Videodefecography: a study of the rectal motile pattern.

The mechanism of rectal motility has remained largely obscure. Recently, by recording rectal electromechanical activity, we identified the rectal motility pattern as occurring in a "mass squeeze" manner. In the current communication, rectal motility was studied by means of videodefecography. The study comprised 28 healthy volunteers (18 men, 10 women; mean age 37.6+/-11.8 years). Evacuation dynamics were studied and registered using a videocassette tape with a high-resolution recorder. The rectum showed no peristaltic or segmentation activity at rest. When the subject was asked to evacuate, a contraction wave started at the rectosigmoid junction (RSJ) and spread aborally. The upper rectum appeared to contract producing anal canal opening and the closure of the RSJ; after rectal evacuation, the anal canal closed and the RSJ opened. The rectal contraction wave was repeated as long as the rectum still contained barium paste. The subjects strained prior to the start of each contraction wave. Some waves did not effect rectal evacuation. These "incomplete" waves started at the mid- or lower rectum and were followed by "complete" waves that produced evacuation. In five of 28 subjects, rectal intussusception occurred during rectal contraction. A small anterior rectocele occurred in another two subjects during rectal contraction. Videodefecography revealed that upon rectal distension with barium paste, a contraction wave, initiated at the RSJ, effected reflex RSJ closure and anal canal opening. The wave spread aborally, "squeezing" the rectal contents towards the opened anal canal. Two types of contraction waves were observed: "complete" which produced rectal evacuation, and "incomplete" which failed to effect evacuation. Physiologic intussusception or rectocele were seen in a few subjects.