title: Spectrum of abnormal rectoanal reflex patterns in patients with fecal incontinence.
abstract: OBJECTIVE
  Abnormalities of rectoanal inhibitory or excitatory reflex in patients with fecal incontinence are well described. A spectrum of abnormal responses, other than those already described in the literature, has been observed in some patients with fecal incontinence and forms the subject of this report.
  
  
  METHODS
  Forty-three patients with idiopathic or traumatic fecal incontinence were studied to evaluate their reflex responses to balloon distention of the rectum, and results were compared with reflex responses of 29 control subjects with no anorectal complaints.
  
  
  RESULTS
  Control subjects revealed normal reflex responses consisting of initial excitation followed by inhibition in the proximal anal canal and an excitatory response in the distal anal canal. Patients who were incontinent revealed five different types of reflex patterns. Eleven patients (25.5 percent) with segmental sphincter defects from obstetric injuries exhibited no distal excitation but had normal response in the proximal anal canal (Group 1). Eleven patients (25.5 percent) with idiopathic incontinence exhibited normal proximal response but an inhibitory as opposed to excitatory response in the distal anal canal (Group 2). Three patients (7 percent) with iatrogenic trauma failed to register an excitatory response in the proximal or distal anal canal but revealed a normal inhibitory reflex (Group 3). Nine patients (21 percent) with idiopathic incontinence revealed excitatory response in the entire anal canal but no inhibition (Group 4). Nine patients (21 percent) with idiopathic incontinence had a normal reflex pattern (Group 5).
  
  
  CONCLUSIONS
  Excitatory and inhibitory components of rectoanal reflexes may selectively be abolished in neurogenic or traumatic insults to visceral and somatic anal sphincters, resulting in altered rectoanal reflex patterns.
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts 01805, USA.
authors.forename: Y P
authors.initials: YP
authors.lastname: Sangwan
authors.forename: J A
authors.initials: JA
authors.lastname: Coller
authors.forename: D J
authors.initials: DJ
authors.lastname: Schoetz
authors.forename: P L
authors.initials: PL
authors.lastname: Roberts
authors.forename: J J
authors.initials: JJ
authors.lastname: Murray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012007:Rectum / Q000503:physiopathology*; D012021:Reflex, Abnormal