Manometric recordings bring out post-stimulus refractory states in the anal canal in neonates

Anorectal manometry is a diagnostic technique used to investigate the correct mechanical performance of the internal anal sphincter (IAS). By distending the rectal ampulla while recording changes in the luminal pressure, this method allows for characterizing the anorectal reflex. It can also provide, indirectly, information about the electrical activity of the IAS. In this study, seventeen neonates having 24-hour delayed passage of meconium or presenting distal intestinal obstruction symptoms underwent anorectal manometry to discard Hirschsprung's disease. All patients had normal anorectal reflex. The time delay between stimulation of the rectal ampulla and the relaxation of the anal canal was studied. The average period of the pressure fluctuations was 5.44 ± 0.13s. The overall duration of the relaxation time was 9.71 ± 0.21s. The maximum lag between the onset of the stimulus and the relaxation of the IAS was 2.90 s, and was achieved when the stimulus was applied following a local maximum of the pressure wave. The existence of a refractory period during the suprathreshold depolarization of smooth muscle cells can explain the evidence of a temporal delay between the stimulus and the mechanical response. In occasions, relaxation appeared first distally. This phenomenon can be explained by the arrangement and morphology of bipolar cells, which may evidence the anisotropic propagation of the mechanical activity. These data may contribute to depict the alterations in excitability underlying the relaxation reflex by means of manometric recording of the anal canal.