Prolonged ambulant assessment of anorectal function in patients with prolapsing hemorrhoids.

Six patients with prolapsing hemorrhoids and 12 control subjects had assessment of anorectal pressure and external sphincter electromyography performed over a prolonged period under ambulant conditions. Patients with prolapsing hemorrhoids demonstrated greater degrees of sampling responses, 12.9 +/- 1.9/hour, vs. 7.4 +/- 2.0/hour (mean +/- SEM) in controls (P less than .05). Ultraslow wave and giant ultraslow wave activity were seen frequently in the patient group occupying more than 30 percent of recording. The external sphincter demonstrated much greater electrical activity (spike potentials) in patients with hemorrhoids than in controls both by day, 24.9 +/- 11.0/10 min vs. 12.8 +/- 3.2/10 min (P less than .02), and by night, 7.4 +/- 2.6 min vs. 1.6 +/- 1.3/10 min (P less than .03). Sleep electrical activity in the presence of hemorrhoids did not differ significantly from that of controls during waking, 7.4 +/- 2.6/10 min vs. 12.8 +/- 3.2/10 min (P less than .1). No difference in phasic and periodic rectal motor activity was noted between patient and control groups. This demonstrates the application of prolonged assessment of anorectal motility and external sphincter activity in a patient group. Abnormalities previously documented in patients with hemorrhoids using conventional manometric tests were confirmed. In addition, evidence of increased external sphincter function during waking and sleep may have implications in the pathophysiology of this disorder.