THE RECTOANAL COMPLIANCE - A NEW APPROACH TO THE RECTOANAL FUNCTIONALTESTING

We have developed an original method of determining the rectal and the anal compliance. The rectum must serve as a fecal reservoir. This sto rage function requires that the rectum must be distensible. The anal c anal must become easily looser for defecation. These features are not explored by the usual rectoanal manometric recordings. Very few invest igations about the compliance are carried out. In our procedure, explo ration balloons are connected via polyethylene tubes to pressure trans ducers, direct-writing electrical recorder and pump under the command of the computer. The pressure generated is as high as the distensibili ty is poor, as the compliance is decreased. The pressure/volume curve shows the compliance. The procedure is different for the rectum on the one hand, and for the anal canal on the other. The rectal device cons ists of a balloon at the end of the tube. It shall be inflated until o nly 60 mi., and then deflated at the same rythm, which is constant dur ing each test. The first test takes place at the speed of 30 mi. per m inute; so the inflation lasts 2 mn and the deflation the same time, af terwards the second test lasts one mn for each one, and finally the th ird one 40 seconds in the same way. For the anal canal, the balloon, r ing shaped around the tube, measuring an inch in length, is inflated a t only 12 mi. For the first test the inflation and deflation rate of s peed is 3 mi per mn, afterwards 6 ml./mn then 9 ml./mn. and thereafter 12 ml./mn/; these series are done in randomized order. In both proced ures, an additional relaxation test at the maximum of inflation takes place for 2 minutes. We have explored ten healthy volunteers and 120 p atients suffering from various digestive diseases. The curves show the rectal compliance, and in the case of the anus a relaxation, which se ems to be an active opening, occurs for a distension of 5-8 mi, i.e. 1 9-21 mn in diameter. In pathology, the excess of compliance is observe d in patients with incontinence, whereas an inadequate compliance is s een in the dyschesia, descending perineum and prolapse, traumatic or s urgical injuries, etc... This exploration will be a useful guide for t he choice of the convenient treatment and the follow-up.