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Evaluating the rectum and anus plays a crucial role in conducting a thorough physical examination of the gastrointestinal system. Although it may be uncomfortable and often embarrassing for the patient, it holds immense diagnostic value, particularly in detecting gastrointestinal diseases and abnormalities. This guide will explain how to perform this assessment using inspection and palpation methods.
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In Vitro Characterization of the Electrophysiological Properties of Colonic Afferent Fibers in Rats
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Rectal Distension Increased the Rectoanal Gradient in Patients with Normal Rectal Sensory Function.

Leila Neshatian1,2, Mary-Jane O U Williams3, Eamonn M Quigley4

  • 1Lynda K and David M Underwood Center for Digestive Disorders Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, 6550 Fannin St Suite 1201, Houston, TX, 77030, USA. lneshati@stanford.edu.

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|August 8, 2020
PubMed
Summary

Rectal distension during simulated evacuation improves anorectal manometry in chronic constipation patients by increasing the rectoanal gradient and reducing dyssynergia, especially in those with normal rectal function and balloon expulsion tests.

Keywords:
Anorectal manometryDyssynergiaRectal distensionRectal hyposensitivityRectoanal gradient

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Area of Science:

  • Gastroenterology
  • Physiology

Background:

  • Anorectal manometry is crucial for diagnosing functional defecatory disorders.
  • Abnormal manometric patterns (dyssynergia) are frequently observed, necessitating method reassessment.
  • The impact of rectal distension on anorectal pressure during simulated evacuation is unknown.

Purpose of the Study:

  • To investigate the effect of rectal distension on anorectal pressure profiles.
  • To determine if rectal distension enhances diagnostic value in functional defecatory disorders.
  • To assess the influence on rectoanal gradient and dyssynergia during simulated evacuation.

Main Methods:

  • 108 patients with chronic constipation underwent high-resolution anorectal manometry.
  • Simulated evacuation was performed with an empty balloon and then with 50 and 100 ml distension.
  • Subgroup analysis included balloon expulsion test (BET) outcomes and rectal sensory function.

Main Results:

  • Rectal balloon distension improved rectoanal gradient and reduced dyssynergia.
  • These improvements were significant only in patients with normal BET and rectal sensory function.
  • Rectoanal gradient, BMI, and maximum tolerable volumes predicted BET results.

Conclusions:

  • Rectal distension during simulated evacuation alters anorectal pressure profiles.
  • Improvements in rectoanal gradient and dyssynergia are primarily seen in patients with normal rectal function and BET.
  • This technique may refine diagnostic accuracy for specific patient subgroups.