RECTAL ADAPTATION TO DISTENSION IN PATIENTS WITH OVERT RECTAL PROLAPSE

Background High recovery rates of continence are observed after surgic al procedures for rectal prolapse. Increases in rectal compliance but no obvious rise in anal pressures have been reported. The authors' hyp othesis was that decreased rectal adaptation to distension may contrib ute to incontinence in patients suffering from overt rectal prolapse. Methods This was a prospective study conducted in 20 consecutive incon tinent patients suffering from overt rectal prolapse with no mucosal c hange (two men and 18 women; mean(s.e.m.) age 50(3) years). They were compared with 20 age- and sex-matched patients with incontinence witho ut rectal prolapse and ten age- and sex-matched healthy volunteers obs erved during the same period. The subjects were submitted to phasic is obaric distension of the rectum with an electronic barostat. Anal pres sures, perception scores and rectal volumes were recorded at six diffe rent preselected pressures. Results Compared with healthy subjects, ma ximum rectal volumes (mean(s.e.m) 98(6) versus 167(11) ml; P = 0.005), volumes related to compliance (56(5) versus 100(9) ml; P = 0.004) and tone (41(3) versus 67(4) ml; P = 0.003) were decreased significantly in the rectal prolapse group. Prolapse and incontinence groups did not differ significantly with respect to rectal adaptation for all three parameters and steps of distension considered. Conclusion Patients suf fering from overt rectal prolapse had markedly impaired rectal adaptat ion to distension which may contribute to incontinence.