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| 번호 | 제목 | 등록일 | 조회수 |
|---|---|---|---|
| 92 | Rectal Hyposensitivity [2003년 2월 DCR] | 2011-11-17 | 3619 |
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Prevalence and Clinical Impact in Patients With Intractable Constipation and Fecal Incontinence
Marc A. Gladman, M.R.C.O.G., M.R.C.S.(Eng.), S. Mark Scott, Ph.D.,Christopher L. H. Chan, F.R.C.S., Norman S. Williams, M.S., F.R.C.S.,Peter J. Lunniss, M.S., F.R.C.S.
From the Academic Department of Surgery and Gastrointestinal Physiology Unit, Barts and The London,
Queen Mary’s School of Medicine and Dentistry, London, United Kingdom PURPOSE: Blunted rectal sensation, or rectal hyposensitivity, has been reported anecdotally in patients with functional disorders of evacuation and continence. The purpose of this study was to determine the prevalence of rectal hyposensitivity and whether the finding of such an abnormality was associated with any clinical impact.
METHODS: One thousand three hundred fifty-one patients, referred for anorectal physiologic investigation, were divided according to presenting symptoms into the following categories: constipation
(subdivided into infrequency of and/or obstructed defecation), fecal incontinence (subdivided into passive, postdefecation, and urge incontinence), fecal incontinence and constipation, or “other.” Rectal hyposensitivity was judged to be present when at least one of the sensory threshold volumes was elevated beyond the normal range (mean plus 2 standard deviations). The prevalence of rectal hyposensitivity was then calculated in each group and in relation to other investigations. RESULTS: Rectal hyposensitivity was present in 16 percent of patients, with males and females equally affected. Twenty-three percent of patients with constipation, 10 percent of patients with fecal incontinence, 27 percent of patients with incontinence associated with constipation, and only 5 percent of patients with other symptoms were found to have rectal hyposensitivity. In patients with obstructed defecation, rectal hyposensitivity was present in 33 percent with rectocele, 40 percent with intussusception, and 53 percent with no mechanical obstruction evident on evacuation proctography.
CONCLUSION: Rectal hyposensitivity is common in patients with constipation and/or fecal incontinence and may thus be important in the etiology of such conditions. Although the clinical relevance of this physiologic abnormality is unknown, its presence may have implications regarding the management of hindgut dysfunction and particularly the selection of patients for surgery. Functional constipation and fecal incontinence are common disorders1 that cause individual suffering
and constitute a substantial economic burden for individual patients and healthcare resources. A significant proportion of these patients are managed surgically when conservative measures fail; however, the long-term results are often disappointing. Successful management requires an understanding of the pathophysiologic mechanisms involved in the etiology of these conditions. Normal anorectal function is dependent on, among other factors, a complex interaction between sensory and motor function, and abnormalities of either component may thus contribute to disorders of evacuation or continence. Disturbances of motor function are widely recognized as contributing to such disorders; interest in the role of sensory dysfunction has only been renewed more recently, even though sensory abnormalities were first implicated 50 years ago. Anorectal physiologic investigation plays an integral role in patient assessment and provides objective
information regarding motor and sensory function. Rectal sensation is commonly quantified with balloon distention techniques, which address the perception of rectal filling. Sensory threshold volumes (or pressures) required to elicit a range of rectal sensations are defined commonly as first constant sensation, a sustained desire to defecate, and maximum toleration. Once normal ranges have been determined in healthy control subjects, abnormalities of rectal sensation can then be described. The term rectal hyposensitivity (RH), defined by elevation of sensory thresholds beyond the normal
range, relates to impaired or blunted rectal sensory function and has frequently been reported in patients with chronic constipation and idiopathic fecal incontinence. Moreover, it has been reported to be a predictor of poor outcome in the treatment of fecal incontinence with biofeedback techniques and surgery. However, despite these observations, the presence of RH is not often considered when clinical decisions are made regarding the management of patients with functional bowel disorders, and perhaps more importantly, in the selection of patients for surgery. There has been no direct study to examine either the clinical impact or prevalence of this physiologic
abnormality, which is surprising given that functional bowel disorders are encountered so commonly in clinical practice and that so many studies have anecdotally reported the presence of RH in such patients. The aim of the present study was to define RH as a clinical entity and to examine its prevalence and clinical impact in patients referred to a tertiary referral center for investigation of hindgut dysfunction. Furthermore, the relationships between RH and other physiologic investigations of constipation and incontinence were examined. |
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