Ambulatory anorectal physiology in patients following restorative proctocolectomy for ulcerative colitis: comparison with normal controls.

The purpose of this study was to determine the manometric activity of ileoanal W pouch reservoirs following restorative proctocolectomy for ulcerative colitis and to compare the results with normal controls. Thirty-one studies were carried out; there were 15 controls (median age 52 years (range 29-80 years), 10 men, 5 women) and 16 pouch patients (median age 40 years (range 28-52 years), 13 men, 3 women). Mid-anal sphincter pressure and 'rectal' pressure were measured with a microtransducer catheter. The signals were digitalized and recorded in a portable electronic memory for later computer display and analysis. The system allowed the study of patients with minimal constraints while fully ambulant. The frequency of sampling (rectal pressure greater than or equal to sphincter pressure), sensation of flatus present and flatus being passed were 7(1-41), 3(1-7) and 1(0-3.5) per hour in the normal controls and 0(0-3), 0(0-1) and 0(0-1) respectively per hour in the pouch patients (P less than 0.001). Compared with the highly dynamic nature of the anorectum in normal subjects the patients with a pouch had very little activity. The sensation of pouch filling and the desire to defaecate were noted on 12 occasions and in six were associated with a rise in pouch pressure greater than 20 mmHg. One patient had nocturnal soiling and this was the only patient in whom frequent pouch contractions were noted. The results suggest that ileoanal pouch motility is usually quiescent and that incontinence in this group may be related to increased pouch activity.