title: Rectal hyposensitivity: evaluation of anal sensation in female patients with refractory constipation with and without faecal incontinence.
abstract: Rectal hyposensitivity (RH) is commonly found in patients with intractable constipation, faecal incontinence or both. Anal sensation may also be blunted in these conditions. We aimed to determine whether RH is associated with anal hyposensitivity, which may reflect a combined viscero-somatic neuropathy. One hundred and fifty-eight female patients with chronic constipation underwent physiological investigation including rectal sensation to volumetric balloon distension, and distal anal mucosal sensation to electrostimulation. Data were also obtained from 32 healthy female volunteers. Anal mucosal electrosensory thresholds were significantly higher in patients compared with volunteers (median: 2.4 mA, range: 0.4-19.6 vs 1.1 mA, range: 0.1-4.2, respectively), although the patient group was older (P < 0.0001), but there was no difference (P = 0.572) in the incidence of blunted anal sensation between those with normal rectal sensation (n = 113, 20% abnormal) and RH (n = 45, 24% abnormal). Irrespective of rectal sensory function, there was a strong association between symptom duration (P = 0.012) and anal hyposensitivity. One-fifth of constipated female patients had evidence of diminished anal sensation. However, the presence of RH was not associated with an increased frequency of anal hyposensitivity, thereby suggesting that different aetiopathogenic mechanisms underlie the development of anal and rectal hyposensitivity. Further studies in carefully selected, homogenous patient populations are necessary to elucidate these mechanisms.
authors.affiliation: Centre for Academic Surgery and the Gastrointestinal Physiology Unit, Barts and The London, Queen Mary's School of Medicine and Dentistry, London, UK. s.p.vasudevan@qmul.ac.uk
authors.forename: S P
authors.initials: SP
authors.lastname: Vasudevan
authors.forename: S M
authors.initials: SM
authors.lastname: Scott
authors.forename: M A
authors.initials: MA
authors.lastname: Gladman
authors.forename: P J
authors.initials: PJ
authors.lastname: Lunniss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000294:innervation / Q000502:physiology*; D002404:Catheterization; D003248:Constipation / Q000503:physiopathology*; D004558:Electric Stimulation; D005242:Fecal Incontinence / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010525:Peripheral Nerves / Q000502:physiology; D011312:Pressure; D012007:Rectum / Q000294:innervation / Q000502:physiology*; D012677:Sensation / Q000502:physiology*; D012684:Sensory Thresholds