The anorectal defaecation reflex: a prospective intervention study

Sanne J. Verkuijl*, Monika Trzpis, Paul M. A. Broens

*Bijbehorende auteur voor dit werk

    OnderzoeksoutputAcademicpeer review

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    Aim Our hypothesis is that there may be a neural pathway with sensory afferent neurons in the anal canal that leads to rectal contraction to assist defaecation. We aimed to compare rectal motility between healthy participants with or without anal anaesthesia. Method This prospective intervention study consisted of two test sessions: a baseline session followed by an identical second session. During each session we performed the anal electrosensitivity test, the rectoanal inhibitory reflex test and rapid phasic barostat distensions. Prior to the second session, participants were randomly assigned to receive either a local anal anaesthetic or a placebo. Results We included 23 healthy participants aged 21.1 +/- 0.5 years, 13 of whom received an anal anaesthetic and 10 a placebo. All participants showed a transient rectal contraction during the first test session, which decreased significantly after anal anaesthesia (18.6 ml vs. 4.9 ml, p = 0.019). The maximum rectal contraction was comparable to the baseline results in the placebo group. Furthermore, the electrosensitivity at the highest centimetre of the anal canal correlated with the maximum rectal contraction (r = -0.452, p = 0.045). Conclusion All healthy study participants display an involuntary, reproducible rectal reflex contraction that appears to be innervated by afferent nerves in the proximal anal canal. The rectal reflex contraction appears to play a role in defaecation and we therefore refer to this phenomenon as the anorectal defaecation reflex. Knowledge of the anorectal defaecation reflex may have consequences for the diagnostics and treatment of constipation.

    Originele taal-2English
    Pagina's (van-tot)845-853
    Aantal pagina's9
    TijdschriftColorectal Disease
    Volume24
    Nummer van het tijdschrift7
    Vroegere onlinedatum2-mrt.-2022
    DOI's
    StatusPublished - jul.-2022

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