PubMed · 488659
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G L Arnold, R A Norton, M E Faison. 1979. Preparation for proctosigmoidoscopy.. https://doi.org/10.1016/s0016-5107(79)73371-2
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The rate and pattern of rectal distension affect rectal distensibility, perception, and anal relaxation in health. Because rectal urgency is a prominent symptom in fecal incontinence (FI), we assessed rectal distensibility, contractions, perception, and anal pressures during rectal distention in 21 healthy, asymptomatic women (age 61 +/- 2 yr, mean +/- SE) and 51 women with FI (60 +/- 2 yr). Rectal staircases (0-32 mmHg, 4-mm steps) and ramp distensions [0-200 ml at 25, 50, and 100 ml/min with a phase of sustained distension (SD), lasting 1 min, between inflation and deflation]. The rectum was stiffer during rapid than slow ramp distention. This effect was more prominent at a lower volume (50 ml) and was also more pronounced in older subjects and in FI. A rectal contractile response was observed not only during inflation but also during SD and during deflation. During inflation, this contractile response was rate dependent in controls but not in FI. During staircase but not ramp distentions, the threshold for the desire to defecate was lower in FI. During ramp distentions, the duration of perception was significantly longer in FI. The rate of distention did not affect rectal perception (i.e., sensory thresholds or duration of perception) during ramp distentions. Baseline anal pressures and the magnitude of anal relaxation during rectal distention were also reduced in FI. In addition to reduced rectal capacity and compliance, women with FI had an exaggerated rate-dependent reduction in rectal distensibility, lower sensory thresholds, and more prolonged perception, indicative of rectoanal dysfunctions.
Antegrade continence enemas can be used to control fecal incontinence caused by neurogenic bowel. Creating a conduit can become a problem when the appendix is unsuitable for use. This paper describes a procedure using a tapered terminal ileum conduit for use with antegrade continence enemas in place of the appendix. This procedure has been attempted and successfully completed on two pediatric patients with good results at 6-month follow-up. The tapered terminal ileum conduit is an option for creating a conduit for antegrade continence enemas in patients without a suitable appendix.
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