Chan C L H, Lunniss P J, Wang D, Williams N S, Scott S M
Centre for Academic Surgery, Barts and the London, Queen Mary's School of Medicine and Dentistry, London, UK.
Gut. 2005 Sep;54(9):1263-72. doi: 10.1136/gut.2005.071613. Epub 2005 May 24.
Although external anal sphincter dysfunction is the major cause of urge faecal incontinence, approximately 50% of such patients have evidence of rectal hypersensitivity and report exaggerated stool frequency and urgency. The contribution of rectosigmoid contractile activity to the pathophysiology of this condition is unclear, and thus the relations between symptoms, rectal sensation, and rectosigmoid motor function were investigated.
Fifty two consecutive patients with urge faecal incontinence, referred to a tertiary surgical centre, and 24 volunteers, underwent comprehensive anorectal physiological investigation, including prolonged rectosigmoid manometry. Patients were classified on the basis of balloon distension thresholds into those with rectal hypersensitivity (n = 27) and those with normal rectal sensation (n = 25). Automated quantitative analysis of overall rectosigmoid contractile activities and, specifically, high amplitude contractions and rectal motor complex activity was performed.
External anal sphincter dysfunction was similar in both patient groups. Overall, phasic activity and high amplitude contraction frequency were greater, and rectal motor complex variables significantly altered, in those with rectal hypersensitivity. Symptoms, more prevalent in the rectal hypersensitivity group, were also more often associated with rectosigmoid contractile events. For individuals, reduced compliance and increased rectal motor complex frequency were only observed in patients with rectal hypersensitivity.
We have identified a subset of patients with urge faecal incontinence-namely, those with rectal hypersensitivity-who demonstrated increased symptoms, enhanced perception, reduced compliance, and exaggerated rectosigmoid motor activity. Comprehensive assessment of rectosigmoid sensorimotor function, in addition to evaluation of anal function, should be considered in the investigation of patients with urge faecal incontinence.
尽管肛门外括约肌功能障碍是急迫性大便失禁的主要原因，但约50%的此类患者有直肠超敏反应的证据，并报告大便频率和急迫感增强。乙状结肠直肠收缩活动对这种疾病病理生理学的作用尚不清楚，因此对症状、直肠感觉和乙状结肠直肠运动功能之间的关系进行了研究。
52例连续转诊至三级外科中心的急迫性大便失禁患者和24名志愿者接受了全面的肛肠生理检查，包括延长的乙状结肠直肠测压。根据球囊扩张阈值将患者分为直肠超敏反应组（n = 27）和直肠感觉正常组（n = 25）。对乙状结肠直肠的整体收缩活动，特别是高幅度收缩和直肠运动复合活动进行了自动定量分析。
两组患者的肛门外括约肌功能障碍相似。总体而言，直肠超敏反应患者的阶段性活动和高幅度收缩频率更高，直肠运动复合变量显著改变。直肠超敏反应组中更普遍的症状也更常与乙状结肠直肠收缩事件相关。对于个体而言，仅在直肠超敏反应患者中观察到顺应性降低和直肠运动复合频率增加。
我们确定了一组急迫性大便失禁患者，即直肠超敏反应患者，他们表现出症状增加、感觉增强降低、顺应性降低和乙状结肠直肠运动活动增强。在对急迫性大便失禁患者进行调查时，除了评估肛门功能外，还应考虑对乙状结肠直肠感觉运动功能进行全面评估。
