Mayank Sharma1, Kelly Feuerhak1, Stephen M Corner2, Armando Manduca3, Adil E Bharucha1. 1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. 2. Division of Engineering, Mayo Clinic, Rochester, MN, USA. 3. Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
Abstract
OBJECTIVES: Defecation requires relaxation of the internal and external anal sphincters. High anal resting pressure is associated with painful constipation, defecatory disorders, and increased healthcare utilization in constipated patients; the mechanisms are unclear. Perhaps patients with a high anal resting pressure have a less distensible canal, which impedes defecation. METHODS: In 50 of 64 participants (33 healthy and 17 constipated women), anal pressures and distensibility were measured, respectively, with manometry and balloon distention combined with magnetic resonance imaging; rectal balloon expulsion time (BET) was also studied. RESULTS: The BET (P = .006) was longer, and the mean (SD) rectoanal pressure gradient (-58[40] vs -34[26] mm Hg, P = .03) was more negative in constipated than healthy women; anal resting pressure was not different. During anal distention, the balloon expanded rapidly at an opening pressure of 49 (18) mm Hg, which was lower (P < .0001) than resting pressure (90 [25] mm Hg). The resting pressure was correlated with the opening pressure (r = 0.57, P < .0001) and inversely (r = -0.38, P = .007) with maximum volume but not with anal distensibility (volume-pressure slope). In healthy women, the difference (opening-resting pressure) was correlated with anal relaxation during evacuation (r = 0.35, P = .04). Anal distensibility and sensory thresholds were not different between constipated and healthy women. CONCLUSIONS: Among healthy and constipated women, a greater anal resting pressure is correlated with greater opening pressure and lower maximum volume during distention, and, hence, provides a surrogate marker of anal distensibility. The difference (opening-resting pressure), which reflects anal relaxation during distention, is correlated with anal relaxation during evacuation. Anal resting pressure and distensibility were comparable in healthy and constipated women.
OBJECTIVES: Defecation requires relaxation of the internal and external anal sphincters. High anal resting pressure is associated with painful constipation, defecatory disorders, and increased healthcare utilization in constipated patients; the mechanisms are unclear. Perhaps patients with a high anal resting pressure have a less distensible canal, which impedes defecation. METHODS: In 50 of 64 participants (33 healthy and 17 constipated women), anal pressures and distensibility were measured, respectively, with manometry and balloon distention combined with magnetic resonance imaging; rectal balloon expulsion time (BET) was also studied. RESULTS: The BET (P = .006) was longer, and the mean (SD) rectoanal pressure gradient (-58[40] vs -34[26] mm Hg, P = .03) was more negative in constipated than healthy women; anal resting pressure was not different. During anal distention, the balloon expanded rapidly at an opening pressure of 49 (18) mm Hg, which was lower (P < .0001) than resting pressure (90 [25] mm Hg). The resting pressure was correlated with the opening pressure (r = 0.57, P < .0001) and inversely (r = -0.38, P = .007) with maximum volume but not with anal distensibility (volume-pressure slope). In healthy women, the difference (opening-resting pressure) was correlated with anal relaxation during evacuation (r = 0.35, P = .04). Anal distensibility and sensory thresholds were not different between constipated and healthy women. CONCLUSIONS: Among healthy and constipated women, a greater anal resting pressure is correlated with greater opening pressure and lower maximum volume during distention, and, hence, provides a surrogate marker of anal distensibility. The difference (opening-resting pressure), which reflects anal relaxation during distention, is correlated with anal relaxation during evacuation. Anal resting pressure and distensibility were comparable in healthy and constipated women.
Authors: Shiva K Ratuapli; Adil E Bharucha; Jessica Noelting; Doris M Harvey; Alan R Zinsmeister Journal: Gastroenterology Date: 2012-11-07 Impact factor: 22.682
Authors: Mayank Sharma; Anjani Muthyala; Kelly Feuerhak; Susrutha Puthanmadhom Narayanan; Kent R Bailey; Adil E Bharucha Journal: Neurogastroenterol Motil Date: 2020-07-01 Impact factor: 3.598
Authors: Nicholas R Oblizajek; Sangeetha Gandhi; Mayank Sharma; Subhankar Chakraborty; Anjani Muthyala; David Prichard; Kelly Feuerhak; Adil E Bharucha Journal: Neurogastroenterol Motil Date: 2019-04-08 Impact factor: 3.598
Authors: David O Prichard; Taehee Lee; Gopanandan Parthasarathy; Joel G Fletcher; Alan R Zinsmeister; Adil E Bharucha Journal: Clin Gastroenterol Hepatol Date: 2016-10-05 Impact factor: 11.382
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Authors: Sushmitha Grama Srinivasan; Mayank Sharma; Kelly Feuerhak; Kent R Bailey; Adil E Bharucha Journal: Neurogastroenterol Motil Date: 2021-04-02 Impact factor: 3.960