Further evaluation of the afferent nervous pathways from the rectum

To evaluate the visceral afferents from the rectum, we recorded cerebral evoked potentials (EPs) in 26 healthy subjects after electrical stimulation of the rectum, pudendal nerve, and posterior tibialis nerve. We found two distinctly different EPs after rectal stimulation, with differences in latencies and pattern. In 13 subjects (group 1), the EP after rectal stimulation had multiple prominent peaks with early onset latencies ranging from 22 to 29 ms (mean 26 ms). In 13 subjects (group 2), the EP after rectal stimulation had a trifid configuration due to a very prominent negative peak between 97 and 108 ms (mean 101 ms) and longer onset latencies ranging from 50 to 61 ms (mean 55 ms). Latencies after pudendal nerve and posterior tibialis nerve stimulation were similar in the two groups. On further study, we found that both types of afferent pathways are present in the distal colon, since both types of EPs were found in the same subjects either in the rectum or in the rectum and sigmoid. We speculate that the early onset EP is a visceral pathway using the same afferents as the pudendal nerve because the early onset EP after rectal stimulation appears similar in number of peaks and interpeak latencies to EPs recorded after pudendal nerve stimulation, and the late onset EP is a visceral pathway using afferents along the pelvic nerve. Early onset EPs were also recorded after sigmoid stimulation, suggesting that both kinds of EPs are visceral afferents.