Evidences for a new colonic motor pattern: Not only propagating but also simultaneous high amplitude contractions are related to internal anal sphincter relaxation

1998 ◽  
Vol 114 ◽  
pp. A719
Author(s):  
G. Bazzocchi ◽  
E. Conti ◽  
R. Chattat ◽  
M. Balloni ◽  
S.N. Reddy ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Motor Pattern ◽  
High Amplitude ◽  
Colonic Motor

scholarly journals On the nature of high-amplitude propagating pressure waves in the human colon

2020 ◽  
Vol 318 (4) ◽  
pp. G646-G660 ◽  
Author(s):  
Natalija Milkova ◽  
Sean P. Parsons ◽  
Elyanne Ratcliffe ◽  
Jan D. Huizinga ◽  
Ji-Hong Chen
Keyword(s):  
Healthy Subjects ◽  
Motor Pattern ◽  
High Amplitude ◽  
Proximal Colon ◽  
Pressure Waves ◽  
Sphincter Pressure ◽  
Average Amplitude ◽  
Colonic Motor ◽  
Balloon Distention ◽  
Descending Colon

Characterization of high-amplitude propagating pressure waves (HAPWs or HAPCs) plays a key role in diagnosis of colon dysmotility using any type of colonic manometry. With the introduction of high-resolution manometry, more insight is gained into this most prominent propulsive motor pattern. Here, we use a water-perfused catheter with 84 sensors with intervals between measuring points of 1 cm throughout the colon, for 6–8 h, in 19 healthy subjects. The catheter contained a balloon to evoke distention. We explored as stimuli a meal, balloon distention, oral prucalopride, and bisacodyl injection, with a goal to optimally evoke HAPWs. We developed a quantitative measure of HAPW activity, the “HAPW Index.” Our protocol elicited 290 HAPWs. 21% of HAPWs were confined to the proximal colon with an average amplitude of 75.3 ± 3.3 mmHg and an average HAPW Index of 440 ± 58 mmHg·m·s. 29% of HAPWs started in the proximal colon and ended in the transverse or descending colon, with an average amplitude of 87.9 ± 3.1 mmHg and an average HAPW Index of 3,344 ± 356 mmHg·m·s. Forty-nine percent of HAPWs started and ended in the transverse or descending colon with an average amplitude of 109.3 ± 3.3 mmHg and an average HAPW Index of 2,071 ± 195 mmHg·m·s. HAPWs with and without simultaneous pressure waves (SPWs) initiated the colo-anal reflex, often abolishing 100% of anal sphincter pressure. Rectal bisacodyl and proximal balloon distention were the most optimal stimuli to evoke HAPWs. These measures now allow for a confident diagnosis of abnormal motility in patients with colonic motor dysfunction. NEW & NOTEWORTHY High-amplitude propagating pressure waves (HAPWs) were characterized using 84 sensors throughout the entire colon in healthy subjects, taking note of site of origin, site of termination, amplitude, and velocity, and to identify optimal stimuli to evoke HAPWs. Three categories of HAPWs were identified, including the associated colo-anal reflex. Proximal balloon distention and rectal bisacodyl were recognized as reliable stimuli for evoking HAPWs, and a HAPW Index was devised to quantify this essential colonic motor pattern.

scholarly journals Gastrointestinal transit and prolonged ambulatory colonic motility in health and faecal incontinence

Gut ◽  
1997 ◽  
Vol 41 (3) ◽  
pp. 381-389 ◽  
Author(s):  
F Herbst ◽  
M A Kamm ◽  
G P Morris ◽  
K Britton ◽  
J Woloszko ◽  
...  
Keyword(s):  
High Pressure ◽  
Anal Sphincter ◽  
Faecal Incontinence ◽  
Urge Incontinence ◽  
Colonic Motility ◽  
Rhythmic Activity ◽  
High Amplitude ◽  
Left Colon ◽  
Pressure Waves ◽  
Colonic Motor

