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Abstract
Background and purpose. Our previous studies have demonstrated that rectal electric waves start at the rectosigmoid
junction (RSJ) and spread caudad along the rectum. A rectosigmoid pacemaker was postulated
to exist at the RSJ. We also demonstrated that electric waves in rectal inertia are
so scarce that a “silent” electrorectogram is recorded; the myoelectric activity in
such cases was stimulated by an artificial pacemaker placed at the RSJ. For this article
we investigated the pacing parameters necessary for rectal evacuation in rectal inertia
patients.
Methods. The study comprised 24 patients with rectal inertia divided into two groups: study
group (10 women, 6 men; mean age, 38.9 ± 10.6 years) and control group (6 women, 2
men; mean age, 36.3 ± 9.8 years). The main complaint was infrequent defecation and
straining at stools. Eight healthy volunteers (6 women, 2 men; mean age, 37.2 ± 9.4
years) with normal stool frequency were included in the study. Through a sigmoidoscope,
an electrode was hooked to the RSJ (stimulating) and two electrodes were hooked to
the rectal mucosa (recording). Rectal electric activity was recorded before (basal
activity) and during electric stimulation of the RSJ electrode with an electrical
stimulator delivering constant electric current of 5-mA amplitude and 200-ms pulse
width.
Results. In the healthy volunteers, rectal pacing effected increases in frequency, amplitude,
and velocity from a mean of 2.3 ± 0.9 to 6.2 ± 1.8 cycles/min (P < 0.01), 1.2 ± 0.6 to 1.7 ± 0.8 mV (P < 0.05), and 4.1 ± 1.2 to 6.3 ± 1.7 cm/s (P < 0.05), respectively. No waves were recorded from rectal inertia patients at rest.
Rectal pacing of the study group showed pacesetter potentials with a mean frequency
of 2.1 ± 1.2 cycles/min, amplitude of 0.9 ± 0.1 mV, and velocity of 3.3 ± 1.6 ms.
The control group, in whom the pacemaker was not activated, showed no electric activity.
Conclusions. Rectal pacing succeeded in producing myoelectric activity in patients with rectal
inertia. It is therefore suggested that this method be applied for rectal evacuation
in patients with inertia constipation.
Keywords
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© 2000 Academic Press. Published by Elsevier Inc. All rights reserved.
