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    Function of the internal anal sphincter and rectal sensitivity in idiopathic constipation

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    Anal manometry was performed in 8 control individuals group A and in 13 patients with idiopathic constipation group B , 6 of whom were grouped apart group C because of an elective delay of the intestinal transit in the rectum. The basal pressure of the internal anal sphincter, the rectal inflation volume necessary to elicit the rectoanal inhibitory reflex, and the duration of the reflex were not significantly different in the three groups, while the maximal amplitude of the reflex was significantly lower in group C at 10 and cm3 of rectal distension. However, the amplitude of the sphincteric relaxation and the rectal inflation volumes were significantly correlated p less than 0. The rectal sensitivity was lower in the patient groups and particularly in group C p less than 0. The results obtained do not support the 'outlet obstruction' hypothesis as a mechanism of idiopathic constipation and point out that rectal hyposensitivity seems to be the only abnormality in these patients, particularly in those with an elective delay of the transit in the rectum.
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    The responses of the external anal sphincter and the internal anal sphincter to rectal distension were studied in 18 female patients who had idiopathic faecal incontinence with perineal descent and 11 female control subjects, by measuring pressures at six sites within the anal canal and the electrical activity of the external sphincter. The pressure profile in the normal anal canal, at rest, was asymmetric with the highest pressure recorded in the outermost channels. Rectal distension caused a transient increase in the activity of the external sphincter, which was associated with an increase in anal pressure, particularly in the outermost two channels.
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