Investigation of anal motor characteristics of the sensorimotor response (SMR) using 3-D anorectal pressure topography
Autor: | Gregory Cheeney, Satish S.C. Rao, José María Remes-Troche, Ashok Attaluri |
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Jazyk: | angličtina |
Rok vydání: | 2010 |
Předmět: |
Adult
Male Adolescent Physiology Manometry Rectum Anal Canal Internal anal sphincter Neuroregulation and Motility Young Adult Imaging Three-Dimensional Feedback Sensory Physiology (medical) Pressure Medicine Humans Defecation Hepatology business.industry Gastroenterology Muscle Smooth Anatomy Anal canal Middle Aged medicine.anatomical_structure Anal verge Female medicine.symptom Rectal Balloon business Puborectalis muscle Muscle contraction Compliance Muscle Contraction |
Popis: | Desire to defecate is associated with a unique anal contractile response, the sensorimotor response (SMR). However, the precise muscle(s) involved is not known. We aimed to examine the role of external and internal anal sphincter and the puborectalis muscle in the genesis of SMR. Anorectal 3-D pressure topography was performed in 10 healthy subjects during graded rectal balloon distention using a novel high-definition manometry system consisting of a probe with 256 pressure sensors arranged circumferentially. The anal pressure changes before, during, and after the onset of SMR were measured at every millimeter along the length of anal canal and in 3-D by dividing the anal canal into 4 × 2.1-mm grids. Pressures were assessed in the longitudinal and anterior-posterior axis. Anal ultrasound was performed to assess puborectalis morphology. 3-D topography demonstrated that rectal distention produced an SMR coinciding with desire to defecate and predominantly induced by contraction of puborectalis. Anal ultrasound showed that the puborectalis was located at mean distance of 3.5 cm from anal verge, which corresponded with peak pressure difference between the anterior and posterior vectors observed at 3.4 cm with 3-D topography ( r = 0.77). The highest absolute and percentage increases in pressure during SMR were seen in the superior-posterior portion of anal canal, reaffirming the role of puborectalis. The SMR anal pressure profile showed a peak pressure at 1.6 cm from anal verge in the anterior and posterior vectors and distinct increase in pressure only posteriorly at 3.2 cm corresponding to puborectalis. We concluded that SMR is primarily induced by the activation and contraction of the puborectalis muscle in response to a sensation of a desire to defecate. |
Databáze: | OpenAIRE |
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