National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK.
Colorectal Unit, Surgical Professorial Unit, St Vincent's University Hospital, Dublin, Ireland.
Neurogastroenterol Motil. 2021 Mar;33(3):e13999. doi: 10.1111/nmo.13999. Epub 2020 Nov 4.
Anorectal manometry is the most commonly performed test of anorectal function. The cough-anorectal response is frequently assessed as part of a routine manometric investigation but has not previously been the subject of detailed analysis. This study systematically examined anorectal pressure responses to cough in health and evaluated the impact of parity and symptoms of fecal incontinence (FI) on measurements.
High-resolution anorectal manometry (HR-ARM) traces from nulliparous (n = 25) and parous (n = 25) healthy volunteers (HV: aged 41, range 18-64), and 57 parous patients with FI (age 47, range 28-72) were retrospectively reviewed. Cough-anorectal pressure responses were analyzed between groups by qualitative and quantitative approaches.
In health, traditional anal pressure measurements ("rest" and "squeeze") were similar between nulliparous and parous women. In contrast, incremental anal-rectal pressure difference during cough significantly differed: nulliparous 42 mm Hg (95% CI: 21-64) vs. parous 6 mm Hg (-14-25), P < 0.036). This measure also differed significantly between nulliparous HVs and patients with FI (-2 mm Hg (95% CI: -15-12), P < 0.001), but not between parous HVs and FI. Qualitatively, a color-contour trace resembling a "spear" in the upper anal canal was observed uniquely in FI. Of 25 patients with normal anal function by traditional measures, cough parameters were abnormal in 52%.
Novel HR-ARM measures during coughing revealed differences in anal function between nulliparous and parous HV, and patients with FI, which were not detected by traditional measures. Cough-anorectal measurements may improve manometric yield, though clinical utility would require assessment by longitudinal studies.
肛门直肠测压是最常用于评估肛门直肠功能的检查。咳嗽-肛门直肠反应通常作为常规测压检查的一部分进行评估，但以前并未对此进行详细分析。本研究系统地检查了健康人群咳嗽时肛门直肠压力的反应，并评估了产次和粪便失禁（FI）症状对测量结果的影响。
回顾性分析了 25 名未生育（n=25）和 25 名已生育（n=25）健康志愿者（HV：年龄 41 岁，范围 18-64 岁）以及 57 名患有 FI 的已生育患者（年龄 47 岁，范围 28-72 岁）的高分辨率肛门直肠测压（HR-ARM）描记图。通过定性和定量方法比较各组之间的咳嗽-肛门直肠压力反应。
在健康人群中，传统的肛门压力测量（“静息”和“收缩”）在未生育和已生育女性之间相似。相比之下，咳嗽时肛-直肠压力差的增量差异显著：未生育者 42mmHg（95%CI：21-64）与已生育者 6mmHg（-14-25），P<0.036）。这一测量结果在未生育的 HV 和 FI 患者之间也存在显著差异（-2mmHg（95%CI：-15-12），P<0.001），但在已生育的 HV 和 FI 患者之间没有差异。定性上，在上肛门管中观察到一种类似于“矛头”的彩色等高线痕迹，这种痕迹仅在 FI 中出现。在 25 名传统测量方法正常的肛门功能患者中，有 52%的患者咳嗽参数异常。
咳嗽时使用新型 HR-ARM 测量方法发现，未生育和已生育的 HV 以及 FI 患者的肛门功能存在差异，这些差异无法通过传统测量方法检测到。咳嗽-肛门直肠测量可能会提高测压的结果，但临床应用需要通过纵向研究来评估。
