The "opening time" and "pelvic floor electromyographic lag time": two novel tools in the assessment of the anorectal evacuation time.
Rectal evacuation necessitates rectal contraction and pelvic floor muscles relaxation; it is not known which action precedes the other. We investigated the hypothesis that pelvic floor muscles relaxation precedes rectal contraction so that rectal contents find the anal canal already opened. Electromyographic activity of the external anal sphincter as well as anal and rectal pressures were recorded during rectal balloon distension and evacuation. Pelvic floor muscles electromyographic lag time (time from start of pelvic floor muscles relaxation to start of evacuation) and opening time (time from start of rectal contraction to start of evacuation) were measured. Rectal balloon distension in increments of 20 mL up to 100 mL effected progressive increase of both external anal sphincter electromyography and anal pressure. At 120 mL balloon distension up to 180 mL, external anal sphincter electromyography and anal pressure exhibited gradual decrease whereas rectal pressure showed no changes. At 200 to 220 mL rectal balloon distension, rectal pressure increased and anal pressure decreased, while external anal sphincter showed no electromyographic activity; rectal balloon was expelled. The opening time recorded a mean of 1.8 +/- 0.7 s and pelvic floor muscles electromyographic lag time of 2.2 +/- 0.9; the two recordings showed no significant difference (p > .05). These, two diagnostic tools in anorectal investigations are presented: the opening time and pelvic floor muscles electromyographic lag time. Pelvic floor muscles relaxation preceded rectal contraction. As there is no significant difference between opening time and pelvic floor muscles electromyographic lag time, it appears easier to apply the latter as it is simple, objective, and noninvasive.
Shafik
Ahmed
A
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt. shafik@ahmedshafik.com
Shafik
Ismail A
IA
El Sibai
Olfat
O
Shafik
Ali A
AA
D000328:Adult; D001003:Anal Canal / Q000502:physiology*; D002404:Catheterization; D003672:Defecation / Q000502:physiology*; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009119:Muscle Contraction / Q000502:physiology; D009126:Muscle Relaxation / Q000502:physiology; D017773:Pelvic Floor / Q000502:physiology*; D013997:Time Factors