Spatial and temporal organization of pressure patterns throughout the unprepared colon during spontaneous defecation

OBJECTIVE: The aim of this study was to examine colonic motor events associ ated with spontaneous defecation in the entire unprepared human colon under physiological conditions. METHODS: In 13 healthy volunteers a perfused, balloon-tipped, 17-lumen cath eter (outer diameter, 3.5 mm; intersidehole spacing, 7.5 cm) was passed per nasally and positioned in the distal unprepared colon. RESULTS: In the hour before spontaneous defecation, there was an increase i n propagating sequence frequency (p = 0.04) and nonpropagating activity whe n compared to basal conditions (p < 0.0001). During this hour the spatial a nd temporal relationships among propagating sequences demonstrated a biphas ic pattern. Both the early (proximal) and late (distal) colonic phases invo lved the whole colon and were characterized by respective antegrade and ret rograde migration of site-of-origin of arrays of propagating sequences. The re was a negative correlation between propagating sequence amplitude and th e time interval from propagating sequence to stool expulsion (p = 0.008). CONCLUSIONS: The colonic motor correlate of defecation is the colonic propa gating sequence, the frequency and amplitude of which begin to increase as early as 1 h before stool expulsion. During the preexpulsive phase, the spa tial and temporal relationship among the sites of origin of individual prop agating sequences demonstrate a stereotypic anal followed by orad migration , which raises the possibility of control by long colocolonic pathways. (C) 2000 by Am. Cell. of Gastroenterology.