Abstract
Distal Colon Motor Coordination: The Role of the Coloanal Reflex and the Rectoanal Inhibitory Reflex in Sampling, Flatulence, and Defecation.
Highlights
Chronic constipation can be associated with a colonic motility disorder and/or obstructive defecation
The authors concluded that the rectoanal inhibitory reflex (RAIR) was impaired in these patients because the average internal anal sphincter (IAS) relaxation was 74% upon rectal distention by a 60 ml balloon compared to 92% in their control group of 20 subjects
The RAIR in daily life is a sampling reflex that allows filling of the proximal anal canal to allow us to make a decision whether or not to accept expulsion of gas or stool; it is an integral part of our ability to maintain continence and can be the first step toward defecation or flatulence
Summary
Chronic constipation can be associated with a colonic motility disorder and/or obstructive defecation. We discuss the physiological and clinical aspects of anal sphincter relaxation associated with continence, flatulence, and defecation, focussing on the rectoanal inhibitory reflex (RAIR) and the coloanal reflex The impetus for this opinion paper was to discuss the conclusion by Pucciani and Trafeli [1] that parameters of a normal RAIR, can reveal the pathophysiology of obstructive defecation. The relaxation evoked by the RAIR was deemed too short because of excessive external anal sphincter (EAS) contraction prior to the relaxation (what was named a rectoanal excitatory reflex RAER) [1] The relevance of this short transient excitatory reflex that gave on average a 13 mmHg pressure increase is unclear because it does not prevent relaxation, and it is fundamentally different from the type of dyssynergia where anal sphincter contraction prevents proper relaxation [4]; this RAER is considered normal [5, 6].
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