 29 patients. The median value of maximum anal resting pressure (MARP) in the two control subjects with USW's was significantly higher than the median MARP in the 18 control subjects without USW's (181.5 vs. 92 cm H2O, p < 0.001, two-tailed Mann-Whitney test). The same difference was found between MARP in patients with and without USW's (158 vs. 138 cm H2O, p < 0.05, two-tailed Mann-Whitney test). All patients were treated by means of lateral internal sphincterotomy (LIS). Two weeks after this procedure USW's had disappeared in half of the patients. The MARP in these patients was reduced to a level found in control subjects without USW's. This pressure reduction was significantly greater than in patients with persistent USW's (40% vs. 15%, p < 0.02, two-tailed Mann-Whitney test). Because USW's are associated with high MARP and disappear when such a high anal canal resting pressure is reduced by LIS to a level found in control subjects without USW's, it can be concluded that USW's are the manifestation of increased activity of the internal anal sphincter.