Background—Colonic motor function has not been studied in the ambulatory setting over a prolonged period in the unprepared state. Furthermore, the disturbance of this function in patients with faecal incontinence is unknown.Aim—To study colonic function over two to three days in the ambulatory, unprepared state in health and in patients with idiopathic faecal incontinence.Methods—Six healthy women and six women with faecal incontinence and a structurally intact anal sphincter ingested a dual radioisotope meal, and had a six sensor, solid state manometric probe colonoscopically inserted into the left colon. Scanning was performed until radioisotope left the gut and pressure was recorded for a median of 44 hours.Results—Three of six patients showed abnormal gastric emptying. Patients showed no disturbance of colonic radioisotope transit. Controls had a median of 12, whereas patients had a median of 16, high amplitude propagated waves per 24 hours. In three patients urge incontinence was associated with high amplitude (up to 500 cm water) propagated waves which often reached the rectum. These high pressure waves were identical to those occuring in healthy subjects, the only difference being the lack of adequate sphincter response. Passive incontinence was not associated with colonic motor activity. Defaecation in all subjects was associated with identical propagated waves, and distal movement of 13% (median) of right colonic content and excretion of 32% from the left colon and rectum. The urge to defaecate was associated with either propagated waves (45%) or non-propagated contractions (55%). Rectal motor complexes were recorded in both groups of subjects, but similar rhythmic activity was also recorded in the sigmoid and descending colon.Conclusions—Normal colonic function consists of frequent high pressure propagated waves. Rhythmic activity occurs both proximal to and in the rectum. Defaecation is characterised by high pressure propagated waves associated with coordinated anal sphincter relaxation. Patients with faecal incontinence may have a widespread disturbance of gut function. Urge incontinence, an urge to defaecate, and defaecation can all be associated with identical high amplitude propagated pressure waves.

scholarly journals Rhythmic calcium transients in smooth muscle cells of the mouse internal anal sphincter

2019 ◽  
Vol 32 (3) ◽  
Author(s):  
Caroline A. Cobine ◽  
Karen I. Hannigan ◽  
Megan McMahon ◽  
Emer P. Ni Bhraonain ◽  
Salah A. Baker ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Smooth Muscle Cells ◽  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Muscle Cells ◽  
Calcium Transients

scholarly journals Topohistology of the Paravaginal Nerves and Fasciae with Special Reference to Nerves to the Internal Anal Sphincter

2014 ◽  
Vol 67 (8) ◽  
pp. 495-503
Author(s):  
Fumitake Hata ◽  
Takashi Arakawa ◽  
Kuniaki Okada ◽  
Hidefumi Nishimori ◽  
Shinichiro Ikeda ◽  
...  
Keyword(s):  
Special Reference ◽  
Anal Sphincter ◽  
Internal Anal Sphincter

scholarly journals RhoA/ROCK pathway is the major molecular determinant of basal tone in intact human internal anal sphincter

2012 ◽  
Vol 302 (7) ◽  
pp. G664-G675 ◽  
Author(s):  
Satish Rattan ◽  
Jagmohan Singh
Keyword(s):  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Control Mechanisms ◽  
Rock Inhibitor ◽  
Critical Determinant ◽  
Molecular Control ◽  
Motility Disorders ◽  
Basal Tone ◽  
Before And After ◽  
Rational Therapy

The knowledge of molecular control mechanisms underlying the basal tone in the intact human internal anal sphincter (IAS) is critical for the pathophysiology and rational therapy for a number of debilitating rectoanal motility disorders. We determined the role of RhoA/ROCK and PKC pathways by comparing the effects of ROCK- and PKC-selective inhibitors Y 27632 and Gö 6850 (10−8to 10−4M), respectively, on the basal tone in the IAS vs. the rectal smooth muscle (RSM). Western blot studies were performed to determine the levels of RhoA/ROCK II, PKC-α, MYPT1, CPI-17, and MLC20in the unphosphorylated and phosphorylated forms, in the IAS vs. RSM. Confocal microscopic studies validated the membrane distribution of ROCK II. Finally, to confirm a direct relationship, we examined the enzymatic activities and changes in the basal IAS tone and p-MYPT1, p-CPI-17, and p-MLC20, before and after Y 27632 and Gö 6850. Data show higher levels of RhoA/ROCK II and related downstream signal transduction proteins in the IAS vs. RSM. In addition, data show a significant correlation between the active RhoA/ROCK levels, ROCK enzymatic activity, downstream proteins, and basal IAS tone, before and after ROCK inhibitor. From these data we conclude 1) RhoA/ROCK and downstream signaling are constitutively active in the IAS, and this pathway (in contrast with PKC) is the critical determinant of the basal tone in intact human IAS; and 2) RhoA and ROCK are potential therapeutic targets for a number of rectoanal motility disorders for which currently there is no satisfactory treatment.

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